Abstract
BackgroundCoxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention.MethodsAn HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases.ResultsThe outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836–47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9–100.0% and 100%).ConclusionThis HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.
Highlights
Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally
We performed a further investigation on this large-scale HFMD outbreak in this kindergarten and found that it was caused by CVA6 infection
According to the “Protocol of control practice for the clustered cases and outbreaks of hand foot and mouth disease” issued by the National Health and Family Planning Commission of China in 2012 [9], an HFMD outbreak was defined as ≥10 cases of HFMD occurring in a kindergarten or school within a week
Summary
Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. From 2012 onward, Coxsackievirus A6 (CVA6) has been reported as an emerging pathogen of the HFMD epidemic globally. In 2015, there were in total six HFMD outbreaks occurred in the kindergartens in Beijing. The number of cases ranged from 11 to 14 among the five of them, and remaining one had 56 cases. This outbreak occurred in a kindergarten in Shijingshan district in Beijing. There were 357 children and 51 school staffs in this kindergarten. We performed a further investigation on this large-scale HFMD outbreak in this kindergarten and found that it was caused by CVA6 infection
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