Volume 22, Number 11—November 2016
Research
Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014–2015
, François Vié le Sage, Bruno Pereira, Robert Cohen, Corinne Levy, Christine Archimbaud, Hélène Peigue-Lafeuille, Jean-Luc Bailly, and Cécile Henquell
Table 2
Demographic and clinical features associated with CV-6 infections in 4 age groups of patients, France, April 2014–March 2015*
| Characteristic |
<1 y, n = 63 |
1–2 y, n = 146 |
2–3 y, n = 50 |
>3 y, n = 26 |
p value† |
|---|---|---|---|---|---|
| Male sex, no. (%) | 35/62 (56.4) | 80/146 (55.5) | 26/49 (53.1) | 10/25 (40 | 0.52 |
| Time between onset and consultation, d, mean (SD)‡ |
1.84 (1.31) |
2.27 (1.43) |
1.87 (1.48) |
2.46 (2.02) |
0.09 |
| Signs and symptoms, no. (%) | |||||
| Fever | 54 (85.7) | 105 (71.92) | 38 (76) | 22 (84.6) | 0.13 |
| Oral ulcerations | 17 (27) | 53 (36.3) | 19 (38) | 12 (46.1) | 0.32 |
| Perioral ulcerations | 18 (28.57) | 67 (45.9) | 25 (50) | 15 (57.7) | 0.003 |
| Eruption | 53 (84.1) | 143 (97.9) | 45 (90) | 26 (100) | 0.001 |
| Vesicular eruption | 43 (71.7) | 120 (83.9) | 41 (83.7) | 21 (84) | 0.21 |
| Nonvesicular eruption |
20 (31.7) |
55(37.7) |
11 (22) |
7 (26.9) |
0.20 |
| Localizations of eruption, no. (%) | |||||
| Palms | 41 (65.1) | 96 (65.75) | 33 (66) | 20 (76.9) | 0.71 |
| Soles | 34 (54) | 86 (58.9) | 24 (48) | 16 (61.5) | 0.53 |
| Buttocks | 29 (46) | 100 (68.5) | 30 (60) | 12 (46.1) | 0.009 |
| Elbows or knees | 15 (23.8) | 49 (33.6) | 16 (32) | 10 (38.5) | 0.46 |
| Lower limbs | 20 (31.8) | 75 (51.4) | 26 (52) | 10 (38.5) | 0.04 |
| Upper limbs | 8 (12.7) | 55 (37.7) | 17 (34) | 3 (11.5) | <0.001 |
| Generalized eruption | 9 (14.3) | 14 (9.6) | 3 (6) | 1 (3.9) | 0.41 |
| Trunk | ND | ND | ND | ND | ND |
| Face, including perioral ulcerations |
21 (33.3) |
70 (48) |
27 (54) |
15 (57.7) |
0.07 |
| Diagnosis, no. (%) | |||||
| Typical HFMD§ | 10 (15.9) | 17 (11.6) | 3 (6) | 2 (7.7) | 0.38 |
| Atypical HFMD | 30 (47.6)¶ | 100 (68.5)¶ | 32 (64) | 19 (73.1)¶ | 0.02 |
| Herpangina | 45 (71.4) | 76 (52.1) | 29 (58) | 15 (57.7) | 0.08 |
| Herpangina alone |
9 (14.3) |
2 (1.4) |
4 (8) |
0 |
0.001 |
| Other signs, no. (%) | |||||
| Digestive signs | 7 (11.1) | 16 (11) | 10 (20) | 5 (19.2) | 0.28 |
| Ear, nose, and throat signs | 4 (6.4) | 18 (12.3) | 3 (6) | 2 (7.7) | 0.41 |
| Respiratory signs | ND | ND | ND | ND | ND |
*For 1 patient, age was not known. CV-A6, coxsackievirus A6; HFMD, hand, foot and mouth disease; ND, not determined because of low sample size (<15 patients total).
†Significant p values (p<0.05) are indicated in bold type.
‡Time from symptom onset and consultation was available for 525 episodes of enterovirus infection.
§Typical HFMD was defined as the presence of >2 of the following signs: oral ulcerations, eruption on palms, soles, buttocks, knees, or elbows, excluding any other localization. Atypical HFMD was defined by the presence of >2 of those signs plus the involvement of another anatomic site.
¶Indicates significant differences between age groups.