Epidemiology of Hand Foot Mouth Disease and Enteroviruses Infection in Thailand, 2013

Abstract

Background: Hand-foot-and-mouth (HFMD) disease can be occurred in worldwide. There were reports of outbreaks caused by enterovirus 71 (EV-71) in many countries around Asia.
Objectives and Methods: Reviewing a disease situation from database of passive surveillance (R506) and database of event base surveillance were a cornerstone to gain knowledge on epidemiological patterns and transfer to health policies on prevention and control program.
Results: In 2013, 46,053 HFMD cases were reported to R.506 (morbidity rate was 72.50 per 100,000 populations). A proportion of female and male was 1:1.32. HFM was mostly found among infants and young children group of 0-4 years old (1,058 per 100,000 populations). Most outbreaks were occurred in child care centers and kindergartens. The Northern, especially in Chiang Rai province were highest morbidity rate (120.84 per 100,000 populations in Northern and 255.41 per 100,000 populations in Chiang Rai). There were 72 events reported in the event base surveillance. A pattern of the disease was categorized into two groups. One was patients who infected to Enterovirus showed skin lesion and most of them were mild symptoms including fever, blisters and ulcers in mouth/hands/feet/bottom. The other group was patients who infected to Enterovirus without skin lesion and most of them were severe case. The severe complications such as high fever, frequent vomit and diarrhea, dehydration, fatigue, dozily, seizures, pulmonary edema, shock and unconscious, cardiomyositis, cardio-circulatory failure caused fatal case. A range of period from date of onset to date of death was 2-11 days (median was 6 days). The infected classmates and infected family members were important host in transmission of the disease. Eight of 12 death cases (67%) had positive results of EV-71 among cases or close contacts. Without a definitely sign of HFMD or Herpangina symptom, physicians should also consider other factors of close contact with neighbor or family members who had signs of HFMD.
Conclusion: It should be strengthening surveillance system at child cares by asking cooperation from babysitter and teacher to screen childhood illness every day. If any child has a symptom of HFMD, activities of isolation, referring and timely reporting to the public Health officer needed to be done.