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Largest outbreak of hand, foot and mouth disease (HFMD) in India at an altitude of 3524 meters (11,562 ft.) in Leh, Union Territory (UT) of Ladakh, India 2016

Journal of Human Virology & Retrovirology
Kadri SM,1 Jenevieve Peecher,2 Williams L,2 Crandall R,2 Kausar Rehana,3 Hinton T,2 Rashid S,2 Kimberley M Mayes4


Introduction: There is an increasing occurrence of Hand, Foot and Mouth Disease (HFMD) in India, Asia, and Australia. The largest ever outbreak in India is discussed in this paper. The geographic location of the case control study was in Leh province which has an average altitude over 3,000 meters (11,000 feet).

Objective: This case control study, and review was done to determine if there is evidence of an increase in HFMD. There is concern that the increase of HFMD will lead to an increase in the number of attributed deaths.

Methods: District Surveillance Unit (DSU) collected the data on a daily basis upon presentation of symptoms. The unit was comprised of: an epidemiologist, a pediatrician, and a District Health Officer (DHO).

Results: There were four hundred and sixty-five confirmed cases of HFMD recorded in the study. Two hundred and sixty-one, 56%, of the cases were male. Two hundred and four, 44%, of the cases were female. The majority of cases affect children ages less than 5.

Discussion: HFMD is usually a childhood disease. Adults who contract the disease are most often caregivers. HFMD is caused by a virus, most often one of the picornaviruses belonging to serotypes EV-A or less frequently the enterovirus EV-A71. EV-A71 infections may more often result in severe complications or death.

Conclusion: Healthcare professionals and government oversight agencies must be vigilant in the detection and control of HFMD outbreaks. Appropriate protocol and incident reporting needs to be standardized.


oral poliovirus vaccine, inactivated poliovirus vaccine, ribonucleic acid, Hand Foot Mouth Disease