title: Risk Factors for Enterovirus A71 Seropositivity in Rural Indigenous Populations in West Malaysia.
abstract: Enterovirus A71 (EV-A71), which is transmitted by the fecal-oral route, causes hand, foot and mouth disease and, rarely, severe neurological complications. In Malaysia, the indigenous rural community (Orang Asli) has a high prevalence of parasitic diseases due to poor sanitation, water supply and hygiene practices. This cross-sectional study compared the seroepidemiology of EV-A71 among rural Orang Asli and urban Kuala Lumpur populations in West Malaysia, and determined the risk factors associated with EV-A71 seropositivity in rural Orang Asli. Seropositive rates were determined by neutralization assay. EV-A71 seropositivity was strongly associated with increasing age in both populations. Rural Orang Asli children ≤12 years had significantly higher EV-A71 seropositivity rates than urban Kuala Lumpur children (95.5% vs 57.6%, P < 0.001), and also higher rates in the age groups of 1-3, 4-6 and 7-12 years. Multivariate analysis confirmed that age ≤12 years (adjusted OR 8.1, 95% CI 3.2-20.7, P < 0.001) and using untreated water (adjusted OR 6.2, 95% CI 2.3-16.6, P < 0.001) were independently associated with EV-A71 seropositivity in the Orang Asli population. Supply of clean drinking water may reduce the risk of EV-A71 infection. With significantly higher EV-A71 seropositive rates, younger rural children should be a priority target for future vaccination programs in Malaysia.
authors: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Nmn
authors: N
authors: NikNadia
authors: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: I-Ching
authors: IC
authors: Sam
authors: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Nasibah
authors: N
authors: Khaidir
authors: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Romano
authors: R
authors: Ngui
authors: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Yvonne A L
authors: YA
authors: Lim
authors: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Xiang Ting
authors: XT
authors: Goh
authors: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Seow Huey
authors: SH
authors: Choy
authors: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Yoke Fun
authors: YF
authors: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004770:Enterovirus; D004769:Enterovirus Infections / Q000097:blood* / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000097:blood / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009500:Neutralization Tests; D044382:Population Groups; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D016036:Seroepidemiologic Studies; D014505:Urban Population; D055815:Young Adult