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 1
Demographic and clinical features of patients with CV-A6 infections compared with those with non–CV-A6 infections, France, April 2014–March 2015*
| Characteristic |
All enterovirus infections, n = 530 |
CV-A6 infections, n = 286 |
Non–CV-A6 infections, n = 210 |
p value† |
|---|---|---|---|---|
| Age at enrollment, y, mean (SD) | 2.1 (1.41) | 1.69 (0.93) | 2.53 (1.78) | <0.001 |
| Male sex, no. (%) | 290/523 (55.4) | 152/281 (54.1) | 123/209 (58.9) | 0.29 |
| Time between onset and consultation, d, mean (SD)‡ |
1.92 (1.35) |
2.13 (1.49) |
1.63 (1.06) |
<0.001 |
| Signs and symptoms, no. (%) | ||||
| Fever | 397 (74.9) | 220 (76.9) | 147 (70.0) | 0.08 |
| Oral ulcerations | 224 (42.3) | 101 (35.3) | 118 (56.2) | <0.001§ |
| Gingivostomatitis | 79 (14.9) | 36 (12.6) | 42 (20) | 0.02 |
| Eruption | 456 (86.0) | 268 (93.7) | 163 (77.6) | <0.001§ |
| Vesicular eruption | 355 (70.3) | 226/278 (81.3) | 119/197 (60.4) | <0.001§ |
| Nonvesicular eruption |
160 (30.2) |
94 (32.9) |
53 (25.2) |
0.07 |
| Localizations of eruption, no. (%) | ||||
| Palms | 308 (58.1) | 190 (66.4) | 114 (54.3) | 0.006§ |
| Soles | 279 (52.6) | 160 (55.9) | 111 (52.9 | 0.49 |
| Buttocks | 251 (47.4) | 171 (59.8) | 73 (34.8) | <0.001§ |
| Elbows / knees | 133 (25.1) | 90 (31.5) | 40 (19.0) | 0.002§ |
| Lower limbs | 170 (32.1) | 131 (45.8) | 27 (12.9) | <0.001§ |
| Upper limbs | 119 (22.5) | 83 (29.0) | 24 (11.4) | <0.001§ |
| Generalized eruption | 46 (8.7) | 27 (9.4) | 14 (6.7) | 0.27 |
| Trunk | 23 (4.3) | 13 (4.5) | 5 (2.4) | 0.20 |
| Face, including perioral ulcerations |
161 (30.4) |
134 (46.9) |
24 (11.4) |
<0.001§ |
| Diagnosis, no. (%) | ||||
| Typical HFMD¶ | 95 (17.9) | 32 (11.2) | 62 (29.5) | <0.001§ |
| Atypical HFMD | 247 (46.6) | 181 (63.3) | 59 (28.1) | <0.001§ |
| Herpangina | 304 (57.4) | 165 (57.7) | 110 (52.4) | 0.24 |
| Herpangina alone |
63 (11.9) |
15 (5.2) |
40 (19.0) |
<0.001§ |
| Other signs, no. (%) | ||||
| Digestive signs | 61 (11.5) | 38 (13.3) | 15 (7.1) | 0.03§ |
| Ear, nose, and throat signs | 54 (10.2) | 27 (9.4) | 26 (12.4) | 0.29 |
| Respiratory signs | 15 (2.8) | 6 (2.1) | 7 (3.3) | 0.39 |
*Non–CV-A6 infections only include infections by another type belonging to the enterovirus A species. CV-A6, coxsackievirus A6; HFMD, hand, foot and mouth disease.
†Statistical analyses were performed to compare clinical characteristics of CV-A6 and non–CV-A6 infections. 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.
§Indicates significant differences between CV-A6 infections and non–CV-A6 infections by multivariate analyses.
¶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.