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.