Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014–2015

• DOI: 10.3201/eid2211.160590
• Publication Date: 2016-09-30T16:06:02Z
• Authors: Audrey Mirand; François Vié le Sage; Bruno Pereira; Robert Cohen; Corinne Levy; Christine Archimbaud; Hélène Peigue-Laf...; Jean-Luc Bailly; Cécile Henquell
• Keywords: Male; 0301 basic medicine; Adolescent; foot and mouth disease; sentinel surveillance; ambulatory; Infectious and parasitic diseases; RC109-216; Serogroup; History, 21st Century; human coxsackievirus infections; Disease Outbreaks; 03 medical and health sciences; [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases; Humans; Prospective Studies; Child; Phylogeny; [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases; [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics; Research; R; Age Factors; Infant, Newborn; Infant; Enterovirus A, Human; 3. Good health; Molecular Typing; Child, Preschool; Population Surveillance; Medicine; RNA, Viral; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; Female; hand; France; enterovirus A; Hand, Foot and Mouth Disease

The clinical impact of enteroviruses associated with hand, foot and mouth disease (HFMD) is unknown outside Asia, and the prevalence of enterovirus A71 (EV-A71) in particular might be underestimated. To investigate the prevalence of enterovirus serotypes and the clinical presentations associated with HFMD in France, we conducted prospective ambulatory clinic-based surveillance of children during April 2014-March 2015. Throat or buccal swabs were collected from children with HFMD and tested for the enterovirus genome. Physical examinations were recorded on a standardized form. An enterovirus infection was detected in 523 (79.3%) of 659 children tested. Two epidemic waves occurred, dominated by coxsackievirus (CV) A6, which was detected in 53.9% of enterovirus-infected children. CV-A6 was more frequently related to atypical HFMD manifestations (eruptions extended to limbs and face). Early awareness and documentation of HFMD outbreaks can be achieved by syndromic surveillance of HFMD by ambulatory pediatricians and rapid enterovirus testing and genotyping.