The Epidemiology of Hand, Foot and Mouth Disease in Asia

Abstract

Context:Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16).Objective:This study reports a systematic review of the epidemiology of HFMD in Asia.Data Sources:PubMed, Web of Science and Google Scholar were searched up to December 2014.Study Selection:Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria.Data Extraction:Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others.Results:HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis.Limitations:Diversity of study designs complicates attempts to identify features of HFMD epidemiology.Conclusions:Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps.

Factors associated with hand foot mouth disease among children in day care center, Chiang Rai, Thailand

“…This is similar with the meta analysis from the papers published in Asia which reported that age and being female were the major risk factors of HFMD [24]. Some studies [25][26][27] reported that age was the main risk factor for HFMD particularly age < 4 years old.…”

Immune responses against enterovirus A71 infection: Implications for vaccine success

“…EV‐A71 usually causes hand, foot, and mouth disease (HFMD) and herpangina in children younger than 5 years. Typical signs and symptoms of HFMD appear 3 to 7 days after exposure, such as fever, sore throat, mouth ulcers, and rashes on the hands and feet, as virus levels increase in blood (Figure ). Besides EV‐A71, coxsackievirus A16 (CV‐A16) and other enteroviruses including CV‐A4, A5, A6, and A10 are also associated with HFMD .…”

“…Most cases of HFMD and herpangina are mild and self‐limiting, and hospitalization is not required. Up to 71% of children can be asymptomatic …”

Prohibitin plays a critical role in Enterovirus 71 neuropathogenesis

“…Being a close relative of poliovirus, EV71 is deemed as an important neurotropic virus worldwide [1]. Since its first isolation in California in 1969, several major outbreaks have been reported in China, Singapore, Korea, and Japan [2][3][4][5]. Although the clinical manifestations are generally mild and self-limiting, including HFMD and herpangina, severe neurological complications have been consistently reported with EV71-associated infections, causing brainstem encephalitis, acute flaccid paralysis, pulmonary edema and cardiopulmonary failure [6,7].…”