Key result
In a localized outbreak of hand, foot, and mouth disease in Bangladesh, younger children (<5 years) were significantly more likely to present with moderate-to-high fever, painful oral ulcers, and painful/itchy rash compared to older children.
Why the study?
Hand, foot and mouth disease is common among children under 5 years, but localized outbreaks had not previously been reported from Bangladesh.
Cross-Sectional (n=143)
No
Clinical diagnosis of HFMD using WHO case definitions is feasible and useful in resource-constrained settings lacking virology laboratories.
Background: Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities. Methods: Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols. Results: The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children (<5 years) were more likely to suffer with moderate-to-high (38.5°C) fever (P<0.04), painful oral ulcers (P<0.03) and painful/itchy rash (P<0.01). Sex did not differ with other symptoms, but boys had less painful oral ulcers than girls (P<0.04). Fever (63%) and chicken-pox-like-rash (62%) was observed more in mid-October to mid-November than September to mid-October (P<0.01 and P<0.03, respectively). No differences in symptoms (fever, oral ulcers and extremity rash) were observed with precipitation, nor with ambient temperature. Children <5 years (85%) had quicker recovery (within 5 days) than those ≥5 years (69%), (P<0.04), with marginal differences in sex (P<0.05). Conclusions: Our findings highlight potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable, which is particularly applicable for resource-constrained countries lacking appropriate virology/essential laboratories. Since no specific treatment or effective vaccination is available for HFMD, supportive therapy and preventive measures remain the primary methods to circumvent disease-transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent-vaccine deem essential towards preventing HFMD.
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Khan et al. (2019) conducted a cross-sectional in Hand, foot and mouth disease (HFMD) (n=143). Hand, foot and mouth disease (HFMD) outbreak was evaluated on Clinical and epidemiological characteristics of HFMD. In a localized outbreak of hand, foot, and mouth disease in Bangladesh, younger children (<5 years) were significantly more likely to present with moderate-to-high fever, painful oral ulcers, and painful/itchy rash compared to older children.
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