Emerging #HFMD in #Bangladeshi #Children- First Report of Rapid Appraisal on Pocket #Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency (F1000Res., abstract)

[Source: F1000 Research, full page: (LINK). Abstract, edited.]

Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency [version 3; peer review: 2 approved]

Md. Azraf Hossain Khan1, Kazi Selim Anwar 2, A. K. M. Muraduzzaman3, Md. Abid Hossain Mollah4, S. M. Akhter-ul-Alam1, Kazi Munisul Islam5, Sheikh Ariful Hoque6, Md. Nazrul Islam1, Md. Ahasan Ali7

Author details: 1 Department of Dermatology and Venereology, Pabna Medical College and General Hospital, Pabna, 6600, Bangladesh; 2 US-CDC’s GHSA Project, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh; 3 Department of Virology, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh; 4 Department of Pediatrics, Ibrahim Medical College & Hospital, Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, 1200, Bangladesh; 5 Infectious Disease Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh; 6 Tissue Culture Laboratory, Centre for Advanced Research in Sciences (CARS), University of Dhaka, Dhaka, 1000, Bangladesh; 7 Microbiology Section, Institute of Public Health (IPH), Mohakhali, Dhaka, 1212, Bangladesh




Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities.


Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols.


The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children (<5 years) were more likely to suffer with moderate-to-high (38.5°C) fever (P<0.04), painful oral ulcers (P<0.03) and painful/itchy rash (P<0.01). Sex did not differ with other symptoms, but boys had less painful oral ulcers than girls (P<0.04). Fever (63%) and chicken-pox-like-rash (62%) was observed more in mid-October to mid-November than September to mid-October (P<0.01 and P<0.03, respectively). No differences in symptoms (fever, oral ulcers and extremity rash) were observed with precipitation, nor with ambient temperature. Children <5 years (85%) had quicker recovery (within 5 days) than those ≥5 years (69%), (P<0.04), with marginal differences in sex (P<0.05).


Our findings highlight potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable, which is particularly applicable for resource-constrained countries lacking appropriate virology/essential laboratories. Since no specific treatment or effective vaccination is available for HFMD, supportive therapy and preventive measures remain the primary methods to circumvent disease-transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent-vaccine deem essential towards preventing HFMD.

Keywords: Emerging Childhood-HFMD, Bangladesh, Rapid-Appraisal, Pocket-Outbreak

Corresponding author: Kazi Selim Anwar

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright:  © 2019 Hossain Khan MA et al. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

How to cite: Hossain Khan MA, Anwar KS, Muraduzzaman AKM et al. Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency [version 3; peer review: 2 approved]. F1000Research 2019, 7:1156 (https://doi.org/10.12688/f1000research.15170.3)

First published: 30 Jul 2018, 7:1156 (https://doi.org/10.12688/f1000research.15170.1)

Latest published: 28 Jun 2019, 7:1156 (https://doi.org/10.12688/f1000research.15170.3)

Keywords: HFMD; Bangladesh.


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Giuseppe Michieli

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.