Association of environmental factors and high HFMD occurrence in northern Thailand

Abstract

Background The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand. Methods A case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews. Results Two variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention. Conclusions The number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs.

Impact of the coronavirus disease 2019 interventions on the incidence of hand, foot, and mouth disease in mainland China

“…Kindergartens are common places for HFMD outbreaks. 24 , 25 , 26 HFMD pathogens can spread easily among children both in and out of classrooms through close contacts via contaminated hands, toiletries, personal products, toys, tableware, and beddings. 27 , 28 HFMD is highly infectious; some children can transmit the virus before the onset of symptoms, and infected patients can excrete the virus for a long period of time.…”

Molecular Epidemiological Study of Hand, Foot, and Mouth Disease in a Kindergarten-Based Setting in Bangkok, Thailand

“…HFMD is transmitted via direct and indirect contact with surfaces and objects contaminated by excretions from infected persons. Risk factors for HFMD in kindergartens and daycare centers are mainly environmental, sanitary, and hygienic [ 34 , 35 ]. A mathematic model of HFMD in Bangkok indicates that direct transmission from asymptomatic persons is an important factor [ 36 ].…”

Impact of the COVID-19 outbreak and interventions on hand, foot and mouth disease in Zhengzhou, China, 2014–2022: a retrospective study

“…In the Asia-Pacific region, including China, HFMD is a serious disease burden in children. And HFMD outbreaks are common in kindergartens and primary schools [ 24 , 25 ]. Children can readily contract HFMD pathogens both within and outside of the classroom by touching infected hands, personal items, toys, tableware, and bedding.…”