Abstract
BackgroundOver the last decade, increases in the number of outbreaks of hand, foot and mouth disease (HFMD) have shifted the disease into the public health spotlight in China. Children under the age of five years are particularly susceptible, with fatalities recorded. However, estimating the burden of HFMD has been difficult to conduct to date.MethodsIn 2012, a cross-sectional survey of healthcare-seeking behaviour for HFMD was undertaken, using computer assisted telephone interviewing (CATI) technology. Sample of telephone numbers was obtained from the Beijing Immunization Information System. Respondents were parents or guardians of children under the age of five. Multiplier model was used to estimate the number of HFMD case, following the telephone survey of healthcare-seeking behavior. The number of laboratory-confirmed cases was also estimated based on the monthly positive rate of each subtype of virus causing HFMD. The age-specific case fatality rate (CFR) was calculated based on the ratio of reported deaths to the estimated number of cases.ResultsFor children under five, the consultation rate of parent-defined cases was estimated at 77.8% ((95% CI = [75.2, 80.4]). Parents or legal guardians of children aged between two and four years were more likely to seek healthcare than those of children aged less than two years. For children under the age of five, we estimated that there were 40,165 (95% CI = [38,471, 41,974]) HFMD cases, with an incidence rate of 5.6%, and 22,166 (95% CI = [21,150, 23,295]) laboratory-confirmed cases in Beijing during 2012. The overall CFR was estimated at 10 deaths per 100,000 cases, while for children aged less than two years it was 15.6 deaths per 100,000 cases.ConclusionsGiven the public health impact of HFMD in China, control measures need to be prioritized for children < 2 years, due to the higher CFR in this age group. Sentinel surveillance approaches could be used to monitor trends and the impact of control measures.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-437) contains supplementary material, which is available to authorized users.
Highlights
Over the last decade, increases in the number of outbreaks of hand, foot and mouth disease (HFMD) have shifted the disease into the public health spotlight in China
Of the children whose parents participated in our survey, 53.2% were male, 47.6% were under the age of 2 years, most of who were under kindergarten age (2–6 years of age)
162/746 cases were diagnosed as probable HFMD cases by a physician
Summary
Increases in the number of outbreaks of hand, foot and mouth disease (HFMD) have shifted the disease into the public health spotlight in China. Foot, and mouth disease (HFMD) is a common illness caused by viruses that belong to the enterovirus genus (group). Enterovirus 71(EV71) and coxsackievirus A16 (CoxA16) are the major causes for current HFMD cases in China. There are limited studies examining the healthcare seeking behaviour for HFMD. Due to a lack of systematic assessment of healthcare usage, the true burden of HFMD in Beijing is unknown. Our study aimed to quantify the healthcare seeking behavior of infants and children under the age of five years, and to use this data to estimate the true burden of HFMD in Beijing
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