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Abstract
Background Hand, foot and mouth disease (HFMD) affects millions of children across Asia annually, leading to an increase in implemented control policies such as surveillance, isolation and social distancing in affected jurisdictions. However, limited knowledge of disease burden and severity causes difficulty in policy optimisation as the associated economic cost cannot be easily estimated. We use a data synthesis approach to provide a comprehensive picture of HFMD disease burden, estimating infection risk, symptomatic rates, the risk of complications and death, and overall disability-adjusted life-year (DALY) losses, along with associated uncertainties.
Methods Complementary data from a variety of sources were synthesised with mathematical models to obtain estimates of severity of HFMD. This includes serological and other data extracted through a systematic review of HFMD epidemiology previously published by the authors, and laboratory investigations and sentinel reports from Singapore’s surveillance system.
Results HFMD is estimated to cause 96 900 (95% CI 40 600 to 259 000) age-weighted DALYs per annum in eight high-burden countries in East and Southeast Asia, with the majority of DALYs attributed to years of life lost. The symptomatic case hospitalisation rate of HFMD is 6% (2.8%–14.9%), of which 18.7% (6.7%–31.5%) are expected to develop complications. 5% (2.9%–7.4%) of such cases are fatal, bringing the overall case fatality ratio to be 52.3 (24.4–92.7) per 100 000 symptomatic infections. In contrast, the EV-A71 case fatality ratio is estimated to be at least 229.7 (75.4–672.1) per 100 000 symptomatic cases. Asymptomatic rate for EV-A71 is 71.4% (68.3%–74.3%) for ages 1–4, the years of greatest incidence.
Conclusion Despite the high incidence rate of HFMD, total DALY due to HFMD is limited in comparison to other endemic diseases in the region, such as dengue and upper respiratory tract infection. With the majority of DALY caused by years of life lost, it is possible to mitigate most with increased EV-A71 vaccine coverage.
- Mathematical Modelling
- Epidemiology
- Paediatrics
- Other Infection, Disease, Disorder, Or Injury
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Handling editor Seye Abimbola
Contributors WMK conceptualised the study, developed the analytical strategy, collected data, performed the statistical analysis, interpreted the results and wrote the first draft of the report. HB contributed to obtaining of data and interpretation of the results. HL and MI-CC contributed to the analysis and interpretation of results. ARC contributed to the conceptualisation of the study, analytical strategy, interpretation of results, performed critical revisions of the report and secured funding. All authors contributed to revising the paper and approved the final version.
Funding The work was funded by Singapore’s Ministry of Health, Health Services Research grant number HSRG12MAY023, Communicable Disease Public Health Research Grant number CDPHRG12NOV021, the Singapore Population Health Improvement Centre, the Centre for Infectious Disease Epidemiology and Research and the President’s Graduate Fellowship to WMK.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Requests for data access should be directed to the corresponding author.