Hand, Foot and Mouth Disease

Abstract

Background: There have been sporadic and periodic large-scale epidemics of hand, foot, and mouth disease (HFMD) with cases at risk for significant morbidity and mortality particularly in Southeast Asia since 1997 and in India since early 2003. Method: We retrospectively studied 403 cases recorded from 2009 to 2019 and reviewed relevant Indian literature published between 2004 and 2019 to understand clinical, epidemiological, and virological attributes of this long-lasting Indian epidemic. Result: There were 96.8% children and adolescents (M:F 1.6:1) aged 2 months to 18 years and 84% were aged <5 years. Adult family contacts comprised 3.2%. Only 12 sporadic cases occurred during 2009-2011 followed by increased number from 2012 to 2015 peaking with 30.8% cases in 2013 and declining slowly until the year 2019 with small resurge in 2018. The major peaks occurred during summers with small peaks in autumns. Literature review showed 3332 cases presenting between 2004 and 2019 across Indian states with similar epidemiological trends whereas serotyping identified Coxsackievirus A16 (CV A16) in 83%, Coxsackievirus A6 (CV A6) in 17%, Enterovirus 71 in 4.1%, and multiple strains in 11.7% samples, respectively. Conclusion: The overall features of this long-lasting HFMD epidemic; affecting children aged <5 years more often than adults, none or minimum neurological or pulmonary complications in few patients, peaks occurring during summer and autumn months, and identity of the pathogenic virus coincide with global trends. However, the continuous spread of the disease across the country appears in sync with pre-epidemic periods of China and Taiwan. It calls for a continuous surveillance and making HFMD a notifiable disease in India.

Hand, foot, and mouth disease (HFMD) in India: A review on clinical manifestations, molecular epidemiology, pathogenesis, and prevention

“…[ 27 ] These detected CV-A16 strains exhibited 97–99% sequence identity with the Japanese and Chinese strains, whereas CV-A6 strains revealed 98–99% identity with the reported strains from Finland, Taiwan, and China. [ 31 ] These observations are in good concordance with the previous reports from India indicating CV-A16 and CV-A6 as major contributors among the other EVs causing HFMD.…”

Hand Foot Mouth Disease During the SARS-CoV-2 Pandemic: A Multicentric Study

“…India has experienced a sudden resurgence of HFMD in the last six months, with the virus spreading to many cities of the country [4]. Between 2009 to 2019, the epidemiological map of India [5] reported only 38 sporadic cases of HFMD from Rajasthan, depicting a significantly lower incidence of HFMD than what we observed during the pandemic outbreak. Though, HFMD is a contagious virus typically affecting young children, it rarely involves adults [6].…”

Epidemiological and Clinical Profile of Hand, Foot, and Mouth Disease in Children in a Tertiary Care Center in Jammu

“…In India, over the last decade, major outbreaks were seen in the years 2004, 2007, 2012, and 2014, whereas the cases peaked in the years 2012 to 2015. In the union territory of Jammu and Kashmir in India, there was an outbreak of HFMD in May 2018, where 300 cases were reported [ 7 ]. The present study was also conducted in Jammu, in a tertiary care hospital, for a period of six months to see the current trend and clinical features along with constitutional symptoms seen in HFMD.…”