Skip to main content
×
×
Home

Important roles of public playgrounds in the transmission of hand, foot, and mouth disease

  • Y. H. XIE (a1) (a2) (a3), V. CHONGSUVIVATWONG (a2), Y. TAN (a1), Zh-Zh. TANG (a1), V. SORNSRIVICHAI (a2) and E. B. McNEIL (a2)...
Summary

Intra-home and kindergarten transmissions were the reported major modes of hand, foot, and mouth disease (HFMD) transmission in preschool children. However, infection at home is not common and 65–80% of cases do not attend preschool. We conducted a matched case-control study to explore the role of public playgrounds in the transmission of HFMD in addition to direct and indirect exposure to HFMD patients. We used 156 hospital source cases and 156 community source controls. Univariate analysis was followed by conditional logistic regression with attributable fraction computed. Adjusted odds ratios were 11·70 [95% confidence interval (CI) 1·26–109·40] for having HFMD cases in the same class, 14·19 (95% CI 3·55–56·74) for having HFMD cases within the 20 nearest neighbourhoods, 6·03 (95% CI 2·84–12·80) for exposure to public playgrounds, 2·13 (95% CI 1·05–4·32) for finger sucking and 0·29 (95% CI 0·11–0·78) for hand washing with soap before meals. The attributable fractions for the first four risk factors were 6·4%, 20·9%, 57·2% and 27·5%, respectively, while the population prevented fraction for hand washing with soap before meals was 18·7%. Based on our findings, hand washing with soap should be advocated. Health education could include topics which underline the precautions which need to be taken and the advice given regarding avoiding the use of public playgrounds during epidemic periods, especially when children have been getting sick.

Copyright
Corresponding author
* Author for correspondence: Dr V. Chongsuvivatwong, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand. (Email: cvirasak@medicine.psu.ac.th)
References
Hide All
1. Ishimaru, Y, et al. Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system. Archives of Disease in Childhood 1980; 55: 583588.
2. Schmidt, NJ, Lennette, EH, Ho, HH. An apparently new enterovirus isolated from patients with disease of the central nervous system. Journal of Infectious Diseases 1974; 129: 304309.
3. Gilbert, GL, et al. Outbreak of enterovirus 71 infection in Victoria, Australia, with a high incidence of neurologic involvement. Pediatric Infectious Disease Journal 1988; 7: 484488.
4. Chang, LY, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics 2002; 109: e88.
5. Goh, KT, et al. An outbreak of hand, foot, and mouth disease in Singapore. Bulletin of World Health Organization 1982; 60: 965969.
6. Brown, GC, O'Leary, TP. Fluorescent antibody responses of cases and contacts of hand, foot, and mouth disease. Infection and Immunity 1974; 9: 10981101.
7. Ooi, EE, et al. Seroepidemiology of human enterovirus 71, Singapore. Emerging Infectious Diseases 2002; 8: 995997.
8. World Health Organisation. Coxsackievirus A16. Weekly Epidemiological Record 1981; 56: 3940.
9. Ma, E, et al. Effects of public health interventions in reducing transmission of hand, foot, and mouth disease. Pediatric Infectious Disease Journal 2011; 30: 432435.
10. Ang, LW, et al. Epidemiology and control of hand, foot and mouth disease in Singapore, 2001–2007. Annals Academy of Medicine Singapore 2009; 38: 106112.
11. Kim, KH. Enterovirus 71 infection: an experience in Korea, 2009. Korean Journal of Pediatrics 2010; 53: 616622.
12. Deng, T, et al. Spatial-temporal clusters and risk factors of hand, foot, and mouth disease at the district level in Guangdong Province, China. PLoS ONE 2013; 8: e56943.
13. Liu, Y, et al. Detecting spatial-temporal clusters of HFMD from 2007 to 2011 in Shandong Province, China. PLoS ONE 2013; 8: e63447.
14. Ruan, F, et al. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics 2011; 127: e898e904.
15. Park, SK, et al. Transmission of seasonal outbreak of childhood enteroviral aseptic meningitis and hand-foot-mouth disease. Journal of Korean Medical Science 2010; 25: 677683.
16. Xu, WT, Gao, L, Zhang, Y. A case-control study on the risk factors of hand, foot and mouth disease in children in Tianjin. Chinese Journal of Epidemiology 2009; 30: 100101.
17. Wu, X, Fu, Z, Deng, G. Epidemiolgical characterisitc of HFMD from 2008 to 2011 in Guangxi, China. Chinese Primary Health Care 2013; 27: 6566.
18. Parker, RA, Bregman, DJ. Sample size for individually matched case-control studies. Biometrics 1986; 42: 919926.
19. The Ministry of Health of China. Hand, foot and mouth disease prevention and control guideline, China (2009 version). 2009 (http://www.gov.cn/gzdt/2009-06/04/content_1332078.htm) Accessed 4 June 2009.
20. Scott, A. Rao-Scott corrections and their impact. Section on survey research methods, 2013, pp. 35143518. (http://www.amstat.org/sections/srms/proceedings/y2007/Files/JSM2007-000874.pdf) Accessed 24 July 2013.
21. Bruzzi, P, et al. Estimating the population attributable risk for multiple risk factors using case-control data. American Journal of Epidemiology 1985; 122: 904914.
22. Guo, RN, Zhang, ZM, Yang, F. Study on the characteristics and risk factors for hand-foot-mouth disease in Guangdong province. Chinese Journal of Epidemiology 2009; 30: 530531.
23. World Health Organization. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD), 2011 (http://www.wpro.who.int/publications/docs/GuidancefortheclinicalmanagementofHFMD.pdf) Accessed 6 January 2013
24. Han, J, et al. Long persistence of EV71 specific nucleotides in respiratory and feces samples of the patients with hand foot mouth disease after recovery. BMC Infectious Diseases 2010; 10: 178.
25. Li, J, et al. Excretion of enterovirus 71 in persons infected with hand, foot and mouth disease. Virology Journal 2013; 10: 31.
26. Guangxi Meteorological Service Centre. Overview of climate in Guangxi (http://www.gx121.com/gx_climate_info.asp) Accessed 6 June 2013.
27. Onozuka, D, Hashizume, M. The influence of temperature and humidity on the incidence of hand, foot, and mouth disease in Japan. Science of the Total Environment 2011; 410–411: 119125.
28. Hii, YL, Rocklov, J, Ng, N. Short term effects of weather on hand, foot and mouth disease. PLoS ONE 2011; 6: e16796.
29. Ma, E, et al. Is hand, foot and mouth disease associated with meteorological parameters? Epidemiology and Infection 2010; 138: 17791788.
30. Pirtle, EC, Beran, GW. Virus survival in the environment. Revue Scientifique et Technique 1991; 10: 733748.
31. Bosch, A, Pinto, RM, Abad, FX. Survival and transport of enteric viruses in the environment. In: Goyal, SM, ed. Viruses in Food. Springer: New York, 2006, pp. 151187.
32. Savolainen-Kopra, C, et al. Single treatment with ethanol hand rub is ineffective against human rhinovirus-hand washing with soap and water removes the virus efficiently. Journal of Medical Virology 2012; 84: 543547.
33. Ejemot, RI, et al. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008; 1: 8-11.
34. Curtis, V, Cairncross, S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infectious Diseases 2003; 3: 275281.
35. Toshima, Y, et al. Observation of everyday hand-washing behavior of Japanese, and effects of antibacterial soap. International Journal of Food Microbiology 2001; 68: 8391.
36. Farsi, NM, Salama, FS. Sucking habits in Saudi children: prevalence, contributing factors and effects on the primary dentition. Pediatric Dentistry 1997; 19: 2833.
37. Fukuta, O, et al. Damage to the primary dentition resulting from thumb and finger (digit) sucking. American Society of Dentistry for Children 1996; 63: 403407.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 9
Total number of PDF views: 100 *
Loading metrics...

Abstract views

Total abstract views: 558 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st September 2018. This data will be updated every 24 hours.