Widespread Hand, Foot, and Mouth Disease Outbreaks: Interventions and Control Measures, Surin Province, 2020

In 2020, Surin Province had the highest incidence proportion of hand, foot, and mouth disease (HFMD) in Thailand, primarily concentrated in Mueang District. Numerous outbreaks occurred in kindergarten schools and child development centers despite the implementation of prevention and control measures. This study aimed to evaluate these interventions using observation and interviews and assess associated factors for the prolonged outbreaks. A cross-sectional study was conducted among 37 facilities that reported HFMD outbreaks. Linear regression analysis was performed to assess the association between factors and the duration of the outbreak. There were 369 confirmed HFMD cases. The attack rate in child development centers was 11.6%; in kindergarten schools was 5.1%. Most facilities with outbreak followed the recommendations and control measures issued by the Department of Disease Control; however, improper sanitation was observed in some facilities. A high student-toilet ratio (coefficient 0.64 days, [95% CI 0.11–1.17]) and a high student-janitor ratio (coefficient 0.12 days, [95% CI 0.07-0.17]) were associated with a longer outbreak duration. Prevention and control measures should include promoting personal hygiene, using an appropriate concentration of disinfectant solution, training teachers about common communicable diseases, early screening for detection and isolation of sick children, and communication with parents about HFMD.