An outbreak investigation of Hand Foot and Mouth Disease caused by Enterovirus in Kisumu County, Kenya, 2021

Globally, various countries have reported mild-self-limiting to fatal Hand, Foot, and Mouth Disease (HFMD) outbreaks. Kenya had never reported outbreaks despite evidence of circulating enteroviruses. On February 19, 2021, a private hospital in Kisumu County confirmed an outbreak via Polymerase Chain Reaction. We described the magnitude of the outbreak and instituted control measures.

We reviewed health records in Kisumu County hospitals and conducted an active case search between 3rd and 10th March 2021. We defined a case as any patient with fever and papulovesicular rash on the palm, feet, and rash on either the mouth, elbow, knees, or buttocks of children aged <15 years. We conducted active case searches in schools and communities linked to hospitalized cases. Identified cases were managed symptomatically. We instituted Water Sanitation and Hygiene (WASH) measures in the affected areas. Data were analyzed using descriptive statistics.

We reviewed 173 records; the number of skin rash conditions increased from 23% (39/173) in December to 52% (90/173) in February. Central Sub County contributed 50% (86/173) of the cases. We identified 50 active cases with an attack rate of 8.0 per 100,000 population. Among the active cases, median age was 3 years (IQR:1–5), age group 1–4 years contributed 58% (29/50), and Central Sub County 44% (22/50). We identified four clusters; three schools in Central Sub County and a community in East Sub County. The cases from households with ≥5 members were 31 (62%), 28 (56%) lived in urban areas, 29 (58%) attended school/daycare, and 44% had a known history of contact with hospitalized cases. Epidemic Curve showed an 80% reduction of new cases six days after instituting WASH measures.

Prompt implementation of WASH measures may have helped in controlling the outbreak. We recommend regular public health education on HFMD recognition, prevention, and control.

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