Risk analysis on enterovirus contamination in child outpatient departments of medical institutions in Guangdong province

  Objective  To investigate the status of enterovirus contamination in child outpatient departments of medical institutions during different epidemic periods of hand-foot-mouth disease (HFMD) in Guangdong province.

  Methods  We conducted three waves of survey at child outpatient departments of medical institutions at different administrative levels in 4 counties or districts with higher HFMD incidence in Guangzhou and Huizhou municipality during pre-peak (January to April), peak (May to July), and post-peak (October to December) period of HFMD epidemics in 2016. Article surface swab specimens were collected in all the child outpatient departments for the detection of HFMD-related enterovirus nucleic acid with fluorogenic quantitative PCR method. Data on monthly incidence rate of HFMD in the regions surveyed were also collected simultaneously.

  Results  Totally 1 568 swab specimens were collected in child outpatient departments of 16 medical institutions surveyed. The overall enterovirus positive rate of the specimens was 4.21% and the positive rate (7.34%) of the specimens collected during the peak period of HFMD epidemic was significantly higher than that of those collected during the pre-peak (3.92%) and post-peak period (1.33%) (χ² = 23.90, P<0.001). There was a significant positive correlation between the positive rate of specimens and the average monthly HFMD incidence rate in the regions surveyed (r = 0.50, P = 0.67). The positive rate of all the specimens collected in Grade-A secondary hospitals (5.87%) was significantly higher than that of the specimens collected in primary medical institutions (5.71%) and Grade-A tertiary hospitals (2.84%) (χ² = 8.46, P = 0.015). During the peak period of HFMD epidemic, the positive rate of the specimens collected in Grade-A secondary hospitals (11.43%) was significantly higher than that of the specimens collected in primary medical institutions (9. 17%) and Grade-A tertiary hospitals (4.61%) (χ² = 7.07, P = 0.029); but there were no significant differences observed for the specimens collected during other periods of the epidemic (P > 0.05). For the specimens collected in Grade-A secondary and tertiary hospitals, the positive rate (5.22%) was higher for those collected at 9 o′clock than that for those collected 16 o′clock (3.71%) and at 11 o′clock (2.45%), but the differences were not significant (both P > 0.05). The positive rate of the specimens collected in clinics for health care of healthy children (4.29%) was unsignificantly higher than that of specimens (3.85%) collected in outpatient clinics for the children seeking medical service (P > 0.05). For the specimens collected in the outpatient clinics, higher positive rates were detected for surface swabs of therapeutic tables (6.14%), intravenous transfusion chairs (5.73%) and waiting-room benches (4.76%); while, for the specimens collected in the clinics for health care, higher positive rates were detected for surface swabs of vaccination tables (28.13%) and physical measurement facilities (7.14%) and the positive rates maintained at a higher level (18.18% – 45.45%) for the surface swabs of vaccination tables during the whole period of the HFMD epidemic.

  Conclusion  The HFMD-related enterovirus contamination in child outpatient departments of medical institutions is prevalent, especially during peak period of HFMD epidemic and at 9 o′clock of a day, and the most frequently detected contaminations are surfaces of vaccination tables, therapeutic tables, intravenous transfusion chairs and waiting-room benches in outpatients. The results suggest that targeted control measures for the contaminations should be developed.