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The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis.
Pediatr Infect Dis J. 2016 10; 35(10):e285-300.PI

Abstract

CONTEXT

Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16).

OBJECTIVE

This study reports a systematic review of the epidemiology of HFMD in Asia.

DATA SOURCES

PubMed, Web of Science and Google Scholar were searched up to December 2014.

STUDY SELECTION

Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria.

DATA EXTRACTION

Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others.

RESULTS

HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis.

LIMITATIONS

Diversity of study designs complicates attempts to identify features of HFMD epidemiology.

CONCLUSIONS

Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps.

Authors+Show Affiliations

From the *Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; †Standard Analytics, New York, New York; ‡Rollins School of Public Health, Emory University, Atlanta, Georgia; §Duke-NUS Graduate Medical School, Singapore; ¶Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; ‖Nuffield Department of Medicine, University of Oxford, United Kingdom; and **Yale-NUS College, National University of Singapore, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27273688

Citation

Koh, Wee Ming, et al. "The Epidemiology of Hand, Foot and Mouth Disease in Asia: a Systematic Review and Analysis." The Pediatric Infectious Disease Journal, vol. 35, no. 10, 2016, pp. e285-300.
Koh WM, Bogich T, Siegel K, et al. The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J. 2016;35(10):e285-300.
Koh, W. M., Bogich, T., Siegel, K., Jin, J., Chong, E. Y., Tan, C. Y., Chen, M. I., Horby, P., & Cook, A. R. (2016). The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. The Pediatric Infectious Disease Journal, 35(10), e285-300. https://doi.org/10.1097/INF.0000000000001242
Koh WM, et al. The Epidemiology of Hand, Foot and Mouth Disease in Asia: a Systematic Review and Analysis. Pediatr Infect Dis J. 2016;35(10):e285-300. PubMed PMID: 27273688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. AU - Koh,Wee Ming, AU - Bogich,Tiffany, AU - Siegel,Karen, AU - Jin,Jing, AU - Chong,Elizabeth Y, AU - Tan,Chong Yew, AU - Chen,Mark Ic, AU - Horby,Peter, AU - Cook,Alex R, PY - 2016/6/9/entrez PY - 2016/6/9/pubmed PY - 2017/6/21/medline SP - e285 EP - 300 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 35 IS - 10 N2 - CONTEXT: Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). OBJECTIVE: This study reports a systematic review of the epidemiology of HFMD in Asia. DATA SOURCES: PubMed, Web of Science and Google Scholar were searched up to December 2014. STUDY SELECTION: Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria. DATA EXTRACTION: Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others. RESULTS: HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis. LIMITATIONS: Diversity of study designs complicates attempts to identify features of HFMD epidemiology. CONCLUSIONS: Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/27273688/full_citation L2 - https://doi.org/10.1097/INF.0000000000001242 DB - PRIME DP - Unbound Medicine ER -