Epidemics of Hand, Foot, and Mouth Disease

Since the mid-twentieth century, hand, foot, and mouth disease (HFMD) was seen as a common cause of viral rash, typically self-limited syndrome in children and adults with classic skin findings. Till the past two decades, HFMD has received new attention because it has led to millions of attacks and several outbreaks across the world. This disease may have completely different clinical epidemiological and etiological characteristics from what was initially believed. Especially, HFMD can be associated with severe complications, such as brainstem encephalitis, meningitis, acute flaccid paralysis (AFP), pulmonary edema (NPE), severe neurological sequelae, and high case-fatality rates. In recent years, it has become a serious health threat and economic burden across the Asia–Pacific region. Historically, outbreaks of HFMD were mainly caused by various enteroviruses. Different pathogens are prevalent in different countries. Vaccines have been developed to provide protection against the most common pathogens in specific countries (e.g., vaccine against enterovirus 71 in China). However, the epidemic of HFMD is complex, such as simultaneous circulation of more than one causative virus and modification of the molecular epidemiology of infectious agents. Awareness of the epidemiological situation and patterns may lead providers to appropriate diagnosis and management.