Hand, foot, and mouth disease (HFMD) is a contagious childhood illness and annually affects millions of children aged less than 5 years across the Asia–Pacific region. HFMD transmission mainly occurs through direct contact (person-to-person) and indirect contact with contaminated surfaces and objects. Therefore, public health measures to reduce the spread of HFMD in kindergartens and daycare centers are essential. Based on the guidelines by the Department of Disease Control, a school closure policy for HFMD outbreaks wherein every school in Thailand must close when several HFMD classrooms (more than two cases in each classroom) are encountered within a week, was implemented, although without strong supporting evidence. We therefore conducted a prospective cohort study of children attending five kindergartens during 2019 and 2020. We used molecular genetic techniques to investigate the characteristics of the spreading patterns of HFMD in a school-based setting in Bangkok, Thailand. These analyses identified 22 index cases of HFMD (symptomatic infections) and 25 cases of enterovirus-positive asymptomatic contacts (24 students and one teacher). Enterovirus (EV) A71 was the most common enterovirus detected, and most of the infected persons (8/12) developed symptoms. Other enteroviruses included coxsackieviruses (CVs) A4, CV-A6, CV-A9, and CV-A10 as well as echovirus. The pattern of the spread of HFMD showed that 45% of the subsequent enteroviruses detected in each outbreak possessed the same serotype as the first index case. Moreover, we found a phylogenetic relationship among enteroviruses detected among contact and index cases in the same kindergarten. These findings confirm the benefit of molecular genetic assays to acquire accurate data to support school closure policies designed to control HFMD infections.
Arboviruses, particularly dengue virus (DENV), Zika virus (ZIKV), and Chikungunya virus (CHIKV), pose a growing threat to global public health. For disease burden estimation and disease control, seroprevalence studies are paramount. This study was performed to determine the prevalence of DENV, ZIKV, and CHIKV on healthy individuals aged from 1–55 years old in Bangphae district, Ratchaburi province, Thailand. Enzyme-linked immunosorbent assays (ELISAs) and rapid diagnostic tests (RDTs) were performed on archived samples from a dengue serological survey conducted from 2012–2015. All 2012 samples had been previously tested using an anti-DENV immunoglobulin (Ig)G ELISA, and 400 randomly selected samples stratified by age, sex, and residential area were assessed by an in-house anti-ZIKV IgG ELISA and a commercial anti-CHIKV IgG ELISA to determine virus-specific antibody levels. An RDT (Chembio DPP® ZCD IgM/IgG System) was also used to investigate the presence of antibodies against DENV, ZIKV, or CHIKV. The ELISA results indicate that the seroprevalences of DENV, ZIKV, and CHIKV were 84.3%, 58.0%, and 22.5%, respectively. The youngest age group had the lowest seroprevalence for all three arboviruses, and the seroprevalences for these viruses were progressively higher with increasing participant age. The DPP® IgG sensitivities, as compared with ELISAs, for DENV, ZIKV, and CHIKV were relatively low, only 43.92%, 25.86%, and 37.78%, respectively. The ELISA results indicate that 16% of the study population was seropositive for all three viruses. DENV had the highest seroprevalence. ZIKV and CHIKV were also circulating in Bangphae district, Ratchaburi province, Thailand. The DPP® ZCD rapid test is not sensitive enough for use in seroprevalence studies.
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