Hand, Foot, and Mouth Disease: Insights and Concerns in West Java, Indonesia

Hand, foot, and mouth disease (HFMD) is a common illness in children but has been largely overlooked in certain regions of Indonesia, particularly in West Java. While previous reports are limited to Banjarmasin, recent serosurveys in West Bandung and Bandung areas have revealed a notably high incidence of the disease. This study offers valuable insights into the prevalence, risk factors, and public health implications of HFMD in West Java.

The Prevalence of HFMD in West Java

Prior to this study, there were no reports of HFMD in West Java. The only mention of the disease was in Banjarmasin, based on limited case reports from 2016. No serosurveys were conducted in Indonesia to confirm the true prevalence of HFMD.
Our research found a high number of HFMD cases, even though demographic data initially showed no significant relationship with the incidence of HFMD in West Bandung and Bandung areas.

Age and Sex Factors

To understand the demographics of HFMD cases, our study examined the relationship between age and sex. Contrary to expected results, HFMD incidence was not significantly associated with age. This finding contrasts with general knowledge that more than 90% of HFMD cases occur in children under 5 years old. Additionally, there was no significant relationship between sex and HFMD incidence, suggesting that other factors might influence the disease’s prevalence.

The Role of StuntingStunting, a condition characterized by impaired growth and development due to poor nutrition, is a growing concern in Indonesia. According to recent studies, stunting rates have been consistently increasing from 2010 to 2013, placing Indonesia second behind Pakistan globally in terms of prevalence.
Our findings, along with data from urban areas in Yogyakarta, show high stunting rates, indicating a significant public health issue that requires urgent attention.

Socioeconomic Factors and Environment

Besides stunting, environmental and socioeconomic factors could play a significant role in the incidence of HFMD. In Indonesia, urban areas often have higher rates of stunting, linked to socioeconomic conditions, access to resources, and nutritional status.
However, our study did not find a significant relationship between income, parental education, and the incidence of HFMD. Socioeconomic factors appear to have a more pronounced effect on disease severity rather than incidence, as evidenced by research in other regions.

Vaccination and Prevention

The HFMD vaccine is crucial in controlling and reducing severe outcomes associated with enterovirus 71 (EV71). Studies have shown significant reductions in severe cases in Fujian Province, China, where the vaccine was introduced.
Despite the vaccine’s effectiveness, it is not yet considered necessary for HFMD prevention in Indonesia. Addressing these gaps in public health education and vaccination can significantly impact disease control and prevention.

The Prevalence of EV71

Our research revealed that 596 individuals in the West Bandung and Bandung regions were infected with EV71. Strikingly, the virus was also prevalent among asymptomatic individuals, similar to studies in other regions.
This finding underscores the importance of serosurveys in identifying EV71 infection, as clinical symptoms alone may not indicate the widespread nature of the virus.

Geographical Distribution and Risk Factors

The incidence of HFMD was not significantly different between urban (West Bandung) and rural (Bandung) areas. This can be attributed to high population mobility and density, leading to increased risk of disease transmission.
However, other studies in different regions show higher HFMD rates among rural and suburban children, linked to poorer public health conditions and hygiene practices.

Methodology and Limitations

This study used the ELISA IgG EV71 test to detect the EV71 antibody response, known for its high sensitivity and specificity. However, factors such as weather conditions, household density, and hygiene practices were not investigated.
The study was also limited to two regions and focused solely on EV71 as the causative agent of HFMD. Further research is warranted to explore additional variables that may affect the incidence of HFMD.

Conclusion

The findings from this study highlight the prevalence of hand, foot, and mouth disease in West Java, Indonesia, and the need for targeted public health interventions. Understanding the factors influencing HFMD’s incidence and severity can help improve child health outcomes.
Addressing stunting, enhancing public health education, and promoting vaccination are critical steps in controlling the spread of HFMD in Indonesia.

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