7) providing an administrative framework to national agencies/bodies to implement
prevention and control options, including the:
- delegation of powers to act to key ministries, including through supportive
legislation;
- development of mechanisms to establish and support interagency/ intersectoral
collaboration; and
- strengthening of coordinated risk communication; and
8) monitoring and evaluation.
It is highly likely that a combination of interventions will be needed to effectively
reduce transmission. Each of these measures is described in more detail below, while
the benefits and limitations of specific approaches are summarized at Appendix 2.
Outbreak definition: Although the criteria used to define an outbreak of HFMD varies
from country to country, it is important to note that such definitions frequently act as
triggers for the implementation of specific public health measures. A commonly used
threshold for an outbreak is when the number of cases reaches two standard deviations
(2SD) above the normal baseline. A cluster is when two or more cases occur within an
institution, indicating transmission within a cohort.
For example, in Malaysia;
• An outbreak is defined as two or more cases occurring within one locality.
• The epidemic threshold is the occurrence of cases 2SD above the normal rate.
• Sporadic cases are defined as single cases in the absence of previous known close
contact with another case.