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An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015.
BMC Pediatr. 2018 08 21; 18(1):277.BPed

Abstract

BACKGROUND

Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention.

METHODS

An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases.

RESULTS

The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836-47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9-100.0% and 100%).

CONCLUSION

This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China. Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China. bjcdcxm@126.com.Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China. heyanlb2014@163.com.

Pub Type(s)

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

Language

eng

PubMed ID

30131060

Citation

Li, Jie, et al. "An Outbreak of Coxsackievirus A6-associated Hand, Foot, and Mouth Disease in a Kindergarten in Beijing in 2015." BMC Pediatrics, vol. 18, no. 1, 2018, p. 277.
Li J, Zhu R, Huo D, et al. An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015. BMC Pediatr. 2018;18(1):277.
Li, J., Zhu, R., Huo, D., Du, Y., Yan, Y., Liang, Z., Luo, Y., Yang, Y., Jia, L., Chen, L., Wang, Q., & He, Y. (2018). An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015. BMC Pediatrics, 18(1), 277. https://doi.org/10.1186/s12887-018-1253-1
Li J, et al. An Outbreak of Coxsackievirus A6-associated Hand, Foot, and Mouth Disease in a Kindergarten in Beijing in 2015. BMC Pediatr. 2018 08 21;18(1):277. PubMed PMID: 30131060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015. AU - Li,Jie, AU - Zhu,Rong, AU - Huo,Da, AU - Du,Yiwei, AU - Yan,Yuxiang, AU - Liang,Zhichao, AU - Luo,Yanxia, AU - Yang,Yang, AU - Jia,Lei, AU - Chen,Lijuan, AU - Wang,Quanyi, AU - He,Yan, Y1 - 2018/08/21/ PY - 2018/03/25/received PY - 2018/08/13/accepted PY - 2018/8/23/entrez PY - 2018/8/23/pubmed PY - 2019/8/14/medline KW - Coxsackievirus A6 KW - Disease outbreak KW - Hand foot and mouth disease KW - Onychomadesis SP - 277 EP - 277 JF - BMC pediatrics JO - BMC Pediatr VL - 18 IS - 1 N2 - BACKGROUND: Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention. METHODS: An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases. RESULTS: The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836-47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9-100.0% and 100%). CONCLUSION: This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents. SN - 1471-2431 UR - https://www.unboundmedicine.com/medline/citation/30131060/An_outbreak_of_Coxsackievirus_A6_associated_hand_foot_and_mouth_disease_in_a_kindergarten_in_Beijing_in_2015_ L2 - https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-1253-1 DB - PRIME DP - Unbound Medicine ER -