Outbreak of Hand, Foot and Mouth Disease in Children at a Child Development Center in a Tertiary-Level Pediatric Hospital in Mexico, October 2023

Background

Hand, foot and mouth disease (HFMD) is a highly contagious viral infection that primarily affects children under 10 years, caused mainly by Coxsackie A16 and Enterovirus A71. The incubation period is 4-6 days, followed by fever, sore throat and a maculopapular or vesicular rash on the palms and soles, along with oral ulcers. Transmission occurs via airborne droplets, contact with secretions and fecal-oral route. Infections are more common in tropical areas with poor sanitation, inadequate hygiene and high population density. Treatment is symptomatic, and most cases resolve without complications.

In October 2023, an HFMD outbreak was detected at the Child Development Center (CENDI) of the Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City. The first case was identified on October 30, 2023, with symptoms starting on October 26. An active case search revealed five additional cases, and the outbreak was confirmed.

Methods

A retrospective cross-sectional observational study was conducted to describe the outbreak and associated risk factors. The study population was conducted to describe the outbreak and associated risk factors. The study population included children aged 2-4 years enrolled at CENDI. Active case surveillance was conducted in collaboration with CENDI staff to monitor new cases.

The operational definitions used were:

Results

A total of 47 individuals were considered exposed, 11 of whom (6 males, 5 females) met the probable case criteria. The cases were mainly in the 1-4 age group, with an overall attack rate of 23.4%. No laboratory confirmation was performed, so the cases remained unconfirmed. Public health measures, including contact and droplet precautions, were implemented. No fatalities occurred and no cases required hospitalization. The last case was reported on November 6, 2023, and the outbreak was closed on November 20, 2023.

Conclusion

The outbreak primarily affected children in the Preschool 1 group. The probable source was linked to contact with secretions and feces, with transmission through direct contact, airborne routes and contaminated surfaces. Control measures included isolating cases, cleaning and disinfecting common areas and reinforcing hand hygiene. These measures contained the outbreak, with no further cases reported. It is recommended to reinforce hand hygiene, ensure proper food handling, maintain cleaning protocols and use face mask for symptomatic staff. Continuous surveillance and early detection are essential to prevent future outbreaks.