title: [Outbreak of hand, foot and mouth disease with onychomadesis caused by Coxsackie virus A16 in Granada].
abstract: BACKGROUND
  Due to the significant increase in the number of cases of hand, foot and mouth disease (HFMD) among pre-school children population during late 2011 and early 2012. A study has been proposed with the aim of describing the HFMD outbreak and analyzing the risk factors associated with suffering onychomadesis.
  
  
  METHODS
  A descriptive and analytical case-control study was designed. The study population was 376 children between 6 and 36 months old, living in the Basic Health Catchment area of Peligros (Granada). The study inclued an epidemiological survey of 28 cases and paired controls in order to collect data on the time, person and place, and implementing preventive actions and family health education. Finally a microbiological viral study of stool samples was made.
  
  
  RESULTS
  There were 64% of girls with average age 20.8 months. The clinical signs fornd were, fever (75%), vesicular palmar eruption (71%), plantar eruption (68%), erosive stomatitis (64%), and nail loss (46%). The risk of getting sick was 14 times greater for those children attending a childcare centre and had contact with sick cases (OR 13.8; 95% CI; 3.79-50.18). The average time since onset of symptoms and onychomadesis was 52 days, and its appearance was linked to the presence of ulcers in mouth (P=.006). Five samples were positive to enteroviruses Coxsackie A16.
  
  
  CONCLUSIONS
  There was an outbreak of HFMD detected by pediatricians and families. The cases presented with marked clinical symptoms, and the nail loss (onychomadesis) generated a social alarm. The cause of the outbreak was an enterovirus Coxsackie A16 transmitted among sick cases and through childcare centres.
authors.affiliation: Unidad de Gestión Clínica (UGC) Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: E
authors.initials: E
authors.lastname: Navarro Moreno
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España. Electronic address: diego.almagro.sspa@juntadeandalucia.es.
authors.forename: D
authors.initials: D
authors.lastname: Almagro López
authors.affiliation: UGC de Peligros, Distrito Sanitario Granada-Metropolitano, Granada, España.
authors.forename: R
authors.initials: R
authors.lastname: Jaldo Jiménez
authors.affiliation: UGC Medicina Preventiva, Vigilancia y Promoción de la Salud, Distrito Sanitario Granada-Metropolitano, Granada, España.
authors.forename: M C
authors.initials: MC
authors.lastname: Del Moral Campaña
authors.affiliation: UGC de Peligros, Distrito Sanitario Granada-Metropolitano, Granada, España.
authors.forename: G
authors.initials: G
authors.lastname: Árbol Fernández
authors.affiliation: UGC de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: M
authors.initials: M
authors.lastname: Pérez Ruiz
authors.affiliation: Unidad de Gestión Clínica (UGC) Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: D
authors.initials: D
authors.lastname: Almagro Nievas
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D004196:Disease Outbreaks; D004770:Enterovirus / Q000145:classification; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D009260:Nail Diseases / Q000209:etiology*; D013030:Spain / Q000453:epidemiology
keywords: Brote; Coxsackie virus; Enfermedad de boca-mano-pie; Hand-foot-mouth disease; Onicomadesis; Onychomadesis; Outbreak; Virus Coxsackie