Abstract
BackgroundHand, foot and mouth disease (HFMD) has emerged as a major public health issue in Vietnam since 2003. We aimed to investigate the household transmission of HFMD and its causative viruses from 150 households in a high incidence province in Vietnam.MethodsA longitudinal study was conducted in patients presenting to the provincial hospital with a HFMD-like syndrome, along with their household members between April and August 2014 in Dong Thap Province. Each participant was followed up for 2 weeks. We enrolled 150 patients aged under 15 who were clinically diagnosed with HFMD in Dong Thap Hospital, 600 household members, and 581/600 household members completed the study. All participants were interviewed using a standard questionnaire. Throat swabs and blood samples were taken for molecular detection of viruses and assessment of neutralizing antibodies, respectively. Index cases were defined using a clinical case definition, household contact cases were defined using a similar definition applied to the 2 weeks before admission and 2 weeks after discharge of the index case. Characteristics of index cases, household contacts, the attack rate, serotype features and related factors of HFMD were reported.ResultAmong 150 index cases, 113 were laboratory confirmed: 90/150 were RT-PCR-positive, 101/142 had a ≥ 4-fold increase of neutralizing antibody against Enterovirus A71 (EV-A71), Coxsackievirus (CV) A6 or CV-A16 across the two samples collected. 80/150 (53%) were males, and 45/150 (30%) were under the age of 1. The predominant serotype was CV-A6, identified in 57/87 (65.5%) of the specimens. No deaths were reported. Among 581 household contacts, 148 were laboratory confirmed: 12/581 were RT-PCR-positive, 142/545 had a ≥ 4-fold increase of neutralizing antibodies against EV-A71, CV-A6 or CV-A16; 4 cases experienced HFMD in the past 4 weeks. Attack rate among household contacts was 148/581 (25.5%). In 7/12 (58%) instances, the index and secondary cases were infected with the same serotype. Having a relationship to index case was significantly associated with EV infection.ConclusionThe attack rate among household contacts was relatively high (25.5%) in this study and it seems justified to also consider the household setting as an additional target for intervention programs.
Highlights
Hand, foot and mouth disease (HFMD) has emerged as a major public health issue in Vietnam since 2003
The attack rate among household contacts was relatively high (25.5%) in this study and it seems justified to consider the household setting as an additional target for intervention programs
The median age was 1.5 years and there was a greater number of males. 113/150 (75%) of index cases were testpositive for EV infection by reverse transcription polymerase chain reaction (RT-PCR) or neutralizing antibodies, 23% of individuals initially exhibiting HFMD-like symptoms returned a negative test result (Table 2)
Summary
Foot and mouth disease (HFMD) has emerged as a major public health issue in Vietnam since 2003. Foot and mouth disease (HFMD) is an emerging, epidemic-prone infectious disease that mainly affects young children [1]. HFMD is caused by serotypes of Enterovirus A (EV-A), with EV-A71 and Coxsackieviruses (CV) A6, A10 and A16 being the most frequently detected [2, 3]. It typically manifests as a sudden onset of fever, accompanied by sores in and around the mouth and blisters on the hands and feet [4]. In terms of absolute numbers, China is the worst affected country in the world; in 2009 for instance, 1, 155,525 cases were recorded, including 13,810 severe cases and 353 fatal cases [10]
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