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Cyclical Patterns of Hand, Foot and Mouth Disease Caused by Enterovirus A71 in Malaysia

Nmn NikNadia1, I-Ching Sam1, Sanjay Rampal2

  • 1Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia.

Plos Neglected Tropical Diseases
|March 25, 2016
PubMed

Insights

Recurrent hand, foot, and mouth disease (HFMD) epidemics in Malaysia are driven by declining population immunity in children. As susceptible children accumulate, immunity wanes, increasing the odds of future Enterovirus A71 (EV-A71) outbreaks.

Area of Science:

  • Virology and Epidemiology
  • Public Health
  • Immunology

Background:

  • Enterovirus A71 (EV-A71) causes significant hand, foot, and mouth disease (HFMD) epidemics in children.
  • Malaysia has experienced cyclical EV-A71 epidemics every 2-3 years since 1997, with the underlying reasons unclear.
  • Understanding population immunity is crucial for predicting and managing recurrent viral outbreaks.

Purpose of the Study:

  • To investigate the hypothesis that cyclical EV-A71 epidemics in Malaysia are linked to changes in child population immunity (seroprevalence).
  • To determine the association between EV-A71 seroprevalence, age, climatic factors, and epidemic periods.
  • To inform future public health strategies, including vaccine program planning.

Main Methods:

  • Measured neutralizing antibody titers against EV-A71 in 2,141 serum samples from children aged ≤12 years (1995-2012).
  • Analyzed national HFMD incidence data, noting higher rates in younger children.
  • Employed cross-sectional time series analysis to model the relationship between seroprevalence, age, climatic variables, and epidemic occurrences.

Main Results:

  • EV-A71 seroprevalence was significantly associated with age, with younger children exhibiting greater susceptibility.
  • A 10% increase in absolute monthly seroprevalence correlated with a 45% higher odds of an epidemic (aOR 1.45).
  • A 10% decrease in seroprevalence between months increased epidemic odds by 16% (aOR 1.16).

Conclusions:

  • The 2-3 year cyclical pattern of EV-A71 epidemics in Malaysia is primarily driven by waning population immunity.
  • The accumulation of susceptible children between epidemics directly contributes to the cyclical nature of outbreaks.
  • Findings provide critical insights for optimizing the timing, planning, and target populations for EV-A71 vaccination programs.

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