Hand, foot and mouth disease outbreak caused by Coxsackies A16 at a kindergarten, Thaphae Subdistrict, Thaphae District, Satun Province, Thailand, 17-22 June 2016

Abstract

Background: On 23 June 2016, Thaphae hospital was informed by a teacher in a kindergarten about the cluster of suspected Hand, foot and mouth Disease (HFMD) among the students. They were in the same classroom. The Surveillance Rapid Response Team (SRRT) of Thaphae District started outbreak investigated in the kindergarten during 23–30 June 2016. The objectives aimed to confirm diagnosis and confirm outbreak, to describe the disease burden, to identify the virus etiology and source of infection and to control the outbreak.
Methods: We conducted descriptive epidemiological study. Active case finding in the kindergarten was done by the case definition of HFMD (a unique stage of rash or vesicle at hands and feet with or without oral ulcer) during 1 June–2 July 2016. We reviewed HFMD situation during 2011-2015 in the passive surveillance system at the district data center. Laboratory confirmation was done by RT-PCR for Enterovirus. Environment survey was also carried out in the kindergarten.
Results: The situation of HFMD in the district in previous 5 years is increasing trend and had highest morbidity (95.53/100,000 population) in 2015. There were totally five cases of students were met HFMD case definition. All cases were in the same classroom (Kindergarten 2/1). Overall attack rate in the school was 2.08% and specific attack rate in class 2/1 was 17.86%. There was three male and median age was 3 years (range 1-4 years). First case’s onset was 17 June and last onset was 22 June 2015. The RT-PCR revealed positive Coxsackies virus A16 in two cases (40%). Both confirmed cases were similar underlying disease with asthma. All students had close contact by playing and studying in the classroom.
Conclusions and discussions: There was confirmed HFMD outbreak, which caused by Coxsackies virus A16 in the kindergarten and focused only one classroom. The pattern of outbreak was propagated source. The most likely behavioral risk was closed contact with the case. The early containment with disinfection in the classroom and toys and specific close only one affected classroom were successful. There was no additional case in the school and community for 14 days.