Evaluation on Hand, Foot and Mouth disease and Enterovirus Surveillance System in Thailand, 2012

Abstract

The surveillance system for hand, foot and mouth disease (HFMD) and enterovirus has been included in the National Disease Surveillance System (506 report) since 2001. After HFMD outbreaks occurred in Thailand, Cambodia and Vietnam during 2012, the Bureau of Epidemiology has adjusted the surveillance case definition and guideline for investigation. Thus, in order to assess the existing situation and epidemiological characteristics of HFMD and enterovirus cases, understand the reporting system and improve the surveillance system, the Bureau of Epidemiology and Office of Disease Prevention and Control1-12 were jointly evaluated the HFMD and enterovirus surveillance system. A cross-sectional study was conducted by assessing quantitative data such as sensitivity, predictive value positive (PVP), data accuracy, representativeness and timeliness, and qualitative features, including simplicity, flexibility, sustainability and usefulness of the surveillance system. The Offices of Disease Prevention and Control selected one province each in the area of their responsibility. Total 12 provinces were included in the study which included Pathum Thani, Kanchanaburi, Lop Buri, Rayong, Khon Kaen, Nakhon Ratchasima, Nakhon Si Thammarat, Yasothorn, Kamphaeng Phet, Sukhothai, Lampang and Songkhla.
The study population included children under 15 who were treated at a public hospital and diagnosed with specific ICD10-TM codes between 1 January and 31 December 2012. The results showed that sensitivity was 46.5% while PVP was 88% and timeliness between date of diagnosis and date of reporting (within 3 days) was 86%. The guidelines for the HFMD and enterovirus surveillance system were similar to any other diseases. Relevant authorities participated and cooperated well in the surveillance system. Although the system was simple, skilled people were needed for adjusting to the disease codes or the computer program, which could render delay in the reporting system. While some patients were not reported to the surveillance system, there were some errors in giving or typing the diagnosis codes (ICD 10 - TM) for some patients treated out of office hours. The surveillance data were utilized to analyze situation, assess disease trends, plan and conduct prevention and control measures. The severe enterovirus infection should be reported to the National Disease Surveillance (506 report) through the HFMD and enterovirus surveillance system. The case definition should be reviewed to improve the reporting so that the surveillance system could be comprehensive and accurate.