A five-year retrospective study on the epidemiology of hand, foot and mouth disease in Sabah, Malaysia

Abstract

Hand, foot, and mouth disease (HFMD) is endemic in Malaysia, with the number of cases increasing. Sabah has experienced several HFMD outbreaks, but information on the epidemiology and molecular characteristics of responsible viruses is scarce. In this study, data of 17,574 reports of HFMD cases in Sabah from 2015 to 2019 were extracted from a public health disease surveillance system and analyzed. Twenty-one swab samples from 13 children were collected from Beaufort, Sabah, during an outbreak in August 2018 for detection and serotyping of causative viruses by semi-nested reverse transcription-polymerase chain reaction (snRT-PCR) of the VP4–VP2 region and consensus degenerate hybrid oligonucleotide primer PCR of the VP1 region, respectively. Nucleotide sequencing and phylogenetic analysis were conducted by the neighbor-joining method. The average annual incidence of HFMD was 94.3 per 100,000 people, with the greatest yearly increase between 2017 and 2018. Swabs from six children were tested positive for enterovirus, of which five were positive for CVA16 and one for EV71. All CVA16 strains belonged to sub-genotype B1a, and the EV71 strain belonged to sub-genotype B5. Phylogenetic analyses indicate that enterovirus genotype shift might be responsible for the increasing trend of HFMD in Sabah, however, further study is needed.

Spatiotemporal cluster patterns of hand, foot, and mouth disease at the province level in mainland China, 2011–2018

“…However, the interrupted time series analysis results indicated that, after the introduction of the vaccine, the incidence of HFMD showed an upward trend, and increased faster than before in mainland China. The incidence of HFMD in Mainland China was 169.41 per 100,000 in 2018, which was only lower than the incidence in 2014 and 2016, higher than Thailand’s incidence rate of 102.51/100,000 [ 46 ] and Malaysia’s incidence rate of 138.6/100,000 [ 47 ]. So, the incidence of HFMD was still at a high level in mainland China in 2018.…”

“…September coincides with the end of summer and the beginning of autumn, so the temperature and humidity are still high. The second peak may be due to the opening of kindergarten in September to increase the contact between children, thereby increasing the possibility of cluster cases [ 19 , 47 , 59 , 60 ].…”

“…The climate of these provinces is characterized by short and mild winter, while summer is long, hot, and very humid. In addition to climatic factors, the high incidence in southern coastal provinces may also be due to the high population density, strong population mobility, developed economy, and more frequent communication and close contact between individuals, which led to a higher risk of spreading HFMD [ 47 , 60 , 68 – 70 ]. The cluster time ranged between April and October, which was consistent with the peak time of HFMD in mainland China [ 1 ].…”

Onychomadesis and Beau's Line Following Hand-Foot-and-Mouth Disease in a Seven-Year-Old Male

“…Patients with HFMD commonly present with fever and erythematous papulovesicular lesions over the palms, soles, and mouth [ 1 ]. A study published in Malaysia reported that the incidence of HFMD accounted for 94.3 per 100,000 people in 2017-2018 [ 2 ]. The standard treatment is symptomatic due to the low rate of sequelae incidence [ 1 ].…”

A retrospective analysis on incidence of hand, foot, and mouth disease in Kota Kinabalu, district of Sabah Malaysia

“…To date, studies in analysis on HFMD cases in Malaysia are scarce, particularly in Sabah. The impact and pattern of HFMD in Sabah is not well recognised even thought there are increasing of HFMD cases in Sabah [19], [20]. It is crucial to understand the epidemiology patterns and the associated risk factors of HFMD in developing effective intervention options.…”