Key result
Hand-foot-and-mouth disease in children under 5 is linked to more severe fever, ulcers, and rash.
Cross-Sectional (n=143)
No
p-value: p=<0.04
HFMD can be diagnosed based on clinical parameters in resource-constrained settings lacking virology laboratory facilities.
May support age-specific symptom monitoring in young children with HFMD; hypothesis-generating for clinical diagnosis in resource-limited settings.
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 gross 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. Age did not differ with sex (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 the potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable. It is particularly applicable for resource-constrained countries who lack appropriate virology/essential laboratory equipment. Since no specific treatment or effective vaccination is available for this disease, supportive therapy and preventive measures remain the primary methods to circumvent transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent vaccine is deemed essential towards preventing HFMD.
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Khan et al. (2018) conducted a cross-sectional in Hand, foot and mouth disease (HFMD) (n=143). Age < 5 years vs. Age ≥ 5 years was evaluated on Moderate-to-high fever (≥38.5°C) (p=<0.04). Younger children (<5 years) with hand, foot and mouth disease were significantly more likely to experience moderate-to-high fever, painful oral ulcers, and painful itchy rash compared to older children.
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