Editing Hand, foot, and mouth disease (section)

==Epidemiology==
Hand, foot and mouth disease most commonly occurs in children under the age of 10<ref name=Hoy2012/><ref name=Sar2013/> and more often under the age of 5, but it can also affect adults with varying symptoms.<ref name="HFMD Symptoms" /> It tends to occur in outbreaks during the spring, summer, and autumn seasons.<ref name="Repass2014"/> This is believed to be due to heat and humidity improving spread.<ref name=Koh2016>{{Cite journal|last1=Koh|first1=Wee Ming|last2=Bogich|first2=Tiffany|last3=Siegel|first3=Karen|last4=Jin|first4=Jing|last5=Chong|first5=Elizabeth Y.|last6=Tan|first6=Chong Yew|last7=Chen|first7=Mark Ic|last8=Horby|first8=Peter|last9=Cook|first9=Alex R.|date=October 2016|title=The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis|journal=The Pediatric Infectious Disease Journal|volume=35|issue=10|pages=e285–300|doi=10.1097/INF.0000000000001242|issn=1532-0987|pmc=5130063|pmid=27273688}}</ref> HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered.<ref>{{Cite journal|last1=Koh|first1=Wee Ming|last2=Bogich|first2=Tiffany|last3=Siegel|first3=Karen|last4=Jin|first4=Jing|last5=Chong|first5=Elizabeth Y.|last6=Tan|first6=Chong Yew|last7=Chen|first7=Mark IC|last8=Horby|first8=Peter|last9=Cook|first9=Alex R.|date=October 2016|title=The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis|journal=The Pediatric Infectious Disease Journal|volume=35|issue=10|pages=e285–e300|doi=10.1097/INF.0000000000001242|pmid=27273688|issn=0891-3668|pmc=5130063}}</ref> Poor hygiene is a risk factor for HFMD.<ref>{{Cite news|url=https://www.webmd.com/children/guide/hand-foot-mouth-disease#1|title=Hand-Foot-and-Mouth Disease|work=WebMD|access-date=November 28, 2017|language=en-US}}</ref>{{better source needed|date=November 2018}}

===Outbreaks===
* In 1997, an [[1997 Sarawak HFMD outbreak|outbreak]] occurred in [[Sarawak]], Malaysia with 600 cases and over 30 children died.<ref>{{cite journal|title=Deaths of Children during an Outbreak of Hand, Foot, and Mouth Disease in Sarawak, Malaysia: Clinical and Pathological Characteristics of the Disease|author1=L. G. Chan|author2=Umesh D. Parashar|author3=M. S. Lye|author4=F. G. L. Ong|author5=Sherif R. Zaki|author6=James P. Alexander|author7=K. K. Ho|author8=Linda L. Han|author9=Mark A. Pallansch|author10=Abu Bakar Suleiman|author11=M. Jegathesan|author12=Larry J. Anderson|journal=Clinical Infectious Diseases|volume=31|issue=3|pages=678–683|via=[[Oxford Academic]]|year=2000|doi=10.1086/314032|pmid=11017815|doi-access=free}}</ref><ref>{{cite book|author=Academy of Medicine (Singapore)|title=Annals of the Academy of Medicine, Singapore|url=https://books.google.com/books?id=dPlNAQAAIAAJ|year=2003|publisher=Academy of Medicine.|page=385|quote=In April 1997, in Sarawak, Malaysia, 600 cases of HFMD were admitted and over 30 children died.}}</ref><ref>{{cite journal|url=http://eprints.um.edu.my/7327/1/Enterovirus_71_in_Malaysia-_A_decade_later.pdf|title=Enterovirus 71 in Malaysia: A decade later|author1=Yoke Fun-Chan|author2=I-Ching Sam|author3=Kai-Li Wee|author4=Sazaly Abu Bakar|journal=Neurology Asia|via=[[University of Malaya]]|year=2011|access-date=August 29, 2019|volume=16|number=1|archive-url=https://web.archive.org/web/20190829040819/http://eprints.um.edu.my/7327/1/Enterovirus_71_in_Malaysia-_A_decade_later.pdf|archive-date=August 29, 2019|url-status=live}}</ref><ref>{{cite journal|url=http://eprints.utm.my/id/eprint/78873/1/NurNajihahHasanMFGHT2017.pdf|title=Assessing the Prevalence of Hand, Foot and Mouth Disease (HFMD) Using Geospatial Density and Distribution Techniques|author=Nur Najihah Hasan|journal=Faculty of Geoinformation and Real Estate|via=[[Universiti Teknologi Malaysia]]|year=2017|access-date=August 29, 2019|pages=2–3 [18–35]|archive-url=https://web.archive.org/web/20190829025807/http://eprints.utm.my/id/eprint/78873/1/NurNajihahHasanMFGHT2017.pdf|archive-date=August 29, 2019|url-status=live}}</ref>
* In 1998, there was an outbreak in [[Taiwan]], affecting mainly children.<ref>{{Cite journal |author=Centers for Disease Control and Prevention (CDC) |title=Deaths among children during an outbreak of hand, foot, and mouth disease—Taiwan, Republic of China, April–July 1998 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=47 |issue=30 |pages=629–32 |year=1998 |pmid=9704628 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm |url-status=live |archive-url=https://web.archive.org/web/20080726222228/http://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm |archive-date=July 26, 2008  }}</ref> There were 405 severe complications, and 78 children died.<ref name=Ho>{{Cite journal |vauthors=Ho M, Chen ER, Hsu KH, etal |title=An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group |journal=N. Engl. J. Med. |volume=341 |issue=13|pages=929–35 |year=1999 |pmid=10498487 |doi= 10.1056/NEJM199909233411301|doi-access=free }}</ref> The total number of cases in that epidemic is estimated to have been 1.5&nbsp;million.<ref name="Repass2014"/>
* In 2008 an outbreak in China, beginning in March in [[Fuyang, Anhui]], led to 25,000 infections, and 42 deaths, by May 13.<ref name="Repass2014"/> Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008),<ref name="Nur">{{Cite news|last=Suhaimi|first=Nur Dianah|title=HFMD: 1,000 cases a week is unusual, says doc|location=Singapore|publisher=The Sunday Times (Straits Times)|date=April 20, 2008|pages=1–2}}</ref> Vietnam (2,300 cases, 11 deaths),<ref>[http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA150508 Viet Nam News: HFMD cases prompt tighter health screening at airport] {{webarchive|url=https://web.archive.org/web/20090213070442/http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA150508 |date=February 13, 2009 }}(accessed May 15, 2008)</ref> Mongolia (1,600 cases),<ref>[http://ubpost.mongolnews.mn/index.php?option=com_content&task=view&id=1847&Itemid=1 EV-71 Virus Continues Dramatic Rise] {{webarchive|url=https://web.archive.org/web/20081021100614/http://ubpost.mongolnews.mn/index.php?option=com_content&task=view&id=1847&Itemid=1 |date=October 21, 2008 }} (accessed May 23, 2008)</ref> and Brunei (1,053 cases from June–August 2008).<ref>{{cite news |url=http://www.bt.com.bn/home_news/2008/11/07/1_053_hfmd_cases_recorded |title=1,053 HFD cases recorded |author=Bandar Seri Begawan |date=November 7, 2008 |newspaper=The Birmingham News |access-date=May 11, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120722220853/http://www.bt.com.bn/home_news/2008/11/07/1_053_hfmd_cases_recorded |archive-date=July 22, 2012  }}</ref>
* In 2009 17 children died in an outbreak during March and April 2009 in China's eastern [[Shandong Province]], and 18 children died in the neighboring [[Henan Province]].<ref>{{Cite news | title=Hand-foot-mouth disease death toll rises to 17 in East China's Shandong Province | date=April 9, 2009 | work=China View | url=http://news.xinhuanet.com/english/2009-04/09/content_11159556.htm | access-date=September 29, 2009 | url-status=dead | archive-url=https://web.archive.org/web/20090413063806/http://news.xinhuanet.com/english/2009-04/09/content_11159556.htm | archive-date=April 13, 2009 | df=mdy-all }}</ref> Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.<ref>{{Cite news | title=Health Ministry: Hand-foot-mouth disease claims 50 lives this year | date=April 10, 2009 | work=China View | url=http://news.xinhuanet.com/english/2009-04/10/content_11165126.htm | access-date=September 29, 2009 | url-status=dead | archive-url=https://web.archive.org/web/20090415093929/http://news.xinhuanet.com/english/2009-04/10/content_11165126.htm | archive-date=April 15, 2009 | df=mdy-all }}</ref>
* In 2010 in China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei, and Shandong provinces. Until March, 70,756 children were infected and 40 died from the disease. By June, the peak season for the disease, 537 had died.<ref>{{cite web |url=http://news.xinhuanet.com/english2010/china/2010-06/24/c_13367598.htm |title=China reports 537 deaths from hand-foot-mouth disease this year |access-date=December 2, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110501194633/http://news.xinhuanet.com/english2010/china/2010-06/24/c_13367598.htm |archive-date=May 1, 2011  }}</ref>
* The [[World Health Organization]] reporting between January and October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June. There were 437 deaths, down from 2010 (537 deaths).<ref>{{cite web |url=http://english.peopledaily.com.cn/90001/90782/90880/7039439.html |title=China reports 537 deaths from hand-foot-mouth disease this year |year=2010 |publisher=People's Daily Online |access-date=October 16, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131017081837/http://english.peopledaily.com.cn/90001/90782/90880/7039439.html |archive-date=October 17, 2013  }}</ref>
* In December 2011, the [[California Department of Public Health]] identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common.<ref>{{cite web|url=http://www.cdph.ca.gov/programs/cder/Pages/CVA6.aspx|title=Coxsackievirus A6 (CVA6)|year=2013|publisher=California Department of Public Health|access-date=October 16, 2013|url-status=dead|archive-url=https://web.archive.org/web/20131017090918/http://www.cdph.ca.gov/programs/cder/Pages/CVA6.aspx|archive-date=October 17, 2013}}</ref>
* In 2012 in [[Alabama]], United States there was an outbreak of an unusual type of the disease. It occurred in a season when it is not usually seen and affected teenagers and older adults.  There were some hospitalizations due to the disease but no reported deaths.<ref>{{cite news|url=http://blog.al.com/spotnews/2012/02/outbreak_of_hand_foot_and_mout.html|title=Outbreak of hand, foot and mouth disease severe in Alabama|author=Hannah Wolfson|date=February 13, 2012|newspaper=The Birmingham News|access-date=May 11, 2012|url-status=live|archive-url=https://web.archive.org/web/20120304001524/http://blog.al.com/spotnews/2012/02/outbreak_of_hand_foot_and_mout.html|archive-date=March 4, 2012}}</ref>
* In 2012 in [[Cambodia]], 52 of 59 reviewed cases of children reportedly<ref>{{cite web|url=http://www.wpro.who.int/cambodiaPRdisease.pdf|title=Joint Press Release Between The Ministry of Health Kingdom of Cambodia and the World Health Organization|author=CBS News Staff|year=2012|publisher=CBS News|access-date=October 16, 2013|url-status=live|archive-url=https://web.archive.org/web/20131017073643/http://www.wpro.who.int/cambodiaPRdisease.pdf|archive-date=October 17, 2013}}</ref> dead ({{as of|2012|July|9|lc=y|df=US}}) due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD.<ref>{{cite web|url=https://www.cbsnews.com/news/mysterious-deadly-illness-in-cambodian-children-tied-to-hand-foot-and-mouth-disease/|title=Mysterious deadly illness in Cambodian children tied to hand, foot and mouth disease|year=2012|work=Hand, Foot and Mouth Disease|publisher=World Health Organization|access-date=June 7, 2022|url-status=live|archive-url=https://web.archive.org/web/20130603011518/http://www.cbsnews.com/8301-504763_162-57468483-10391704/mysterious-deadly-illness-in-cambodian-children-tied-to-hand-foot-and-mouth-disease/|archive-date=June 3, 2013}}</ref> Although a significant degree of uncertainty exists with reference to the diagnosis, the WHO report states, "Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients."<ref>{{cite web|url=https://www.who.int/csr/don/2012_07_09/en/index.html|title=Global Alert and Response (GAR)|year=2012|work=Undiagnosed illness in Cambodia-update|publisher=World Health Organization|access-date=October 16, 2013|url-status=dead|archive-url=https://web.archive.org/web/20131017073810/http://www.who.int/csr/don/2012_07_09/en/index.html|archive-date=October 17, 2013}}</ref>
* HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China.<ref>{{cite web |url=http://www.wpro.who.int/emerging_diseases/HFMD/en/index.html |title=Emerging disease surveillance and response |year=2013 |work=Hand, Foot and Mouth Disease |publisher=World Health Organization |access-date=October 16, 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131017073800/http://www.wpro.who.int/emerging_diseases/HFMD/en/index.html |archive-date=October 17, 2013  }}</ref>
* In 2018, more than 50,000 cases occurred through a [[2018 Malaysia HFMD outbreak|nationwide outbreak]] in Malaysia with two deaths also reported.<ref>{{cite web|url=https://www.thestar.com.my/news/nation/2018/08/16/over-50000-cases-of-hfmd-recorded-virus-strain-relatively-benign|title=Over 50,000 cases of HFMD recorded, virus strain relatively benign|author1=Martin Carvalho|author2=Hemananthani Sivanandam|author3=Rahimy Rahim|author4=Loshana K Shagar|work=The Star|date=August 16, 2018|access-date=August 29, 2019|quote=Over 50,000 cases of hand, foot and mouth disease (HFMD) stemming from the Coxsackie virus have been reported since the outbreak of the disease.}}</ref><ref>{{cite web|url=https://says.com/my/news/hfmd-claimed-its-first-victim-as-two-year-old-died-from-the-virus|title=A 2-Year-Old Boy In Sarawak Suffering From HFMD Has Died|author=Katrina Khairul Azman|publisher=Says.com|date=July 29, 2018|access-date=August 29, 2019|archive-url=https://web.archive.org/web/20190829030802/https://says.com/my/news/hfmd-claimed-its-first-victim-as-two-year-old-died-from-the-virus|archive-date=August 29, 2019|url-status=live}}</ref><ref>{{cite web|url=https://www.thestar.com.my/news/nation/2018/07/30/17monthold-boys-death-in-penang-due-to-hfmd|title=17-month-old boy's death in Penang due to HFMD|work=The Star|date=July 30, 2018|access-date=August 29, 2019}}</ref>

=== India 2022 <span class="anchor" id="Tomato fever"></span>===
<!-- 
Please do not remove anchor, used for redirect from [[Tomato fever]]
-->An outbreak of an illness referred to as ''tomato fever'' or ''tomato flu'' was identified in the [[Kollam district]] on May 6, 2022.<ref name=Chavda2022>{{cite journal |vauthors=Chavda VP, Patel K, Apostolopoulos V |title=Tomato flu outbreak in India |journal=Lancet Respir Med  |date=August 2022 |volume=11 |issue=1 |pages=e1–e2 |pmid=35987204 |doi=10.1016/S2213-2600(22)00300-9 |pmc=9385198 }}</ref> The illness is endemic to [[Kerala]], India and gets its name because of the red and round [[blister]]s it causes, which look like [[tomato]]es.<ref name=Chavda2022/> The disease may be a new variant of the viral HFMD or an effect of [[chikungunya]] or [[dengue fever]].<ref name=Chavda2022/><ref name=NIE>{{Cite web |title=It's not tomato flu, fever caused by HFMD virus variant: Health Secy Radhakrishnan |url=https://www.newindianexpress.com/states/tamil-nadu/2022/may/14/its-not-tomato-flu-fever-caused-by-hfmd-virus-variant-health-secy-radhakrishnan-2453387.html |access-date=June 16, 2022 |website=[[The New Indian Express]]|date = May 14, 2022}}</ref><ref>{{Cite web |date=May 11, 2022 |title=Tomato flu in Kerala: No need to panic, authorities instructed to be vigilant |url=https://www.livemint.com/news/india/tomato-flu-in-kerala-no-need-to-panic-authorities-instructed-to-be-vigilant-minister-says-11652286503501.html |access-date=June 30, 2022 |website=livemint.com}}</ref> ''Flu'' may be a misnomer.<ref name= NIE/><ref>{{Cite web |title=Tomato fever or HFMD virus in Kerala? Know causes, and symptoms of HFMD |url=https://zeenews.india.com/india/tomato-fever-or-hfmd-virus-in-kerala-know-causes-and-symptoms-of-head-foot-and-mouth-disease-2463642.html |access-date=June 16, 2022 |website=Zee News |date= May 15, 2022}}</ref>

The condition mainly affects children under the age of five.<ref name=Chavda2022/><ref>{{cite journal |vauthors=Thiagarajan K |title=Reports of "tomato flu" outbreak in India are not due to new virus, say doctors |journal=BMJ |volume=378 |pages=o2101 |date=August 2022 |pmid=36028244 |doi=10.1136/bmj.o2101 |s2cid=251814659 |url=https://www.bmj.com/content/378/bmj.o2101.long}}</ref> An article in ''[[The Lancet]]'' states that the appearance of the blisters is similar to that seen in [[Mpox]], and the illness is not thought to be related to [[SARS-CoV-2]].<ref name= Chavda2022/> Symptoms, treatment and prevention are similar to HFMD.<ref name= Chavda2022/>