The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

Abstract

The incidence of hand, foot, and mouth disease (HFMD) is increasing over the years despite current prevention and control policies in Singapore. A retrospective case-control study was conducted among parents whose children attended childcare centres in Singapore to assess the epidemiological risk factors associated with HFMD among children below 7 years old. Parents of 363 children with HFMD (as cases) and 362 children without HFMD (as controls) were enrolled from 22 childcare centres. Data of potential risk factors were collected through a standardised self-administered questionnaire from parents which include demographics and hygiene practices. Multivariate analysis were adjusted for age group, parent's education level, mother's age, HFMD-infected siblings, and preschool admission period. Child's age between 1.5 and 4.9 years, child who had been in childcare for more than 1.9years, having HFMD-infected siblings, two or more children in a family, higher educated parents, parents who had HFMD episode previously, wash toys with soap once every two to three weeks, sanitise toys once every two to three weeks, out-sourced cleaner in childcare centre, no domestic helper at home and more than 22 children in a classroom were independent risk factors of HFMD. These evidence provide crucial implications to guide more effective prevention and control of HFMD in Singapore.

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

“… 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. 29 In a previous outbreak, HFMD rapidly spread across 10 out of 11 classrooms within 11 days before HFMD control measures were implemented.…”

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 ].…”

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

“…Children aged six years and below accounted for about 93% of the total case, with the highest incidence (29%) occurred among 1-year-old children as shown in Figure 3. This contagious illness is highly common in young children aged six years and below, as claimed in most of the previous studies [1], [8], [16], [27], [28]. The disease spreads among young children through close gatherings, such as in day care centres, nursery schools, and kindergartens [29].…”

“…Incidence of HFMD and percentage of severe HFMD cases were calculated for each category. Odd ratio of severe HFMD for each category was assessed using the logistic regression model shown in (1):…”

“…It is caused by a group of enteroviruses. The most common pathogenic agents include coxsackievirus A16 and enterovirus 71 (EV71) [1], [2]. HFMD can present as fever, a bullous rash on palms, soles of the foot, and mouth ulcer.…”