title: Transmission of seasonal outbreak of childhood enteroviral aseptic meningitis and hand-foot-mouth disease.
abstract: This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sue K
authors.initials: SK
authors.lastname: Park
authors.forename: Boyoung
authors.initials: B
authors.lastname: Park
authors.forename: Moran
authors.initials: M
authors.lastname: Ki
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
authors.forename: Kwan
authors.initials: K
authors.lastname: Lee
authors.forename: Cheoll
authors.initials: C
authors.lastname: Jung
authors.forename: Young Mo
authors.initials: YM
authors.lastname: Sohn
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Choi
authors.forename: Doo-Kwun
authors.initials: DK
authors.lastname: Kim
authors.forename: Dong Seok
authors.initials: DS
authors.lastname: Lee
authors.forename: Joon Tae
authors.initials: JT
authors.lastname: Ko
authors.forename: Moon Kyu
authors.initials: MK
authors.lastname: Kim
authors.forename: Hae-Kwan
authors.initials: HK
authors.lastname: Cheong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000635:transmission*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons