Hand foot and mouth disease outbreak investigation in primary school, Bangkae District, Bangkok, June 2016

Abstract

Background: The Bureau of Epidemiology, Department of Disease Control was notified of hand, foot and mouth disease (HFMD) cases among kindergarten students in a primary school in Bangkae District, Bangkok. An investigation was conducted to confirm the diagnosis and find the associated risk factors in order to control the disease.
Methods: A descriptive epidemiological study was performed by collecting the retrospective information of HFMD cases from the 506 reports during the past 3 years and reviewing medical records from public health facilities. The classroom teachers were interviewed and more patients were screened in the school. Risk factors were identified by a case-control study. The laboratory testing and environmental survey were also carried out.
Results: Total 63 HFMD cases were identified, with the age ranged from 3 to 6 years. Male to female ratio was 1.25:1 and more than half was pre-kindergarten students. The most common clinical presentations were blisters in the mouth (83.33%), blisters on the hands (51.67%) and fever (48.33%). The laboratory results revealed that 10 cases of Coxsackies A16 and 3 cases of Enterovirus 71 were confirmed by polymerase chain reaction. The associated risk factors of this outbreak were playing with other patients (Adjusted OR = 11.38, 95% CI = 3.52, 36.76), having a sibling with HFMD (Adjusted OR = 11.25, 95% CI = 2.29, 55.33), and touching drumsticks and musical instruments (Adjusted OR = 10.39, 95% CI = 3.74, 28.84).
Conclusion: This event was a propagated outbreak, associated as playing with other patients and having a sibling with same disease to be risk factors. Using drumsticks was an unexpected important factor. Screening and isolation of the patients were a general measure to control HFMD. The disease investigation to identify the etiological cause should be done to increase the effectiveness of disease control, especially in larger schools with more complex factors than small schools or child centers.