Changing Epidemiology of HFMD Points to Need for Vaccine

With the emergence of new causative agents, a global solution focusing on a multivalent HFMD vaccine is needed.

Within the past month, there have been numerous reports of patients with hand, foot, and mouth disease (HFMD). 

Students with HFMD have been reported at local high schools in North Dakota (East Grand Forks), Vermont (Newport), Indiana (La Porte), and 2 separate locations in New Jersey (Pequannock and Kinnelon).  HFMD reports have also been noted at universities such as Trinity University in San Antonio, Texas, University of Colorado, Boulder, and the most notable with 15 reported cases at Florida State University in Tallahassee, Florida.1,2,3

HFMD is mainly caused by 2 enteroviruses: the coxsackievirus A16 (CV-A16) and the enterovirus 71 (EV-A71). There is no vaccine and no specific treatment for HFMD.  A person can lower their risk of being infected by washing hands frequently, cleaning surface areas, and avoiding contact such as kissing, hugging, or sharing eating utensils or cups with people with HFMD, according to data on the Centers for Disease Control and Prevention website.4

While the most common causes of HFMD are CV-A16 and EV-A71, “increasing cases of HFMD due to other viruses such as CV-A6 and CV-A10 have been reported recently,” particularly in India, South East Asia, and Europe, according to research published in Medical Microbiology and Immunology.5

The “epidemiology of HFMD has considerably changed over the last decade” with the emergence of CV-A10 and CV-A6 as important HFMD agents.  The researchers noted that “coinfection with multiple enteroviruses, recombination events, and the lack of effective vaccination could explain the spread of the disease worldwide and the frequent atypical presentations. These unusual clinical features can lead to an incorrect diagnosis by clinicians.” 

“Given the changing epidemiology of HFMD, a global solution focusing on a multivalent HFMD vaccine, designed to target the major viruses involved, should be the ultimate goal,” the researchers concluded.  In addition, “Epidemiological surveillance of HFMD viruses also needs to be strengthened to allow regular updates with regard to such a multivalent vaccine.”

Infectious Disease Advisor Editorial Board Member Stanford T. Shulman, MD, commented on the recent rise in HFMD reports, noting that although “a vaccine would be of theoretical value, realistically much more widespread and more serious infections would be needed to justify expense and effort for vaccine development and implementation.” He added that more data are needed on the rise in the number of people with HFMD, and said that “EV71 also has caused some very serious infections with some mortality especially in the past couple of years.”

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  1. Heine D. Hand, foot and mouth disease outbreaks forcing schools across the country to cancel events. September 15, 2016. Accessed September 28, 2016.
  2. Uri A. Hand, foot and mouth disease. The Trinitonian. September 25, 2016. Accessed September 28, 2016.
  3. What’s Going Around: Hand, foot, and mouth disease in EGF. September 6, 2016. Accessed September 28, 2016.
  4. Hand, Foot, and Mouth Disease (HFMD). Centers for Disease Control and Prevention website. Updated August 18, 2015. Accessed September 28, 2016.
  5. Aswathyraj S, Arunkumar G, Alidjinou EK, Hober D. Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategyMed Microbiol Immunol. 2016;205(5):397-407. doi: 10.1007/s00430-016-0465-y.