that countries collect baseline data to inform risk assessments and facilitate earlier
interventions.
Given the endemicity of this common childhood illness, it is unnecessary to detect and
report each case of HFMD. Rather, the focus should be on the detection of events that
indicate an outbreak situation; clusters; serious disease manifestations; or deaths.
Data on rates of asymptomatic or subclinical infections are limited. A study conducted
in Singapore found that only one out of 124 (0.8%) samples from children aged 1-23
months had anti-EV71 antibodies. In children age 2-5 years the seropositive rate
increased by 12% per year, suggesting that most infections occur in preschool-aged
children (2).
Seroepidemiological studies in Taiwan (China) show an inverse relationship between
pre-epidemic seroprevalence and severe disease mortality, suggesting age-related
disease susceptibility or a protective effect from specific antibodies (3). Knowing the preepidemic
seroprevalence of EV71 could help in determining the risk factors associated
with infection, severe disease and mortality during epidemics. Such information is
also important in identifying and examining the cost-effectiveness of appropriate local
intervention measures for the prevention and control of HFMD.
Different enteroviral species responsible for HFMD circulate in communities. At times
of outbreaks, specific virus types (such as CA16 or EV71) will dominate. While EV71 has
been associated with more severe disease outcomes, as yet there is a lack of association
between specific genogroups of EV71 and the severity of clinical outcomes. Monitoring
changes at the subgenotype level for EV71 is therefore important for establishing
potential severity links, for vaccine development and for detecting evidence of crossprotection
and cross-antigenicity (4-7).
(2) Conducting information and education campaigns on good
hygiene and basic sanitation
National strategies on health education and the promotion of individual and public health
behaviours, developed jointly by ministries of health and education in collaboration
with relevant professional bodies, such as infection control societies, can provide a
framework that is appropriate to individual country and cultural needs. Education
campaigns directed at reducing the spread of disease, particularly in high-risk age
groups, include disseminating information on good personal hygiene habits, such as
frequent hand-washing and avoiding thumb-sucking and nail-chewing.
Using local health promotion boards to disseminate information, advertisements and
resources may assist in filling gaps in parents’ understanding of HFMD and its control.
It can also encourage the general public to exercise greater social responsibility and take
stronger ownership of hygiene and health issues in the child-care/pre-school setting