Estimating the number of hand, foot and mouth disease amongst children aged under-five in Beijing during 2012, based on a telephone survey of healthcare seeking behavior

Abstract

BackgroundOver the last decade, increases in the number of outbreaks of hand, foot and mouth disease (HFMD) have shifted the disease into the public health spotlight in China. Children under the age of five years are particularly susceptible, with fatalities recorded. However, estimating the burden of HFMD has been difficult to conduct to date.MethodsIn 2012, a cross-sectional survey of healthcare-seeking behaviour for HFMD was undertaken, using computer assisted telephone interviewing (CATI) technology. Sample of telephone numbers was obtained from the Beijing Immunization Information System. Respondents were parents or guardians of children under the age of five. Multiplier model was used to estimate the number of HFMD case, following the telephone survey of healthcare-seeking behavior. The number of laboratory-confirmed cases was also estimated based on the monthly positive rate of each subtype of virus causing HFMD. The age-specific case fatality rate (CFR) was calculated based on the ratio of reported deaths to the estimated number of cases.ResultsFor children under five, the consultation rate of parent-defined cases was estimated at 77.8% ((95% CI = [75.2, 80.4]). Parents or legal guardians of children aged between two and four years were more likely to seek healthcare than those of children aged less than two years. For children under the age of five, we estimated that there were 40,165 (95% CI = [38,471, 41,974]) HFMD cases, with an incidence rate of 5.6%, and 22,166 (95% CI = [21,150, 23,295]) laboratory-confirmed cases in Beijing during 2012. The overall CFR was estimated at 10 deaths per 100,000 cases, while for children aged less than two years it was 15.6 deaths per 100,000 cases.ConclusionsGiven the public health impact of HFMD in China, control measures need to be prioritized for children < 2 years, due to the higher CFR in this age group. Sentinel surveillance approaches could be used to monitor trends and the impact of control measures.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-437) contains supplementary material, which is available to authorized users.

The Epidemiology of Hand, Foot and Mouth Disease in Asia

“…The extracted data on Southwest China, 15,21 South China, 2,15,22,23 Hong Kong 24,25 and Taiwan [26][27][28] show that outbreaks typically happen in late spring and fall. No distinct pattern is obvious for tropical regions as seen from data in Thailand, [29][30][31] Vietnam, 32,33 Malaysia 34 and Singapore, [35][36][37][38] where outbreaks occur sporadically throughout the year, although models have been developed for Singapore (≈1° north) that show a positive statistical relationship between maximum daily temperature above 32°C with HFMD incidence in the subsequent 1-2 weeks. 37 To assess how general the relationship between climate and transmissibility of HFMD was, we took incidence data from Tokyo, Hong Kong, Taiwan and Singapore (Fig.…”

“…The earliest recorded cases of HFMD in Asia are from Japan (1967), 30 Singapore (1970), 31 Taiwan (1980) 32 and Shanghai, China (1981). 33 Since then, outbreaks have been reported in many parts of Asia, including mainland China, [12][13][14][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] Korea, [53][54][55] Japan, [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] Taiwan, 6,69,[71][72][73]…”

Estimated incidence and number of outpatient visits for seasonal influenza in 2015–2016 in Beijing, China

“…A multiplier model approach was previously used to estimate the disease burden of pandemic A(H1N1) pdm09 virus infection, hand, foot and mouth disease, and group A streptococcal pharyngitis in China [16][17][18]. In this study, we used the same model to estimate the burden of seasonal influenza (all symptomatic and asymptomatic cases whether seeking healthcare or not) by age groups in the 2015-2016 season in Beijing, China.…”

Enterovirus A71 vaccine effectiveness in preventing enterovirus A71 infection among medically-attended hand, foot, and mouth disease cases, Beijing, China

“…In 2008, probable HFMD cases began to be reported in the electronic National Notifiable Infectious Diseases Reporting Information System (NNIDRIS), 25 capturing demographic information, date of symptoms onset, date of diagnosis, date of death (if applicable), disease severity, and clinical symptoms. 26 In HFMD virological surveillance, trained clinicians collected specimens from probable HFMD cases visiting outpatient departments of 29 sentinel hospitals in 16 districts of Beijing. Throat and/or rectal swabs were collected from probable HFMD cases sequentially, starting on the first day of each month until at least 5 mild probable HFMD cases were sampled per hospital.…”

“…In addition to the throat or rectal swabs we obtained, fecal samples, vesicular fluid, and cerebrospinal fluid sampleswere collected from all the probable HFMD cases that met the definition of being severe or fatal HFMD cases, when possible. 7,26 EV-A71, CV-A16 and CV-A6have been routinely tested for in Beijingsince 2013. A probable HFMD case was defined as a person clinically diagnosed with HFMD, with a papular or vesicular rash on the hands, feet, mouth, or buttocks, with or without fever.Probable HFMD cases with Note: EV-A71: enterovirus A71.HFMD: hand, foot, and mouth disease.…”