RISK FACTORS OF HAND, FOOT AND MOUTH DISEASE (HFMD) OUTBREAK CASES AMONG CHILDREN UNDER FIVE YEARS OLD IN NORTH EASTERN STATE OF MALAYSIA
Hand, foot and mouth disease (HFMD) outbreak is a contagious illness and typically occur in the children of less than five years old. The was a marked rise in the number of HFMD outbreak cases was observed in Kelantan, a north-eastern State of Malaysia in 2018. This study aimed to determine risk factors for HFMD outbreak cases to inform potential strategies for prevention and control to reduce the occurrence of outbreak in the population. The data of HFMD cases was collected from Communicable Disease Control Information System (CDCIS) e-Notifikasi, managed by the Disease Control Division, Ministry of Health Malaysia for 2018. Totally, 1026 HFMD data cases were retrieved in the descriptive study. Of the total cases, a comparative cross-sectional analysis was performed on 70 HFMD outbreak cases and 198 non-outbreak cases using simple random sampling. Multiple logistic regression test was done to identify factors associated with HFMD outbreak cases among the children aged under five years old. Home-care (aOR 0.008; 95% CI: 0.001, 0.067, p-value<0.001), attendance to the kindergarten (aOR 0.330; 95% CI: 0.114, 0.957, p-value=0.041) and warm season (aOR 0.154; 95% CI: 0.043, 0.557, p-value=0.004) were found to have a significant association to lower the risk for HFMD outbreak cases in the study. This study was able to identify few significant factors associated with the HFMD outbreak which should be considered by the stakeholders. Further research to evaluate the epidemiology of the HFMD outbreak in Malaysia are needed.
Esposito S, Principi N. Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2018; 37(3): 391-398.
Bian L, Wang Y, Yao X, Mao Q, Xu M, Liang Z. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Review of Anti-infective Therapy 2015; 13(9): 1061-1071.
Gui J, Liu Z, Zhang T et al. Epidemiological Characteristics and Spatial-Temporal Clusters of Hand, Foot, and Mouth Disease in Zhejiang Province, China, 2008-2012. PLOS ONE 2015; 10(9): e0139109.
Chua KB, Kasri AR. Hand foot and mouth disease due to enterovirus 71 in Malaysia. Virologica Sinica. [journal article] 2011; 26(4): 221.
Chan Y-F, Sam I-C, Wee K-L, Abubakar S. Enterovirus 71 in Malaysia: A decade later. Neurology Asia 2011; 16(1): 1-15.
Chen Y, Badaruddin H, Lee VJ, Cutter J, Cook AR. The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach. The American journal of tropical medicine and hygiene 2018; 99(6): 1625-1632.
Crabol Y, Pean P, Mey C et al. A prospective, comparative study of severe neurological and uncomplicated hand, foot and mouth forms of paediatric enterovirus 71 infections. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2017; 59: 69-76.
Inta C, Apidechkul T, Sittisarn S et al. Factors associated with hand foot mouth disease among children in day care center, Chiang Rai, Thailand. Asian Pacific J Trop Dis 2017; 7(7): 391-395.
Qiu J, Yan H, Cheng N et al. The Clinical and Epidemiological Study of Children with Hand, Foot, and Mouth Disease in Hunan, China from 2013 to 2017. Sci Rep 2019; 9(1): 11662.
Mao L-X, Wu B, Bao W-X et al. Epidemiology of hand, foot, and mouth disease and genotype characterization of Enterovirus 71 in Jiangsu, China. Journal of Clinical Virology 2010; 49(2): 100-104.
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 pediatrics 2018; 18(1): 277.
Samphutthanon R, Tripathi NK, Ninsawat S, Duboz R. Spatio-temporal distribution and hotspots of Hand, Foot and Mouth Disease (HFMD) in northern Thailand. Int J Environ Res Public Health 2013; 11(1): 312-336.
Upala P, Apidechkul T, Suttana W, Kullawong N, Tamornpark R, Inta C. Molecular epidemiology and clinical features of hand, foot and mouth disease in northern Thailand in 2016: a prospective cohort study. BMC Infect Dis 2018; 18(1): 630-630.
Communicable Disease Unit. HFMD Statistics of Kelantan 2018. Kota Bharu,: Kelantan Health Department 2019.
Kelantan Health Department. Kelantan Weekly Epid Review. Kota Bharu: Kelantan State Health Department 2019. 23-29 Disember 2018.
Suhaila J, Deni SM, Zin WZW, Jemain AA. Trends in Peninsular Malaysia Rainfall Data During the Southwest Monsoon and Northeast Monsoon Seasons: 1975–2004. Sains Malaysiana 2010; 39(4): 533–542.
MOH Malaysia. Case Definitions for Infectious Diseases In Malaysia. Putrajaya, Malaysia: MOH Malaysia 2017.
Xiaona W, Ying S, Changying L et al. A Case-Control Study to Identify Environmental Risk Factors for Hand, Foot, and Mouth Disease Outbreaks in Beijing. Jpn J Infect Dis 2014; 67(2): 95-99.
Mahadzar SAS, Abdul Rahman H. Knowledge, Attitude and Practice towards Hand, Foot and Mouth Disease (HFMD) Among Nursery Governesses in Klang Valley, Selangor. Malaysian J Med Health Sci 2019; 15(SP4): 40-47.
Zeng M, Pu D, Mo X et al. Children of rural-to-urban migrant workers in China are at a higher risk of contracting severe hand, foot and mouth disease and EV71 infection: a hospital-based study. Emerging Microbes & Infections 2013; 2(1): 1-6.
Wang XF, Lu J, Liu XX, Dai T. Epidemiological Features of Hand, Foot and Mouth Disease Outbreaks among Chinese Preschool Children: A Meta-analysis. Iranian journal of public health 2018; 47(9): 1234-1243.
Hii YL, Rocklöv J, Ng N. Short Term Effects of Weather on Hand, Foot and Mouth Disease. PLOS ONE 2011; 6(2): e16796.