Abstract
The first large outbreak of hand, foot, and mouth disease (HFMD) with severe complications primarily caused by enterovirus 71 was reported in Taiwan in 1998. Surveillance of HFMD to evaluate the spread of HFMD with and without infection control policy is needed. We developed a new dynamic epidemic Susceptible-Infected-Recovered (SIR) model to fit the surveillance data on containing valuable information on the severity of HFMD in order to accurately estimate the basic reproductive number (R 0) of HFMD. After fitting the empirical data, in conjunction with other relevant parameters extracted from the literature, the estimated transmission coefficients were close to 5 × 10-7 (per day) and the proportion of severe HFMD cases ranged between 0 and 0·0036 (per day). Taking into account the distribution of all parameters considered in our dynamic epidemic model, the R 0 computed was 1·37 (95% confidence interval 0·24-5·84), suggesting a higher likelihood of the spread of HFMD if no infection control policy is provided. The isolation strategy against the spread of HFMD not only delayed the epidemic peak with the delayed time ranging from 4 weeks for only 20% isolation to 47 weeks for 100% isolation but also reduced total number of HFMD cases with the percentage of reduction ranging from 1·3% for only 20% isolation to 13·3% for 100% isolation. The proposed model can also be flexible for evaluating the effectiveness of two other possible policies for containing HFMD, quarantine and vaccination (if the vaccine can be developed).
Highlights
Hand, foot, and mouth disease (HFMD) is, to a large extent, caused by coxsackievirus A16 (CVA16) and, to a lesser extent, associated with other serotypes such as A4, A5, A9, A10, B2, and B5 viruses as well as echovirus and enterovirus 71 (EV71) [1,2,3]
No 17, Hsu Chow Road, Taipei, Taiwan, 10055. (Email: chenlin@ntu.edu.tw) self-limiting but HFMD caused by EV71 may be more likely to result in severe complications such as acute flaccid paralysis, encephalitis, meningitis, myocarditis and pulmonary oedema
It is intractable to estimate the relevant parameters for deriving R0 using this traditional compartmental model. To cope with this problem, we developed a new modified SIR model by adding information on clinical symptomatic and severe cases to fit the empirical surveillance data in order to accurately estimate the parameters governing the evolution from susceptibility to infection, recovery, and the development of severe HFMD
Summary
Foot, and mouth disease (HFMD) is, to a large extent, caused by coxsackievirus A16 (CVA16) and, to a lesser extent, associated with other serotypes such as A4, A5, A9, A10, B2, and B5 viruses as well as echovirus and enterovirus 71 (EV71) [1,2,3]. The majority of diseases afflicting children are typically benign and self-limiting but HFMD caused by EV71 may be more likely to result in severe complications such as acute flaccid paralysis, encephalitis, meningitis, myocarditis and pulmonary oedema
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