Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study

Abstract

Background:Hand, foot, and mouth disease (HFMD) is caused mostly by Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India.Materials and Methods:A case detection system developed with 1) three private clinics in three districts; two at Howrah and one at Hooghly, 2) Pediatrics Department of two medical colleges in Kolkata, 3) 12 practioners of these three districts with 4) a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit.Results:A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49). Males were slightly higher than females (M:F - 21:17). Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93). Oral lesions were found in 33 (86.8%) cases.Conclusion:This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.

Circulation of multiple enterovirus serotypes causing hand, foot and mouth disease in India

“…Serotypic identification and classification of EV rely on virus isolation in cell culture. In India, the role of enteroviruses in causing HFMD is not very clear on account of lack of accurate diagnosis, as most of the cases reported earlier were diagnosed on the basis of clinical signs compatible with HFMD (Sarma et al, 2009). A single study conducted to investigate an outbreak of HFMD in Calicut, Kerala, identified association of EV-71 by an immunological approach (Sasidharan et al, 2005).…”

“…Investigations of two outbreaks of HFMD that occurred in the Kerala and West Bengal states of India in 2003 and 2007, respectively, have been reported (Sasidharan et al, 2005;Sarma et al, 2009). These investigations identified 119 cases of HFMD on the basis of clinical examination and serological tests.…”

Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review

“…3,59 Evidence available from other countries has derived mostly from community surveillance or outbreaks among wider population age-groups, without laboratory confirmation of EV71 as the causative strain, and were therefore excluded from this review. 7,44,58,[60][61][62][63][64][65] Recommendations for future outbreaks…”

Molecular Diagnosis of Enteroviruses Associated with Hand, Foot and Mouth Disease (HFMD)

“…In India, the role of enteroviruses in causing HFMD is not very clear on account of lack of accurate diagnosis, as most of the cases reported earlier have been diagnosed on the basis of clinical signs compatible with HFMD [3]. In the present study, use of sensitive molecular method, RT-PCR targeted against conserved and variable regions of the EV genome revealed the presence of significant EV RNA positivity [2].…”