Materiały źródłowe

• #1 Hand, Foot, and Mouth Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431082/

  Hand, foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children but can also affect adults. […] This viral infection is not indigenous to 1 area in particular but occurs worldwide. Children (particularly those younger than 7 years of age) tend to be infected at a higher rate than adults, so you can see outbreaks in daycares, summer camps, or within the family. Large-scale surveillance from China demonstrated that more than 90% of HFMD cases occurred in children less than 5 years of age, mortality was around 0.03%, and that cases tended to occur more frequently during late spring and early summer. […] In 2021, French surveillance found a rapid increase in HFMD cases, with more than 3400 cases. Although more than 90% of sequenced cases were found to be linked to Enterovirus, atypical cases were found to be associated with Coxsackievirus A6 and A16. […] Coxsackievirus A6 remains the dominant cause of HFMD in the United States.

• #2 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. […] Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. […] It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. […] At present, there is no specific pharmaceutical intervention for HFMD. […] Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.

• #3 Key document

  https://www.who.int/westernpacific/emergencies/surveillance/archives/hand-foot-and-mouth-disease

  Hand, foot and mouth disease (HFMD) is a common infectious disease that occurs most often in children, but can also occur in adolescents and occasionally in adults. […] Through the Regional Event Based Surveillance System, WHO monitors HFMD in the region to detect outbreaks and other significant events. […] However, the WHO Western Pacific Regional Office will no longer produce the bi-weekly Western Pacific Region Hand, Foot and Mouth Disease Surveillance Summary.

• #4 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  The criteria for diagnosing of HFMD, which are widely accepted at present, primarily rely on the patients epidemiological history, symptoms additional tests to determine the cause or presence of the disease. […] The incubation period of HFMD is mostly 2-10 days, with an average of 3-5 days. […] The prevention in patients with severe HFMD depends on the timely and accurate identification of danger signs in the disease progression. […] Human is usually considered to be the only reservoir of human EVs, and both cases and asymptomatic infections are the sources of HFMD infection. […] Currently, the fecal-oral transmission and contact are considered as the primary transmission routes of HFMD. […] As a common childhood infectious disease, HFMD primarily occurs in children under 5 years old, although HFMD has also been reported in adults.

• #5 Hand, Foot, and Mouth Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431082/

  Hand, foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children but can also affect adults. […] This viral infection is not indigenous to 1 area in particular but occurs worldwide. Children (particularly those younger than 7 years of age) tend to be infected at a higher rate than adults, so you can see outbreaks in daycares, summer camps, or within the family. Large-scale surveillance from China demonstrated that more than 90% of HFMD cases occurred in children less than 5 years of age, mortality was around 0.03%, and that cases tended to occur more frequently during late spring and early summer. […] In 2021, French surveillance found a rapid increase in HFMD cases, with more than 3400 cases. Although more than 90% of sequenced cases were found to be linked to Enterovirus, atypical cases were found to be associated with Coxsackievirus A6 and A16. […] Coxsackievirus A6 remains the dominant cause of HFMD in the United States.

• #6 A five-year retrospective study on the epidemiology of hand, foot and mouth disease in Sabah, Malaysia | Scientific Reports

  https://www.nature.com/articles/s41598-021-96083-3

  Although a number of HFMD outbreaks have been reported in Sabah, information on the genetic characteristics of these strains in Sabah is limited. More surveillance is necessary to understand and monitor the emergence and spread of new strains. Understanding the epidemiological pattern of HFMD is important for the implementation of appropriate intervention strategies. […] From the eNotifikasi system, a total of 17,574 reports of HFMD cases were recorded in Sabah during the five-year study period, with no deaths reported. The annual incidence rate from 2015 to 2019 varied from 39.9 per 100,000 people to 166.1 per 100,000 people, with a five-year average annual incidence of 94.3 per 100,000 people. The greatest year-to-year increase, approximately 2.7-fold, was observed from 2017 to 2018.

• #7

  https://journals.lww.com/md-journal/fulltext/2021/05210/epidemiological_characteristics_of_hand,_foot,_and.47.aspx

  To study the epidemic features of hand-foot-mouth disease (HFMD) in mainland China through systematic review and meta-analysis so as to provide evidence for the future prevention and control of HFMD. […] A total of 23 articles were included in this study, the total number of cases was 377,083, of which the total number of male cases was 231,798 and the total number of female cases was 145,285, the sex ratio was about 1.6:1, and the incidence of HFMD in China was 1.61 (95% confidence interval [CI]: 1.211.94). […] There were differences in the distribution of region, time, population, and etiology of HFMD in mainland China. Health departments should adopt key strategies and measures for key populations in key areas to prevent and control the development of HFMD, and improve the ability of pathogen detection and typing in laboratories.

• #8 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Health care professionals working with children are at risk of contracting hand-foot-and-mouth disease, and males and females are equally affected. Hand-foot-and-mouth disease has a low fatality rate in uncomplicated cases in the United States (0.06% to 0.11%). However, there were 10.7 million cases in China between May 2008 and June 2014, with 3,046 deaths attributed to neurologic and cardiopulmonary complications. Patients with more severe disease are more likely to have been infected with enterovirus 71. […] Lack of access to clean water partially explains the burden of disease in the developing world and Asia, where hand-foot-and-mouth disease is a significant public health threat.

• #9 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Health care professionals working with children are at risk of contracting hand-foot-and-mouth disease, and males and females are equally affected. Hand-foot-and-mouth disease has a low fatality rate in uncomplicated cases in the United States (0.06% to 0.11%). However, there were 10.7 million cases in China between May 2008 and June 2014, with 3,046 deaths attributed to neurologic and cardiopulmonary complications. Patients with more severe disease are more likely to have been infected with enterovirus 71. […] Lack of access to clean water partially explains the burden of disease in the developing world and Asia, where hand-foot-and-mouth disease is a significant public health threat.

• #10

  https://journals.lww.com/pidj/fulltext/2016/10000/the_epidemiology_of_hand,_foot_and_mouth_disease.3.aspx

  Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). […] This study reports a systematic review of the epidemiology of HFMD in Asia. […] HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. […] Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. […] Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies.

• #11 Hand, Foot, and Mouth Disease – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/hand-foot-and-mouth-disease/

  HFMD is most common in the summer and early fall. […] HFMD is a common viral illness that usually affects infants and children younger than five years old. […] Infected persons are most contagious during the first week of illness. […] HFMD can cause outbreaks in settings that involve a lot of close contact, such as childcare settings.

• #12 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #13

  https://journals.lww.com/pidj/fulltext/2016/10000/the_epidemiology_of_hand,_foot_and_mouth_disease.3.aspx

  Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). […] This study reports a systematic review of the epidemiology of HFMD in Asia. […] HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. […] Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. […] Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies.

• #14 Hand, foot and mouth disease

  https://www.health.vic.gov.au/infectious-diseases/hand-foot-and-mouth-disease

  Hand, foot and mouth disease is not notifiable, but school exclusions do apply. […] The disease occurs worldwide, sporadically and in epidemics. The greatest incidence is in summer and early autumn. […] Outbreaks occur frequently among groups of children in childcare centres and schools. […] HFMD occurs worldwide, sporadically and in epidemics. The greatest incidence is in summer and early autumn. In tropical and subtropical countries, circulation of the virus tends to be year-round, with more outbreaks in the rainy season. Outbreaks occur frequently among groups of children in childcare centres and schools. […] Individual cases and outbreaks of HFMD occur around the world. […] Since 1997, large outbreaks of HFMD caused by enterovirus 71 have been reported, mainly in children, in east and South-East Asia.

• #15 Evolving pathogen trends and spatial–temporal dynamics of hand, foot, and mouth disease in Fengxian District, Shanghai (2009–2022) | Scientific Reports

  https://www.nature.com/articles/s41598-024-71389-0

  The disease incidence demonstrated significant positive correlations with several meteorological variables: daily average temperature (r=0.30, P0.05), relative humidity (r=0.20, P0.05), wind speed (r=0.17, P0.05), and precipitation (r=0.17, P0.05). […] Geographically, Nanqiao Town, Fengcheng Town, and Xidu Subdistrict reported the highest incidence rates. […] The demographic analysis revealed a male-to-female ratio of 1.60:1, predominantly affecting children aged 13 years. […] Prior to 2017, Enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16) were the primary detected strains; post-2017, Coxsackievirus A6 (CoxA6) emerged as the dominant strain. […] Statistical analysis confirmed significant year-to-year variations in virus detection rates, with decreasing trends for EV71 and other enteroviruses and an increasing trend for CoxA6.

• #16 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The urban area with high EV-A71 transmission in China initiated vaccination with inactivated EV-A71 vaccine, a dramatic decline in EV-A71-associated HFMD incidence was observed. […] The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] In addition to reducing the clustering of susceptible populations and enhancing individual protection, herd immunity through vaccination is more effective in reducing population susceptibility. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #17

  https://journals.lww.com/md-journal/fulltext/2021/05210/epidemiological_characteristics_of_hand,_foot,_and.47.aspx

  The incidence of HFMD in the 5 age groups ranged from high to low was in 1-year old (15.20, 95% CI: 5.0025.30), 3-years old (11.40, 95% CI: 4.9017.90), 2-years old (10.00, 95% CI: 4.1015.90), 4-years old (9.00, 95% CI: 4.3013.70), and 0-years old (3.10, 95% CI: 1.205.00). […] The results showed that the incidence of HFMD associated with the 3 dominant epidemic strains was followed by other intestinal viruses (1.83, 95% CI: 1.322.33), EV71 (1.72, 95% CI: 1.032.41), and Cox A16 (0.73, 95% CI: 0.361.09) from high to low. […] The incidence of HFMD decreased year by year from 2014 to 2018. In the under-5 age group, the incidence was highest in the 1-year group and lowest in the 0-year group. Compared with Cox A16 and EV71, regions with other types of enteroviruses as the dominant strains had a higher annual incidence.

• #18

  https://journals.lww.com/md-journal/fulltext/2021/05210/epidemiological_characteristics_of_hand,_foot,_and.47.aspx

  To study the epidemic features of hand-foot-mouth disease (HFMD) in mainland China through systematic review and meta-analysis so as to provide evidence for the future prevention and control of HFMD. […] A total of 23 articles were included in this study, the total number of cases was 377,083, of which the total number of male cases was 231,798 and the total number of female cases was 145,285, the sex ratio was about 1.6:1, and the incidence of HFMD in China was 1.61 (95% confidence interval [CI]: 1.211.94). […] There were differences in the distribution of region, time, population, and etiology of HFMD in mainland China. Health departments should adopt key strategies and measures for key populations in key areas to prevent and control the development of HFMD, and improve the ability of pathogen detection and typing in laboratories.

• #19 Evolving pathogen trends and spatial–temporal dynamics of hand, foot, and mouth disease in Fengxian District, Shanghai (2009–2022) | Scientific Reports

  https://www.nature.com/articles/s41598-024-71389-0

  The disease incidence demonstrated significant positive correlations with several meteorological variables: daily average temperature (r=0.30, P0.05), relative humidity (r=0.20, P0.05), wind speed (r=0.17, P0.05), and precipitation (r=0.17, P0.05). […] Geographically, Nanqiao Town, Fengcheng Town, and Xidu Subdistrict reported the highest incidence rates. […] The demographic analysis revealed a male-to-female ratio of 1.60:1, predominantly affecting children aged 13 years. […] Prior to 2017, Enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16) were the primary detected strains; post-2017, Coxsackievirus A6 (CoxA6) emerged as the dominant strain. […] Statistical analysis confirmed significant year-to-year variations in virus detection rates, with decreasing trends for EV71 and other enteroviruses and an increasing trend for CoxA6.

• #20 Hand, foot, and mouth disease – Wikipedia

  https://en.wikipedia.org/wiki/Hand,_foot,_and_mouth_disease

  Hand, foot and mouth disease most commonly occurs in children under the age of 10 and more often under the age of 5, but it can also affect adults with varying symptoms. […] It tends to occur in outbreaks during the spring, summer, and autumn seasons. […] This is believed to be due to heat and humidity improving spread. […] HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered. […] Poor hygiene is a risk factor for HFMD. […] In 1997, an outbreak occurred in Sarawak of Malaysia with 600 cases and over 30 children died. […] In 1998, there was an outbreak in Taiwan, affecting mainly children. […] There were 405 severe complications, and 78 children died. […] The total number of cases in that epidemic is estimated to have been 1.5 million.

• #21 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The urban area with high EV-A71 transmission in China initiated vaccination with inactivated EV-A71 vaccine, a dramatic decline in EV-A71-associated HFMD incidence was observed. […] The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] In addition to reducing the clustering of susceptible populations and enhancing individual protection, herd immunity through vaccination is more effective in reducing population susceptibility. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #22 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] The World Health Organization (WHO) primarily manages the existing global surveillance network for poliovirus, but has not yet established a specialized network to monitor HFMD or EVs. […] In 2008, HFMD was incorporated into China’s notifiable infectious disease reporting system. […] In order to better prevent and control HFMD, China has gradually established and improved a nationwide monitoring network system for HFMD laboratories, with prefecture-level laboratories, provincial-level laboratories, and national-level laboratories as the main body. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #23 Hand, Foot, and Mouth Disease – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/hand-foot-and-mouth-disease/

  HFMD is most common in the summer and early fall. […] HFMD is a common viral illness that usually affects infants and children younger than five years old. […] Infected persons are most contagious during the first week of illness. […] HFMD can cause outbreaks in settings that involve a lot of close contact, such as childcare settings.

• #24 Surveillance for severe hand, foot, and mouth disease from 2009 to 2015 in Jiangsu province: epidemiology, etiology, and disease burden | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3659-7

  The severe illness rate was the highest in the 12-23 months age group, and the greatest mortality rate was in the 6-11 months age group. […] Patients infected with EV-A71 were at a higher proportion in different CNS involvement even death. […] The severity of the diseases and deaths were inversely related to age. […] The highest severe illness rate of 502.1/1 million appeared in the 12 to 23 months age group, while the rate for the 24-35 months age group, for 36-47 months age group, for 48-59 months age group, and over 60 months age group were 304.4/1 million, 222.6/1 million 114.8/1 million, and 0.93/1 million, respectively. […] Our study showed that it was more likely for EV-A71 infection than other enterovirus types to cause serious CNS and EV-A71 usually led to encephalitis, pulmonary oedema/ haemorrhage, circulation failure and death, which was in line with other published studies on EV-A71 infection. […] Careful surveillance of clinical manifestation, infectious agent activities and pathogenic features is crucial in monitoring non-EV-A71/ CV-A16 virus infection associated with severe HFMD of neurological complications.

• #25

  https://link.springer.com/article/10.1007/s00430-016-0465-y

  Hand, foot, and mouth disease (HFMD) is a contagious viral disease and mainly affects infants and young children. […] Historically, outbreaks of HFMD were mainly caused by two enteroviruses: the coxsackievirus A16 (CV-A16) and the enterovirus 71 (EV-A71). […] In the recent years, coxsackievirus A6 and coxsackievirus A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide, particularly in India, South East Asia and Europe with an increased frequency of neurological complications as well as mortality. […] Currently, there is no pharmacological intervention or vaccine available for HFMD. […] Therefore, the development of a globally representative multivalent HFMD vaccine could be the best strategy. […] Shimizu H, Nakashima K (2014) Surveillance of hand, foot, and mouth disease for a vaccine.

• #26 Hand-Foot-and-Mouth Disease (HFMD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/802260-overview

  Hand-foot-and-mouth disease (HFMD) is an acute viral illness that presents as a vesicular eruption in the mouth, but it also can involve the hands, feet, buttocks, and/or genitalia. Hand-foot-and-mouth disease is common and potentially but infrequently fatal in children younger than 5 years. […] Coxsackievirus A type 16 (CVA16) is the etiologic agent involved in most cases of HFMD, but the illness also is associated with coxsackievirus A5, A7, A9, A10, B2, and B5 strains. […] Enterovirus 71 (EV-71) has caused outbreaks of HFMD with associated neurologic involvement in the western Pacific region and Southeast Asia. […] Hand-foot-and-mouth disease (HFMD) has become a societal burden in parts of Asia with pandemic potential, particularly in Vietnam. […] HFMD epidemics associated with EV-71 have been more frequent in Southeast Asia in recent years, including the Republic of China (1998) and Singapore (2000). […] The incidence of HFMD is increasing despite current preventive efforts in Singapore. […] Neurologic involvement with sequelae is less likely to occur in patients with HFMD caused by coxsackievirus strains than with HFMD caused by EV-71.

• #27 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #28 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 20132018 […] While hand, foot and mouth disease (HFMD) is primarily self-resolvingsoaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. […] We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. […] Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection.

• #29 Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

  https://www.mdpi.com/1999-4915/13/5/781

  Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1–6 years old) mainly, and show seasonality with peaks in spring–summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.

• #30 Hand, Foot, and Mouth Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431082/

  Hand, foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children but can also affect adults. […] This viral infection is not indigenous to 1 area in particular but occurs worldwide. Children (particularly those younger than 7 years of age) tend to be infected at a higher rate than adults, so you can see outbreaks in daycares, summer camps, or within the family. Large-scale surveillance from China demonstrated that more than 90% of HFMD cases occurred in children less than 5 years of age, mortality was around 0.03%, and that cases tended to occur more frequently during late spring and early summer. […] In 2021, French surveillance found a rapid increase in HFMD cases, with more than 3400 cases. Although more than 90% of sequenced cases were found to be linked to Enterovirus, atypical cases were found to be associated with Coxsackievirus A6 and A16. […] Coxsackievirus A6 remains the dominant cause of HFMD in the United States.

• #31 Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

  https://www.mdpi.com/1999-4915/13/5/781

  Up until a few years ago, there were no data about the EV serotypes circulating in Europe and causing HFMD, because there is no obligatory notification due to the benign course of infections, as most of them do not require hospitalization. However, the increasing circulation of the emerging types, such as CVA6, firstly detected in an outbreak in Finland during 2008, along with the detection of more severe cases worldwide, and the appearance of accompanying symptoms, such as onychomadesis, suggests the necessity of a surveillance system of HFMD and its clinical evolution in Europe as well. […] In Spain, CVA6 started to circulate between 2008 and 2010, and some works have reported outbreaks and disease cases in different regions, associated to typical, non-typical, or onychomadesis presentations. However, and with the exception of an interesting study of all cases diagnosed in 5 primary care centres from Barcelona during one year, there are no long studies nationwide about the detection and characterization of EV serotypes involved in mucocutaneous diseases. In this retrospective study, the epidemiology of EV detected in these types of pathologies in Spain during a period of 15 years was described, as well as the associated clinical characteristics.

• #32

  https://link.springer.com/article/10.1007/s00430-016-0465-y

  Hand, foot, and mouth disease (HFMD) is a contagious viral disease and mainly affects infants and young children. […] Historically, outbreaks of HFMD were mainly caused by two enteroviruses: the coxsackievirus A16 (CV-A16) and the enterovirus 71 (EV-A71). […] In the recent years, coxsackievirus A6 and coxsackievirus A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide, particularly in India, South East Asia and Europe with an increased frequency of neurological complications as well as mortality. […] Currently, there is no pharmacological intervention or vaccine available for HFMD. […] Therefore, the development of a globally representative multivalent HFMD vaccine could be the best strategy. […] Shimizu H, Nakashima K (2014) Surveillance of hand, foot, and mouth disease for a vaccine.

• #33 Pathogen Spectrum of Hand, Foot, and Mouth Disease Based on Laboratory Surveillance — China, 2018

  https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2020.044

  Enterovirus 71 (EV-A71) is the main causative pathogen for severe and fatal patients with Hand, Foot, and Mouth Disease (HFMD) in mainland China from 2008 to 2017. Non-EV-A71 and non-CV-A16 (other enterovirus) serotypes were the major causative-serotypes for mild HFMD in years of 2013, 2015, and 2017. […] In 2018, other enterovirus serotypes replaced EV-A71 for the first time as the major cause of severe HFMD with a proportion of 70.7%. However, at the national level, only a small proportion of the other enterovirus serotypes were further identified as CV-A6 and CV-A10. […] Further identification of other enterovirus serotypes is highly recommended for provincial CDCs, especially for severe HFMD. Studies contributing to a multivalent vaccine for HFMD should be prioritized. […] The pathogen surveillance is a part of HFMD national surveillance routine work, which was launched in 31 provincial-level administrative divisions (PLADs) in China from 2008.

• #34 Evolving pathogen trends and spatial–temporal dynamics of hand, foot, and mouth disease in Fengxian District, Shanghai (2009–2022) | Scientific Reports

  https://www.nature.com/articles/s41598-024-71389-0

  The disease incidence demonstrated significant positive correlations with several meteorological variables: daily average temperature (r=0.30, P0.05), relative humidity (r=0.20, P0.05), wind speed (r=0.17, P0.05), and precipitation (r=0.17, P0.05). […] Geographically, Nanqiao Town, Fengcheng Town, and Xidu Subdistrict reported the highest incidence rates. […] The demographic analysis revealed a male-to-female ratio of 1.60:1, predominantly affecting children aged 13 years. […] Prior to 2017, Enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16) were the primary detected strains; post-2017, Coxsackievirus A6 (CoxA6) emerged as the dominant strain. […] Statistical analysis confirmed significant year-to-year variations in virus detection rates, with decreasing trends for EV71 and other enteroviruses and an increasing trend for CoxA6.

• #35 Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

  https://www.mdpi.com/1999-4915/13/5/781

  Up until a few years ago, there were no data about the EV serotypes circulating in Europe and causing HFMD, because there is no obligatory notification due to the benign course of infections, as most of them do not require hospitalization. However, the increasing circulation of the emerging types, such as CVA6, firstly detected in an outbreak in Finland during 2008, along with the detection of more severe cases worldwide, and the appearance of accompanying symptoms, such as onychomadesis, suggests the necessity of a surveillance system of HFMD and its clinical evolution in Europe as well. […] In Spain, CVA6 started to circulate between 2008 and 2010, and some works have reported outbreaks and disease cases in different regions, associated to typical, non-typical, or onychomadesis presentations. However, and with the exception of an interesting study of all cases diagnosed in 5 primary care centres from Barcelona during one year, there are no long studies nationwide about the detection and characterization of EV serotypes involved in mucocutaneous diseases. In this retrospective study, the epidemiology of EV detected in these types of pathologies in Spain during a period of 15 years was described, as well as the associated clinical characteristics.

• #36 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 20132018 […] While hand, foot and mouth disease (HFMD) is primarily self-resolvingsoaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. […] We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. […] Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection.

• #37 Key document

  https://www.who.int/westernpacific/emergencies/surveillance/archives/hand-foot-and-mouth-disease

  Hand, foot and mouth disease (HFMD) is a common infectious disease that occurs most often in children, but can also occur in adolescents and occasionally in adults. […] Through the Regional Event Based Surveillance System, WHO monitors HFMD in the region to detect outbreaks and other significant events. […] However, the WHO Western Pacific Regional Office will no longer produce the bi-weekly Western Pacific Region Hand, Foot and Mouth Disease Surveillance Summary.

• #38 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] The World Health Organization (WHO) primarily manages the existing global surveillance network for poliovirus, but has not yet established a specialized network to monitor HFMD or EVs. […] In 2008, HFMD was incorporated into China’s notifiable infectious disease reporting system. […] In order to better prevent and control HFMD, China has gradually established and improved a nationwide monitoring network system for HFMD laboratories, with prefecture-level laboratories, provincial-level laboratories, and national-level laboratories as the main body. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #39 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #40 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] The World Health Organization (WHO) primarily manages the existing global surveillance network for poliovirus, but has not yet established a specialized network to monitor HFMD or EVs. […] In 2008, HFMD was incorporated into China’s notifiable infectious disease reporting system. […] In order to better prevent and control HFMD, China has gradually established and improved a nationwide monitoring network system for HFMD laboratories, with prefecture-level laboratories, provincial-level laboratories, and national-level laboratories as the main body. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #41 JMIR Public Health and Surveillance – The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study

  https://publichealth.jmir.org/2024/1/e59446/

  Background: South Korea has implemented a hand, foot, and mouth disease (HFMD) surveillance system since 2009 to monitor incidence trends and identify disease burden. This nationwide surveillance involves a network of approximately 100 pediatric clinics that report all probable and confirmed HFMD cases. […] South Korea has had an HFMD surveillance system since 2009 to monitor incidence trends and identify the HFMD burden; it is provided by the Korea Disease Control and Prevention Agency (KDCA). […] It is important to evaluate the HFMD surveillance system as it provides data for key epidemiological findings, including seasonality and economic burden. […] Previous studies report a decline in HFMD notifications during the acute phase of the COVID-19 pandemic. […] This study aimed to review and systematically evaluate the HFMD surveillance system in South Korea from 2017 to 2022 based on the CDC surveillance evaluation guidelines.

• #42

  https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Hand-Foot-and-Mouth-Disease.aspx

  Infection leads to specific immunity against the particular virus but can be reinfected by a different virus from the enterovirus group. […] After an epidemic of HFMD in Sarawak in 1997 and Taiwan in 1998, a system of surveillance for the disease, based on notifications from child-care centres was implemented in April 1998. Singapore experienced an epidemic of HFMD in September-October 2000 during which 3790 cases were reported. The predominant virus was EV71. There were four EV71-related deaths in 2000 and three in 2001. Reporting the disease was made legally mandatory on October 1, 2000. The outbreak was finally interrupted by a swift coordinated inter-agency response that led to the closure of all preschools from 1 Oct 15 Oct. […] MOH monitors the regional EV 71-associated HFMD situation and tracks the types of enteroviruses circulating in the community through a sentinel surveillance system. […] MOH, together with MCYS and MOE, closely monitors the local disease incidence and trends and provides guidance to childcare centres and kindergartens to ensure that these institutions exercise a high level of vigilance in their management of HFMD.

• #43 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #44 Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

  https://www.mdpi.com/1999-4915/13/5/781

  Up until a few years ago, there were no data about the EV serotypes circulating in Europe and causing HFMD, because there is no obligatory notification due to the benign course of infections, as most of them do not require hospitalization. However, the increasing circulation of the emerging types, such as CVA6, firstly detected in an outbreak in Finland during 2008, along with the detection of more severe cases worldwide, and the appearance of accompanying symptoms, such as onychomadesis, suggests the necessity of a surveillance system of HFMD and its clinical evolution in Europe as well. […] In Spain, CVA6 started to circulate between 2008 and 2010, and some works have reported outbreaks and disease cases in different regions, associated to typical, non-typical, or onychomadesis presentations. However, and with the exception of an interesting study of all cases diagnosed in 5 primary care centres from Barcelona during one year, there are no long studies nationwide about the detection and characterization of EV serotypes involved in mucocutaneous diseases. In this retrospective study, the epidemiology of EV detected in these types of pathologies in Spain during a period of 15 years was described, as well as the associated clinical characteristics.

• #45 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The criteria for diagnosing of HFMD, which are widely accepted at present, primarily rely on the patients epidemiological history, symptoms additional tests to determine the cause or presence of the disease. […] The incubation period of HFMD is mostly 2-10 days, with an average of 3-5 days. […] The prevention in patients with severe HFMD depends on the timely and accurate identification of danger signs in the disease progression. […] Human is usually considered to be the only reservoir of human EVs, and both cases and asymptomatic infections are the sources of HFMD infection. […] Currently, the fecal-oral transmission and contact are considered as the primary transmission routes of HFMD. […] As a common childhood infectious disease, HFMD primarily occurs in children under 5 years old, although HFMD has also been reported in adults.

• #46 Hand, foot, and mouth disease | Communicable Diseases Agency

  https://www.cda.gov.sg/professionals/diseases/hand–foot-and-mouth-disease

  Hand, foot, and mouth disease (HFMD) is a common childhood disease that is generally mild and self-limiting. HFMD is endemic in Singapore and can affect all ages, particularly children below 5 years old. […] HFMD is a common childhood viral illness that is mild and self-limiting. Majority of infections occur at the pre-school age, although infection can also occur in adults. […] Infection leads to a specific immunity against the particular virus that caused the current infection; however, reinfection can occur through a different virus from the enterovirus group. […] HFMD is typically diagnosed based on its clinical presentation. […] In cases with atypical presentation or for public health investigations, laboratory tests through detection of viruses of the Enteroviruses group in throat or vesicles swab through Polymerase Chain Reaction (PCR) or virus isolation may be considered. […] HFMD is not a legally notifiable disease in Singapore.

• #47 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] The World Health Organization (WHO) primarily manages the existing global surveillance network for poliovirus, but has not yet established a specialized network to monitor HFMD or EVs. […] In 2008, HFMD was incorporated into China’s notifiable infectious disease reporting system. […] In order to better prevent and control HFMD, China has gradually established and improved a nationwide monitoring network system for HFMD laboratories, with prefecture-level laboratories, provincial-level laboratories, and national-level laboratories as the main body. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #48 JMIR Public Health and Surveillance – The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study

  https://publichealth.jmir.org/2024/1/e59446/

  Our study findings indicate that the completeness, sensitivity, and age-specific representativeness of HFMD surveillance in South Korea decreased to moderate levels from 2020 to 2021 but recovered in 2022. […] The notification data quality is important to enable public health authorities to respond in a timely and appropriate manner. […] The current Korean HFMD electronic surveillance system is mainly operated by web-based reporting records to track reporting at each sentinel site. […] We identified that the geological distribution of HFMD sentinels in South Korea was good during the study period. However, having more sentinels in underrepresented areas will enhance the local resolution of HFMD occurrence. […] In conclusion, the completeness, sensitivity, and age representativeness of the HFMD surveillance system were temporarily reduced during the acute period of the COVID-19 pandemic. Continuous evaluation of surveillance performance will provide robust and reliable data to support public health policy development.

• #49 JMIR Public Health and Surveillance – The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study

  https://publichealth.jmir.org/2024/1/e59446/

  Our study findings indicate that the completeness, sensitivity, and age-specific representativeness of HFMD surveillance in South Korea decreased to moderate levels from 2020 to 2021 but recovered in 2022. […] The notification data quality is important to enable public health authorities to respond in a timely and appropriate manner. […] The current Korean HFMD electronic surveillance system is mainly operated by web-based reporting records to track reporting at each sentinel site. […] We identified that the geological distribution of HFMD sentinels in South Korea was good during the study period. However, having more sentinels in underrepresented areas will enhance the local resolution of HFMD occurrence. […] In conclusion, the completeness, sensitivity, and age representativeness of the HFMD surveillance system were temporarily reduced during the acute period of the COVID-19 pandemic. Continuous evaluation of surveillance performance will provide robust and reliable data to support public health policy development.

• #50 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #51 Evolving pathogen trends and spatial–temporal dynamics of hand, foot, and mouth disease in Fengxian District, Shanghai (2009–2022) | Scientific Reports

  https://www.nature.com/articles/s41598-024-71389-0

  Hand, foot, and mouth disease (HFMD) is a prevalent acute infectious disease caused by enteroviruses, presenting substantial public health challenges in Shanghai, especially among children. […] The dynamic nature of HFMDs etiology necessitates an ongoing evaluation of its epidemiological and virological trends to inform effective control strategies. […] This study aims to investigate the epidemiological patterns and viral evolution of HFMD in Fengxian District, Shanghai, China, with a focus on shifts in predominant viral strains over a 14-year period. […] Epidemiological trends, strain prevalence, and demographic impacts were assessed. […] A total of 27,272 HFMD cases were documented during the study period, with incidence showing pronounced seasonal fluctuations peaking in spring and summer and a lesser peak in autumn.

• #52 Hand-Foot-and-Mouth Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1001/p408.html

  Hand-foot-and-mouth disease was first described after an outbreak in Canada in the 1950s. It is caused by picornaviruses, specifically human enteroviruses and coxsackieviruses. The most common viruses that cause hand-foot-and-mouth disease are enterovirus 71 and coxsackievirus A16. Currently, hand-foot-and-mouth disease is not listed as a notifiable condition in the United States by the Centers for Disease Control and Prevention; however, it has been a reportable illness in the Western Pacific region, where there are more severe outbreaks. […] Spring to fall seasonal outbreaks of hand-foot-and-mouth disease are typical in North America and temperate zones. Years can pass between cyclical epidemics, during which time the pool of unexposed children increases. Outbreaks of hand-foot-and-mouth disease are possible during the winter, and some are associated with coxsackievirus A6. Year-round outbreaks are common in tropical zones.

• #53 The surveillance of the epidemiological and serotype characteristics of hand, foot, mouth disease in Neijiang city, China, 2010-2017: A retrospective study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217474

  Hand, foot, and mouth disease (HFMD) is well recognized as one of the major threats to children’s health globally. The increasing complexity of the etiology of HFMD still challenges disease control in China. There is little surveillance of the molecular epidemiological characteristics of the enteroviruses (EVs) that cause HFMD in Neijiang city or the Sichuan Basin area in Southwest China. In this study, demographic and epidemiological information for 14,928 probable HFMD cases was extracted and analyzed to describe the epidemic features of HFMD in Neijiang city from Jan 2010 to Dec 2017. The eight-year average annual incidence was 49.82 per 100,000 in Neijiang. The incidence rates varied between 19.51 and 70.73 per 100,000, demonstrating peaks of incidence in even-number years (2012, 2014 and 2016). Our findings provide important evidence that aids the improvement of strategies for vaccination against HFMD and comprehensive disease control in China.

• #54 A five-year retrospective study on the epidemiology of hand, foot and mouth disease in Sabah, Malaysia | Scientific Reports

  https://www.nature.com/articles/s41598-021-96083-3

  Although a number of HFMD outbreaks have been reported in Sabah, information on the genetic characteristics of these strains in Sabah is limited. More surveillance is necessary to understand and monitor the emergence and spread of new strains. Understanding the epidemiological pattern of HFMD is important for the implementation of appropriate intervention strategies. […] From the eNotifikasi system, a total of 17,574 reports of HFMD cases were recorded in Sabah during the five-year study period, with no deaths reported. The annual incidence rate from 2015 to 2019 varied from 39.9 per 100,000 people to 166.1 per 100,000 people, with a five-year average annual incidence of 94.3 per 100,000 people. The greatest year-to-year increase, approximately 2.7-fold, was observed from 2017 to 2018.

• #55 Spatio-temporal epidemiology of hand, foot and mouth disease in Liaocheng City, North China

  https://www.spandidos-publications.com/10.3892/etm.2015.2207

  Hand, foot and mouth disease (HFMD) has posed a notable threat to public health and become a public health priority in China. This study was based on the reported cases of HFMD between 2007 and 2011. A total of 34,176 HFMD cases were geocoded at town level (n=134). […] The spatial distribution of HFMD was nonrandom and clustered with a significant Moran’s I value every year. The local Moran’s I Zscore detected three significant spatial clusters for high incidence of HFMD. […] The magnitude of HFMD epidemics varies in response to the scale of the original infection challenge, the geographical distribution of the animal population at risk and the effectiveness of control efforts during eradication. […] In recent years, the HFMD epidemic has rapidly spread in Liaocheng City, China. The incident cases have increased year by year and caused serious social harm.

• #56 Surveillance of Hand, Foot, and Mouth Disease in Mainland China (2008-2009)

  https://www.besjournal.com/en/article/doi/10.3967/0895-3988.2011.04.005

  Objective Since HFMD was designated as a class C communicable disease in May 2008, 18 months surveillance data have been accumulated to December 2009. This article was to describe the distribution of HFMD for age, sex, area, and time between 2008 and 2009, to reveal the characteristics of the epidemic. […] We analyzed weekly reported cases of HFMD from May 2008 to December 2009, and presented data on the distribution of age, sex, area and time. A discrete Poisson model was used to detect spatial-temporal clusters of HFMD. […] More than 1 065 000 cases of HFMD were reported in Mainland China from May 2008 to December 2009 (total incidence: 12.47 per 10 000). Male incidence was higher than female for all ages and 91.9 of patients were 5 years old. The incidence was highest in Beijing, Shanghai, Zhejiang and Hainan. The highest peak of HFMD cases was in April and the number of cases remained high from April to August. The spatial-temporal distribution detected four clusters. […] Children 5 years old were susceptible to HFMD and we should be aware of their vulnerability. The incidence was higher in urban than rural areas, and an annual pandemic usually starts in April.

• #57 Spatio-temporal epidemiology of hand, foot and mouth disease in Liaocheng City, North China

  https://www.spandidos-publications.com/10.3892/etm.2015.2207

  The present study provides useful information on the prevailing epidemiological situation of HFMD in Liaocheng City. This new knowledge of the presence of clusters of HFMD in Liaocheng City may help the Liaocheng Institute to intensify their remedial measures in the identified areas of high HFMD prevalence and determine future strategies for more effective HFMD control. […] The present study has revealed the presence of three hotspots of HFMD in Liaocheng City, China.

• #58

  https://journals.lww.com/md-journal/fulltext/2021/05210/epidemiological_characteristics_of_hand,_foot,_and.47.aspx

  The incidence of HFMD is relatively high in low latitudes such as the tropics and temperate zones. In addition, many meteorological factors such as high temperature, low pressure, and abundant precipitation are also closely related to the incidence of HFMD. […] The meta-analysis results showed that the average incidence of HFMD in all regions of China was (1.68, 95% CI: 1.362.01). […] The meta-analysis results showed that the incidence of HFMD in the 7 regions ranged from high to low in South China (3.48, 95% CI: 1.225.73), East China (1.86, 95% CI: 04.39), Central China (1.84, 95% CI: 1.002.68), Southwest China (0.90, 95% CI: 0.671.14), Northwest China (0.77, 95% CI: 0.111.43), and Northeast China (0.54, 95% CI: 01.11), and North China (0.36, 95% CI: 0.300.42), among which South China has the highest and North China the lowest.

• #59

  https://journals.lww.com/md-journal/fulltext/2021/05210/epidemiological_characteristics_of_hand,_foot,_and.47.aspx

  The incidence of HFMD is relatively high in low latitudes such as the tropics and temperate zones. In addition, many meteorological factors such as high temperature, low pressure, and abundant precipitation are also closely related to the incidence of HFMD. […] The meta-analysis results showed that the average incidence of HFMD in all regions of China was (1.68, 95% CI: 1.362.01). […] The meta-analysis results showed that the incidence of HFMD in the 7 regions ranged from high to low in South China (3.48, 95% CI: 1.225.73), East China (1.86, 95% CI: 04.39), Central China (1.84, 95% CI: 1.002.68), Southwest China (0.90, 95% CI: 0.671.14), Northwest China (0.77, 95% CI: 0.111.43), and Northeast China (0.54, 95% CI: 01.11), and North China (0.36, 95% CI: 0.300.42), among which South China has the highest and North China the lowest.

• #60 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The criteria for diagnosing of HFMD, which are widely accepted at present, primarily rely on the patients epidemiological history, symptoms additional tests to determine the cause or presence of the disease. […] The incubation period of HFMD is mostly 2-10 days, with an average of 3-5 days. […] The prevention in patients with severe HFMD depends on the timely and accurate identification of danger signs in the disease progression. […] Human is usually considered to be the only reservoir of human EVs, and both cases and asymptomatic infections are the sources of HFMD infection. […] Currently, the fecal-oral transmission and contact are considered as the primary transmission routes of HFMD. […] As a common childhood infectious disease, HFMD primarily occurs in children under 5 years old, although HFMD has also been reported in adults.

• #61 Hand, Foot & Mouth Disease | South Dakota Department of Health

  https://doh.sd.gov/diseases/hand-foot-mouth-disease/

  Anyone can get Hand, Foot, Mouth disease. Man is the only known source for these viruses. […] A person can be considered infectious during the time symptoms are present. These viruses inhabit the human intestinal tract and may persist in stool for several weeks, even after symptoms disappear. […] Diagnosis is based mainly on clinical symptoms. Virus may be isolated from lesions, nasopharyngeal or stool specimens. Since many viruses may produce the same syndrome, these tests are not routinely done.

• #62 Hand, Foot, and Mouth Disease (HFMD) – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/hand-foot-and-mouth-disease/

  HFMD was first reported in New Zealand in 1957. Outbreaks associated with EV71 infection have been reported throughout the world since the early 1970s. Humans are the only reservoir of the enterovirus family that causes HFMD. The virus can be passed to other people though contact with respiratory droplets, nose and throat secretions, saliva, fluid from the blisters, and from feces. It can be spread by close personal contact (kissing or hugging), touching an infected person, changing diapers, or touching a contaminated object or surface followed by touching eyes, nose or mouth. In rare cases, swallowing contaminated pool water can also transmit the virus. […] WHO monitors HFMD in the region by the Regional Event Based Surveillance System, to detect any outbreaks. […] Although HFMD is not a notifiable disease in Canada, each summer, a spike in cases is seen in provinces. Individual outbreaks have occurred in childcare centres throughout Canada.

• #63 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The criteria for diagnosing of HFMD, which are widely accepted at present, primarily rely on the patients epidemiological history, symptoms additional tests to determine the cause or presence of the disease. […] The incubation period of HFMD is mostly 2-10 days, with an average of 3-5 days. […] The prevention in patients with severe HFMD depends on the timely and accurate identification of danger signs in the disease progression. […] Human is usually considered to be the only reservoir of human EVs, and both cases and asymptomatic infections are the sources of HFMD infection. […] Currently, the fecal-oral transmission and contact are considered as the primary transmission routes of HFMD. […] As a common childhood infectious disease, HFMD primarily occurs in children under 5 years old, although HFMD has also been reported in adults.

• #64 Hand, Foot, and Mouth Disease – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/hand-foot-and-mouth-disease/

  HFMD is most common in the summer and early fall. […] HFMD is a common viral illness that usually affects infants and children younger than five years old. […] Infected persons are most contagious during the first week of illness. […] HFMD can cause outbreaks in settings that involve a lot of close contact, such as childcare settings.

• #65 Hand, Foot and Mouth Disease « North Central Health District

  https://northcentralhealthdistrict.org/hand-foot-mouth-disease/

  Hand, foot and mouth disease (HFMD) is a common viral illness that affects people of all ages, but infants and children younger than 5 years old are especially vulnerable. […] HFMD is caused by several different viruses and it’s possible that people can get the disease again. […] HFMD is an illness that commonly affects infants and children under age 5, but it can sometimes occur in older children and adults. […] People with HFMD are most contagious during the first week of their illness. However, they may sometimes remain contagious for weeks after symptoms go away. […] Report all Hand, Foot and Mouth Disease clusters to NCHD at 478-751-6303 or via the State Electronic Notifiable Disease Surveillance System. For more reporting options, visit our Epidemiology and Infectious Disease page.

• #66 Hand, foot and mouth disease (HFMD) | Epidemic Control Toolkit

  https://epidemics.ifrc.org/manager/disease/hand-foot-and-mouth-disease-hfmd

  HFMD infects children in particular and is often caused by a group of Enteroviruses, Coxsackie and Enterovirus 71 being the most common. Outbreaks associated with Enterovirus 71 infection have been reported globally since the 1970s, predominantly in the Asia-Pacific region and largely affecting children. […] Given the endemicity of this illness, it is not necessary to report every single case of detected HFMD. Instead, the objective should be to detect events that indicate an outbreak, clusters of cases, severe cases or deaths. […] The number of cases reaches two standard deviations above the normal baseline OR two or more cases occur within an institution, indicating transmission within a cohort. […] Attack rates have varied from one country to another. […] People with HFMD are usually most contagious during the first week of illness. For EV71, viral shedding from the throat can occur up to two weeks after an acute EV71 infection, and virus can be isolated from stools for up to 11 weeks.

• #67

  https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Hand-Foot-and-Mouth-Disease.aspx

  Infection leads to specific immunity against the particular virus but can be reinfected by a different virus from the enterovirus group. […] After an epidemic of HFMD in Sarawak in 1997 and Taiwan in 1998, a system of surveillance for the disease, based on notifications from child-care centres was implemented in April 1998. Singapore experienced an epidemic of HFMD in September-October 2000 during which 3790 cases were reported. The predominant virus was EV71. There were four EV71-related deaths in 2000 and three in 2001. Reporting the disease was made legally mandatory on October 1, 2000. The outbreak was finally interrupted by a swift coordinated inter-agency response that led to the closure of all preschools from 1 Oct 15 Oct. […] MOH monitors the regional EV 71-associated HFMD situation and tracks the types of enteroviruses circulating in the community through a sentinel surveillance system. […] MOH, together with MCYS and MOE, closely monitors the local disease incidence and trends and provides guidance to childcare centres and kindergartens to ensure that these institutions exercise a high level of vigilance in their management of HFMD.

• #68 Hand, foot, and mouth disease | Communicable Diseases Agency

  https://www.cda.gov.sg/professionals/diseases/hand–foot-and-mouth-disease

  Hand, foot, and mouth disease (HFMD) is a common childhood disease that is generally mild and self-limiting. HFMD is endemic in Singapore and can affect all ages, particularly children below 5 years old. […] HFMD is a common childhood viral illness that is mild and self-limiting. Majority of infections occur at the pre-school age, although infection can also occur in adults. […] Infection leads to a specific immunity against the particular virus that caused the current infection; however, reinfection can occur through a different virus from the enterovirus group. […] HFMD is typically diagnosed based on its clinical presentation. […] In cases with atypical presentation or for public health investigations, laboratory tests through detection of viruses of the Enteroviruses group in throat or vesicles swab through Polymerase Chain Reaction (PCR) or virus isolation may be considered. […] HFMD is not a legally notifiable disease in Singapore.

• #69 Hand, foot, and mouth disease – Wikipedia

  https://en.wikipedia.org/wiki/Hand,_foot,_and_mouth_disease

  Hand, foot and mouth disease most commonly occurs in children under the age of 10 and more often under the age of 5, but it can also affect adults with varying symptoms. […] It tends to occur in outbreaks during the spring, summer, and autumn seasons. […] This is believed to be due to heat and humidity improving spread. […] HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered. […] Poor hygiene is a risk factor for HFMD. […] In 1997, an outbreak occurred in Sarawak of Malaysia with 600 cases and over 30 children died. […] In 1998, there was an outbreak in Taiwan, affecting mainly children. […] There were 405 severe complications, and 78 children died. […] The total number of cases in that epidemic is estimated to have been 1.5 million.

• #70 Hand, foot, and mouth disease – Wikipedia

  https://en.wikipedia.org/wiki/Hand,_foot,_and_mouth_disease

  In 2008 an outbreak in China, beginning in March in Fuyang, Anhui, led to 25,000 infections, and 42 deaths, by May 13. […] Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008), Vietnam (2,300 cases, 11 deaths), Mongolia (1,600 cases), and Brunei (1053 cases from June-August 2008). […] In 2009 17 children died in an outbreak during March and April 2009 in China’s eastern Shandong Province, and 18 children died in the neighboring Henan Province. […] Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal. […] In 2010 in China, an outbreak occurred in southern China’s Guangxi Autonomous Region as well as Guangdong, Henan, Hebei, and Shandong provinces. […] Until March, 70,756 children were infected and 40 died from the disease.

• #71 Hand, foot, and mouth disease – Wikipedia

  https://en.wikipedia.org/wiki/Hand,_foot,_and_mouth_disease

  By June, the peak season for the disease, 537 had died. […] The World Health Organization reporting between January and October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June. […] There were 437 deaths, down from 2010 (537 deaths). […] In December 2011, the California Department of Public Health identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common. […] In 2012 in Alabama, United States there was an outbreak of an unusual type of the disease. […] It occurred in a season when it is not usually seen and affected teenagers and older adults. […] There were some hospitalizations due to the disease but no reported deaths. […] In 2012 in Cambodia, 52 of 59 reviewed cases of children reportedly dead due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD. […] HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China. […] In 2018, more than 50,000 cases occurred through a nationwide outbreak in Malaysia with two deaths also reported.

• #72 Hand, Foot, and Mouth Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431082/

  Hand, foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children but can also affect adults. […] This viral infection is not indigenous to 1 area in particular but occurs worldwide. Children (particularly those younger than 7 years of age) tend to be infected at a higher rate than adults, so you can see outbreaks in daycares, summer camps, or within the family. Large-scale surveillance from China demonstrated that more than 90% of HFMD cases occurred in children less than 5 years of age, mortality was around 0.03%, and that cases tended to occur more frequently during late spring and early summer. […] In 2021, French surveillance found a rapid increase in HFMD cases, with more than 3400 cases. Although more than 90% of sequenced cases were found to be linked to Enterovirus, atypical cases were found to be associated with Coxsackievirus A6 and A16. […] Coxsackievirus A6 remains the dominant cause of HFMD in the United States.

• #73 Eurosurveillance | Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam, 2018: preliminary report of an impending outbreak

  https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.46.1800590

  Since January 2018, over 53,000 hospitalisations and six deaths due to hand, foot and mouth disease (HFMD) have occurred across Vietnam with most cases from September onward. […] The re-emergence of C4 after causing a severe HFMD outbreak with 200 deaths in 2011-12 among susceptible young children raises concern of another impending severe outbreak.

• #74

  https://journals.lww.com/pidj/fulltext/2016/10000/the_epidemiology_of_hand,_foot_and_mouth_disease.3.aspx

  Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. […] There are nearly 25 years of literature from Asia that describes the epidemiology of HFMD, drawing on pediatric cohorts, national surveillance systems, outbreak investigations and clinical data. […] The objective of this paper is to provide a robust systematic review of the epidemiology of HFMD that informs public health policy making about HFMD epidemics. […] The literature is ambiguous about the importance of locations for transmission. […] Overall, the evidence points to both home and school environments contributing to transmission, but the relative importance of these venues remains murky. […] Despite the substantial number of papers on HFMD, this systematic review shows that many fundamental questions about EV-A71 and CV-A16 persist.

• #75 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  The burden of HFMD remains prevalent among young children in institutional settings. […] Given the health and social impact in the Western Pacific Region, China, Taiwan, and Singapore started developing EV71 vaccines for children under 5 years old. […] It remains a challenge to control HFMD outbreaks at a community or institutional level that are often caused by multiple Enterovirus strains. […] Past studies suggested that early implementation of outbreak management practices can be effective in minimising HFMD spread. […] The findings from this review derive mainly from studies in China which has a loose cross-border relationship with HKSAR regarding climate pattern, culture, and ethos. […] Timely notification of a clustered outbreak within 24 hours and implementation of isolation measures according to the CDC guidelines are crucial to minimise attack rate of HFMD within childcare facilities.

• #76

  https://he02.tci-thaijo.org/index.php/OSIR/article/view/263641

  In 2020, Surin Province had the highest incidence proportion of hand, foot, and mouth disease (HFMD) in Thailand, primarily concentrated in Mueang District. […] Numerous outbreaks occurred in kindergarten schools and child development centers despite the implementation of prevention and control measures. […] A cross-sectional study was conducted among 37 facilities that reported HFMD outbreaks. […] Most facilities with outbreak followed the recommendations and control measures issued by the Department of Disease Control; however, improper sanitation was observed in some facilities. […] Prevention and control measures should include promoting personal hygiene, using an appropriate concentration of disinfectant solution, training teachers about common communicable diseases, early screening for detection and isolation of sick children, and communication with parents about HFMD. […] Control measures during the COVID-19 outbreak reduced the transmission of hand, foot, and mouth disease.

• #77 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  Timely implementation of a control response is effective in minimising incidence and length of an outbreak in childcare facilities. […] The government should provide incentives for childcare facilities to train infection control specialists who can serve as the first contact, knowledge, and communication points, as well as facilitate exchange of information and provision of support across stakeholders during a communicable disease epidemic. […] In 2011, following the emergence of HFMD outbreaks throughout the Western Pacific Region, the HKSAR Government announced EV71 infection as one of the 47 statutorily notifiable communicable diseases under the Prevention and Control of Disease Ordinance. […] Despite efforts of the HKSAR Government and health education through public media over the years, institutional outbreaks of HFMD have continued to occur within childcare facilities during the summer and winter periods with approximately 780, 350, and 700 outbreaks in 2013, 2014, and 2015, respectively.

• #78 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  The burden of HFMD remains prevalent among young children in institutional settings. […] Given the health and social impact in the Western Pacific Region, China, Taiwan, and Singapore started developing EV71 vaccines for children under 5 years old. […] It remains a challenge to control HFMD outbreaks at a community or institutional level that are often caused by multiple Enterovirus strains. […] Past studies suggested that early implementation of outbreak management practices can be effective in minimising HFMD spread. […] The findings from this review derive mainly from studies in China which has a loose cross-border relationship with HKSAR regarding climate pattern, culture, and ethos. […] Timely notification of a clustered outbreak within 24 hours and implementation of isolation measures according to the CDC guidelines are crucial to minimise attack rate of HFMD within childcare facilities.

• #79 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  To achieve this, communication between stakeholders (childcare facilities, CHP, parents, and health care providers) about outbreak confirmation, risk assessment, and sentinel surveillance in the form of regular body checks should be enhanced by the provision of clear guidelines and an interactive platform.

• #80

  https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Hand-Foot-and-Mouth-Disease.aspx

  Infection leads to specific immunity against the particular virus but can be reinfected by a different virus from the enterovirus group. […] After an epidemic of HFMD in Sarawak in 1997 and Taiwan in 1998, a system of surveillance for the disease, based on notifications from child-care centres was implemented in April 1998. Singapore experienced an epidemic of HFMD in September-October 2000 during which 3790 cases were reported. The predominant virus was EV71. There were four EV71-related deaths in 2000 and three in 2001. Reporting the disease was made legally mandatory on October 1, 2000. The outbreak was finally interrupted by a swift coordinated inter-agency response that led to the closure of all preschools from 1 Oct 15 Oct. […] MOH monitors the regional EV 71-associated HFMD situation and tracks the types of enteroviruses circulating in the community through a sentinel surveillance system. […] MOH, together with MCYS and MOE, closely monitors the local disease incidence and trends and provides guidance to childcare centres and kindergartens to ensure that these institutions exercise a high level of vigilance in their management of HFMD.

• #81 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. […] Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. […] It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. […] At present, there is no specific pharmaceutical intervention for HFMD. […] Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.

• #82 Hand, Foot, and Mouth Disease (HFMD) – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/hand-foot-and-mouth-disease/

  The viruses that cause HFMD can be found worldwide. Young children are most at risk. Travelers are at increased risk, especially when visiting areas where many people are in proximity. Measures that can be taken to avoid getting infected include frequent handwashing, disinfection of contaminated surfaces with bleach, and washing soiled articles of clothing. The viruses are resistant to many disinfectants, so it is important to use chlorinated (bleach) or iodized disinfectants. During epidemics, the closure of schools or childcare facilities may be considered to reduce transmission, especially among young children. It is not necessary to restrict travel or trade.

• #83 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The criteria for diagnosing of HFMD, which are widely accepted at present, primarily rely on the patients epidemiological history, symptoms additional tests to determine the cause or presence of the disease. […] The incubation period of HFMD is mostly 2-10 days, with an average of 3-5 days. […] The prevention in patients with severe HFMD depends on the timely and accurate identification of danger signs in the disease progression. […] Human is usually considered to be the only reservoir of human EVs, and both cases and asymptomatic infections are the sources of HFMD infection. […] Currently, the fecal-oral transmission and contact are considered as the primary transmission routes of HFMD. […] As a common childhood infectious disease, HFMD primarily occurs in children under 5 years old, although HFMD has also been reported in adults.

• #84

  https://link.springer.com/article/10.1007/s10096-018-3206-x

  Vaccines able to confer protection against the most common aetiologic agents in a given country have been developed. […] However, simultaneous circulation of more than one causative virus and modification of the molecular epidemiology of infectious agents make preparations based on a single agent relatively inadequate. […] Vaccines with multiple components are a possible solution. […] However, several problems concerning their development must be solved before adequate prevention of severe cases of HFMD can be achieved.

• #85

  https://journals.lww.com/pidj/fulltext/2016/10000/the_epidemiology_of_hand,_foot_and_mouth_disease.3.aspx

  Studies on risk factors were rare, and we identified only 3 papers that describe risk factors for hygiene and contact patterns, making a meta-analysis of risk factors unfeasible. […] A recently developed EV-A71 vaccine has undergone phase 3 trials in China. […] To determine the cost-effectiveness of incorporating the vaccine in pediatric vaccination schedules, or of other interventions such as school closure or isolation, would require epidemiologic models that account for the protective effects of herd immunity. […] More research to assess risk factors and measure key epidemiologic parameters is needed.

• #86 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The urban area with high EV-A71 transmission in China initiated vaccination with inactivated EV-A71 vaccine, a dramatic decline in EV-A71-associated HFMD incidence was observed. […] The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] In addition to reducing the clustering of susceptible populations and enhancing individual protection, herd immunity through vaccination is more effective in reducing population susceptibility. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #87

  https://link.springer.com/article/10.1007/s10096-018-3206-x

  Vaccines able to confer protection against the most common aetiologic agents in a given country have been developed. […] However, simultaneous circulation of more than one causative virus and modification of the molecular epidemiology of infectious agents make preparations based on a single agent relatively inadequate. […] Vaccines with multiple components are a possible solution. […] However, several problems concerning their development must be solved before adequate prevention of severe cases of HFMD can be achieved.

• #88 Pathogen Spectrum of Hand, Foot, and Mouth Disease Based on Laboratory Surveillance — China, 2018

  https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2020.044

  A total of 116,290 probable and laboratory-confirmed HFMD cases were reported from 27 provincial-level CDCs in 2018. The number of laboratory-confirmed cases was 80,793 and the enterovirus detection positive rate was 69.5%. […] Other enterovirus serotypes were the predominant serotypes in both mild and severe cases in age groups aged under 5 years. […] A total of 5 laboratory-confirmed case fatalities were reported. Of the 5, 3 patients had been infected by EV-A71 and were in the age groups of 12-24 months. 2 patients had been infected by CV-A16 and were in the age groups of 6-11 months and 12-24 months. […] Therefore, further identification of other enterovirus serotypes is highly recommended for provincial CDCs, especially for severe HFMD cases. The testing of CV-A6 and CV-A10 should be included in routine HFMD surveillance and researches contributing to a multivalent vaccine for HFMD should be prioritized.

• #89 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  The burden of HFMD remains prevalent among young children in institutional settings. […] Given the health and social impact in the Western Pacific Region, China, Taiwan, and Singapore started developing EV71 vaccines for children under 5 years old. […] It remains a challenge to control HFMD outbreaks at a community or institutional level that are often caused by multiple Enterovirus strains. […] Past studies suggested that early implementation of outbreak management practices can be effective in minimising HFMD spread. […] The findings from this review derive mainly from studies in China which has a loose cross-border relationship with HKSAR regarding climate pattern, culture, and ethos. […] Timely notification of a clustered outbreak within 24 hours and implementation of isolation measures according to the CDC guidelines are crucial to minimise attack rate of HFMD within childcare facilities.

• #90 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  Additionally, we detected enteroviruses in a large amount of saliva samples collected routinely from childcare centres across Singapore, allowing us to identify subclinical infections. This amount of subclinical infections associated with symptomatic HFMD in childcare centres is rather alarming. It will be of interest to study the host and viral factors contributing to asymptomatic status to these individuals as well as, the long term effect of these subclinical enterovirus infection on children health, immunity and development. All in all, routine systematic surveillance programs will be essential in future to monitor and study these subclinical infections lurking in the background. […] In retrospect, our findings support that CV-A6 is increasingly gaining the spotlight as the most prevalent serotype responsible for causing HFMD in Singapore from the year 2013 to 2018. Such shift in seroprevalence from 2,000s could be due to the lack of herd immunity against CV-A6, making the infection highly susceptible. This is rather alarming as in some occasions CV-A6 is associated with post-symptomatic disease complications such as desquamation and onychomadesis.

• #91 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The urban area with high EV-A71 transmission in China initiated vaccination with inactivated EV-A71 vaccine, a dramatic decline in EV-A71-associated HFMD incidence was observed. […] The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] In addition to reducing the clustering of susceptible populations and enhancing individual protection, herd immunity through vaccination is more effective in reducing population susceptibility. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #92 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  CV-A6 remained as the dominant HFMD causative strain in Singapore. Silent subclinical enteroviral infections were detected and warrant further investigations. […] Hand, foot and mouth disease (HFMD) primarily affects children below the age of five and was one of the top 5 most contagious febrile viral illness of 2018 in Singapore. Infection with more than 20 genetically diverse viruses from the genus Enterovirusfamily Picornaviridae causes HFMD which consequently impedes vaccine and antiviral development despite half a century old endemic status in majority of Asia-Pacific region. Albeit serotype dominance of HFMD largely depending on temporal and geographical factors, underlying epidemiologic indices inflicting such paradigms are still not clearly understood. […] Above all, epidemiological surveillance is a paramount instrument in anticipating and minimising outbreaks. By understanding the circulating serotypes, genotypes and sub-genotypes along with their evolutions in paediatric patients and asymptomatic individuals, we aim to better appreciate HFMD transmission patterns, corresponding to their respective clinical outcomes which paints a holistic picture that captures HFMD causing human enterovirus epidemiology in Singapore.

• #93 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  Additionally, we detected enteroviruses in a large amount of saliva samples collected routinely from childcare centres across Singapore, allowing us to identify subclinical infections. This amount of subclinical infections associated with symptomatic HFMD in childcare centres is rather alarming. It will be of interest to study the host and viral factors contributing to asymptomatic status to these individuals as well as, the long term effect of these subclinical enterovirus infection on children health, immunity and development. All in all, routine systematic surveillance programs will be essential in future to monitor and study these subclinical infections lurking in the background. […] In retrospect, our findings support that CV-A6 is increasingly gaining the spotlight as the most prevalent serotype responsible for causing HFMD in Singapore from the year 2013 to 2018. Such shift in seroprevalence from 2,000s could be due to the lack of herd immunity against CV-A6, making the infection highly susceptible. This is rather alarming as in some occasions CV-A6 is associated with post-symptomatic disease complications such as desquamation and onychomadesis.

• #94

  https://journals.lww.com/pidj/fulltext/2016/10000/the_epidemiology_of_hand,_foot_and_mouth_disease.3.aspx

  Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. […] There are nearly 25 years of literature from Asia that describes the epidemiology of HFMD, drawing on pediatric cohorts, national surveillance systems, outbreak investigations and clinical data. […] The objective of this paper is to provide a robust systematic review of the epidemiology of HFMD that informs public health policy making about HFMD epidemics. […] The literature is ambiguous about the importance of locations for transmission. […] Overall, the evidence points to both home and school environments contributing to transmission, but the relative importance of these venues remains murky. […] Despite the substantial number of papers on HFMD, this systematic review shows that many fundamental questions about EV-A71 and CV-A16 persist.

• #95 Evolving pathogen trends and spatial–temporal dynamics of hand, foot, and mouth disease in Fengxian District, Shanghai (2009–2022) | Scientific Reports

  https://www.nature.com/articles/s41598-024-71389-0

  The findings indicate a distinct seasonal incidence of HFMD in Fengxian District. […] This study underscores the need for targeted public health education, enhanced surveillance, and proactive measures in childcare facilities to mitigate disease spread during peak seasons. […] Moreover, the evolving viral landscape warrants accelerated efforts in vaccine development against new strains to reduce HFMD incidence.

• #96 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  The urban area with high EV-A71 transmission in China initiated vaccination with inactivated EV-A71 vaccine, a dramatic decline in EV-A71-associated HFMD incidence was observed. […] The incidence of HFMD in urban residents, transportation hub cities, and economically developed areas compared to rural area, this is due to the higher population density and mobility in these areas. […] In addition to reducing the clustering of susceptible populations and enhancing individual protection, herd immunity through vaccination is more effective in reducing population susceptibility. […] In recent years, the increasing occurrence of multiple EV infections and novel patterns of recombinant EV infections in patients with HFMD highlights the need for more vigilant pathogen surveillance of HFMD, especially in regards to emerging and co-infected pathogens.

• #97 Severity and burden of hand, foot and mouth disease in Asia: a modelling study | BMJ Global Health

  https://gh.bmj.com/content/3/1/e000442

  Hand, foot and mouth disease (HFMD) affects millions of children across Asia annually, leading to an increase in implemented control policies such as surveillance, isolation and social distancing in affected jurisdictions. […] This includes serological and other data extracted through a systematic review of HFMD epidemiology previously published by the authors, and laboratory investigations and sentinel reports from Singapore’s surveillance system. […] The symptomatic case hospitalisation rate of HFMD is 6% (2.8%14.9%), of which 18.7% (6.7%31.5%) are expected to develop complications. […] Policies directed at HFMD should be re-evaluated based on this updated estimate of disease severity and burden. […] An outbreak in Malaysia between April and June 1997 in which 29 children died was a harbinger of fatal outbreaks that have continued to recent years (170 deaths in Vietnam in 2011 and 98 deaths in Cambodia in 2012).

• #98 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  CV-A6 remained as the dominant HFMD causative strain in Singapore. Silent subclinical enteroviral infections were detected and warrant further investigations. […] Hand, foot and mouth disease (HFMD) primarily affects children below the age of five and was one of the top 5 most contagious febrile viral illness of 2018 in Singapore. Infection with more than 20 genetically diverse viruses from the genus Enterovirusfamily Picornaviridae causes HFMD which consequently impedes vaccine and antiviral development despite half a century old endemic status in majority of Asia-Pacific region. Albeit serotype dominance of HFMD largely depending on temporal and geographical factors, underlying epidemiologic indices inflicting such paradigms are still not clearly understood. […] Above all, epidemiological surveillance is a paramount instrument in anticipating and minimising outbreaks. By understanding the circulating serotypes, genotypes and sub-genotypes along with their evolutions in paediatric patients and asymptomatic individuals, we aim to better appreciate HFMD transmission patterns, corresponding to their respective clinical outcomes which paints a holistic picture that captures HFMD causing human enterovirus epidemiology in Singapore.

• #99 Severity and burden of hand, foot and mouth disease in Asia: a modelling study | BMJ Global Health

  https://gh.bmj.com/content/3/1/e000442

  The parameters which describe the severity of HFMD are the proportions of individuals in one state who reach the next higher severity level. […] The infection rate model estimates the age-specific proportion of children who must be infected by the EV-A71 virus each year to reach the observed level of seroprevalence. […] The symptomatic case hospitalisation ratio is estimated to be 6% (2.8%14.9%). Among hospitalised cases, 18.7% (6.7%31.5%) develop CNS complications, of which 5.0% (2.9%7.4%) were fatal. Overall, the CFR for HFMD is estimated to be 52.3 (24.492.7) per 100000 symptomatic infections. […] The disease burden estimated using our approach is 96900 (40 600259 000) DALYs per annum in eight high-endemic countries in East and Southeast Asia.

• #100 Severity and burden of hand, foot and mouth disease in Asia: a modelling study | BMJ Global Health

  https://gh.bmj.com/content/3/1/e000442

  The parameters which describe the severity of HFMD are the proportions of individuals in one state who reach the next higher severity level. […] The infection rate model estimates the age-specific proportion of children who must be infected by the EV-A71 virus each year to reach the observed level of seroprevalence. […] The symptomatic case hospitalisation ratio is estimated to be 6% (2.8%14.9%). Among hospitalised cases, 18.7% (6.7%31.5%) develop CNS complications, of which 5.0% (2.9%7.4%) were fatal. Overall, the CFR for HFMD is estimated to be 52.3 (24.492.7) per 100000 symptomatic infections. […] The disease burden estimated using our approach is 96900 (40 600259 000) DALYs per annum in eight high-endemic countries in East and Southeast Asia.

• #101 Current status of hand-foot-and-mouth disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9951172/

  Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. […] Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. […] It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. […] At present, there is no specific pharmaceutical intervention for HFMD. […] Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.

• #102 Current status of hand-foot-and-mouth disease | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-023-00908-4

  Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. […] Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. […] It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. […] Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.

• #103 Severity and burden of hand, foot and mouth disease in Asia: a modelling study | BMJ Global Health

  https://gh.bmj.com/content/3/1/e000442

  The parameters which describe the severity of HFMD are the proportions of individuals in one state who reach the next higher severity level. […] The infection rate model estimates the age-specific proportion of children who must be infected by the EV-A71 virus each year to reach the observed level of seroprevalence. […] The symptomatic case hospitalisation ratio is estimated to be 6% (2.8%14.9%). Among hospitalised cases, 18.7% (6.7%31.5%) develop CNS complications, of which 5.0% (2.9%7.4%) were fatal. Overall, the CFR for HFMD is estimated to be 52.3 (24.492.7) per 100000 symptomatic infections. […] The disease burden estimated using our approach is 96900 (40 600259 000) DALYs per annum in eight high-endemic countries in East and Southeast Asia.

• #104 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 20132018 […] While hand, foot and mouth disease (HFMD) is primarily self-resolvingsoaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. […] We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. […] Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection.

• #105 JMIR Public Health and Surveillance – The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study

  https://publichealth.jmir.org/2024/1/e59446/

  Background: South Korea has implemented a hand, foot, and mouth disease (HFMD) surveillance system since 2009 to monitor incidence trends and identify disease burden. This nationwide surveillance involves a network of approximately 100 pediatric clinics that report all probable and confirmed HFMD cases. […] South Korea has had an HFMD surveillance system since 2009 to monitor incidence trends and identify the HFMD burden; it is provided by the Korea Disease Control and Prevention Agency (KDCA). […] It is important to evaluate the HFMD surveillance system as it provides data for key epidemiological findings, including seasonality and economic burden. […] Previous studies report a decline in HFMD notifications during the acute phase of the COVID-19 pandemic. […] This study aimed to review and systematically evaluate the HFMD surveillance system in South Korea from 2017 to 2022 based on the CDC surveillance evaluation guidelines.

• #106 An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013–2018 | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008885

  An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 20132018 […] While hand, foot and mouth disease (HFMD) is primarily self-resolvingsoaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. […] We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. […] Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection.

• #107 Severity and burden of hand, foot and mouth disease in Asia: a modelling study | BMJ Global Health

  https://gh.bmj.com/content/3/1/e000442

  Many affected countries, such as China, Japan and Singapore, adopted routine control measures akin to those from pandemic preparedness plans including surveillance, mandatory reporting, isolation, school closures and social distancing but optimal use of such interventions requires the disease burden of HFMD to be quantified so that the public health response can be calibrated accordingly. […] The main aetiological agents of HFMD are the human enterovirus A71 (EV-A71) and coxsackieviruses 10 and 16, with EV-A71 being associated with more severe outcomes. […] The severity of infection was classified into tiers which require different levels of care: (i) clinically apparent, or symptomatic, cases; (ii) hospitalisations; (iii) complications, or severe cases when the child displays neurological or cardiopulmonary complications; and (iv) fatal cases.

• #108 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. […] Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. […] This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. […] Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. […] Effective communication facilitates timely notification (within 24 hours) of clustered outbreaks to a local Center for Disease Control and Prevention.

• #109 JMIR Public Health and Surveillance – The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study

  https://publichealth.jmir.org/2024/1/e59446/

  Our study findings indicate that the completeness, sensitivity, and age-specific representativeness of HFMD surveillance in South Korea decreased to moderate levels from 2020 to 2021 but recovered in 2022. […] The notification data quality is important to enable public health authorities to respond in a timely and appropriate manner. […] The current Korean HFMD electronic surveillance system is mainly operated by web-based reporting records to track reporting at each sentinel site. […] We identified that the geological distribution of HFMD sentinels in South Korea was good during the study period. However, having more sentinels in underrepresented areas will enhance the local resolution of HFMD occurrence. […] In conclusion, the completeness, sensitivity, and age representativeness of the HFMD surveillance system were temporarily reduced during the acute period of the COVID-19 pandemic. Continuous evaluation of surveillance performance will provide robust and reliable data to support public health policy development.

• #110 Pathogen Spectrum of Hand, Foot, and Mouth Disease Based on Laboratory Surveillance — China, 2018

  https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2020.044

  A total of 116,290 probable and laboratory-confirmed HFMD cases were reported from 27 provincial-level CDCs in 2018. The number of laboratory-confirmed cases was 80,793 and the enterovirus detection positive rate was 69.5%. […] Other enterovirus serotypes were the predominant serotypes in both mild and severe cases in age groups aged under 5 years. […] A total of 5 laboratory-confirmed case fatalities were reported. Of the 5, 3 patients had been infected by EV-A71 and were in the age groups of 12-24 months. 2 patients had been infected by CV-A16 and were in the age groups of 6-11 months and 12-24 months. […] Therefore, further identification of other enterovirus serotypes is highly recommended for provincial CDCs, especially for severe HFMD cases. The testing of CV-A6 and CV-A10 should be included in routine HFMD surveillance and researches contributing to a multivalent vaccine for HFMD should be prioritized.

• #111 Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015 – Volume 24, Number 3—March 2018 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/24/3/17-1303_article

  According to the surveillance study by Huang and colleagues, which of the following statements about the clinical implications of the epidemiologic and virologic features of recurrent HFMD, using national surveillance data during 20082015 in mainland China, is correct? […] The burden of HFMD recurrence was likely overestimated in this study […] To protect against an HFMD epidemic, multivalent vaccines are needed, such as EV-A71 combined with CV-A16, CV-A6, and other prevalent circulating viruses causing HFMD.

• #112 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. […] Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. […] This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. […] Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. […] Effective communication facilitates timely notification (within 24 hours) of clustered outbreaks to a local Center for Disease Control and Prevention.

• #113 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  Timely implementation of a control response is effective in minimising incidence and length of an outbreak in childcare facilities. […] The government should provide incentives for childcare facilities to train infection control specialists who can serve as the first contact, knowledge, and communication points, as well as facilitate exchange of information and provision of support across stakeholders during a communicable disease epidemic. […] In 2011, following the emergence of HFMD outbreaks throughout the Western Pacific Region, the HKSAR Government announced EV71 infection as one of the 47 statutorily notifiable communicable diseases under the Prevention and Control of Disease Ordinance. […] Despite efforts of the HKSAR Government and health education through public media over the years, institutional outbreaks of HFMD have continued to occur within childcare facilities during the summer and winter periods with approximately 780, 350, and 700 outbreaks in 2013, 2014, and 2015, respectively.

• #114 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  The burden of HFMD remains prevalent among young children in institutional settings. […] Given the health and social impact in the Western Pacific Region, China, Taiwan, and Singapore started developing EV71 vaccines for children under 5 years old. […] It remains a challenge to control HFMD outbreaks at a community or institutional level that are often caused by multiple Enterovirus strains. […] Past studies suggested that early implementation of outbreak management practices can be effective in minimising HFMD spread. […] The findings from this review derive mainly from studies in China which has a loose cross-border relationship with HKSAR regarding climate pattern, culture, and ethos. […] Timely notification of a clustered outbreak within 24 hours and implementation of isolation measures according to the CDC guidelines are crucial to minimise attack rate of HFMD within childcare facilities.

• #115 Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review | HKMJ

  https://www.hkmj.org/abstracts/v23n2/177.htm

  The burden of HFMD remains prevalent among young children in institutional settings. […] Given the health and social impact in the Western Pacific Region, China, Taiwan, and Singapore started developing EV71 vaccines for children under 5 years old. […] It remains a challenge to control HFMD outbreaks at a community or institutional level that are often caused by multiple Enterovirus strains. […] Past studies suggested that early implementation of outbreak management practices can be effective in minimising HFMD spread. […] The findings from this review derive mainly from studies in China which has a loose cross-border relationship with HKSAR regarding climate pattern, culture, and ethos. […] Timely notification of a clustered outbreak within 24 hours and implementation of isolation measures according to the CDC guidelines are crucial to minimise attack rate of HFMD within childcare facilities.

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