Background

Hand, Foot and Mouth Disease (HFMD) is one of the common diseases in children caused by various serotypes of enterovirus. Although most of HFMD infections are considered mild and self-limiting, usually resolving in 5-6 days, a small fraction of patients develops severe complications, such as cardiopulmonary and neurologic manifestations which may be fatal.  HFMD has become a serious public health in South East Asia and occasionally large outbreaks are being reported.

Indonesia, with an estimated population of 275 million people of whom 33% are children, is highly susceptible to HFMD outbreaks. However, to date, data on HFMD in Indonesia is very limited. Although HFMD like illness outbreaks have been regularly reported in many areas, laboratory confirmation has only been conducted in an outbreak in Banjarmasin in 2016, revealing  Enterovirus A71 (EV-A71) as the etiologic serotype. EV-A71 has been associated with severe and sometimes fatal neurologic complications, but systematic data on its burden in susceptible Indonesian populations in Indonesia is lacking.

Aims

The study aims to characterize the viral etiology of clinical cases of HFMD, presenting at health facilities in Medan and Denpasar. Specific objectives are to determine and compare the diagnostic accuracy of different sample types for diagnosing HFMD, to investigate the associations between the enterovirus serotypes, patient profiles and clinical outcomes, and to estimate the (indirect and direct) costs of illness of HFMD in Indonesia.