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[The possibility of outbreak control by real-time surveillance with PCR method perfomed immediately--a case study of hand foot and mouth disease outbreak in a day care facility for children].

OBJECT
We examined the relationship between syndromic surveillance and laboratory confirmation, at an early stage of an outbreak of hand foot and mouth disease and RS virus infection.


METHOD
We observed the epidemiological situation from a surveillance system at a day care facility for young children in Tokyo from one week before onset of the indicator until one month thereafter. For laboratory diagnosis, we collected a rectal swab or a nasal swab from one patient in the early stage of the outbreak.


RESULT
A total of 20 patients, comprising 12 1-year-old, 5 2-year-old and 3 3-year-old children, were found to have hand foot and mouth disease on August 1st, 2011. From a rectal swab from one HFMD patient, enterovirus genome was detected and identified as coxsackievirus type A6 (CA6) with PCR sequencing. The CA6 had 99% identity to CA6 (Genbank No AB663318) in the VP4 coding region. RS virus also was detected from a nasal swab.


DISCUSSION
The establishment of a surveillance system at day care facilities for children can monitor infectious diseases among young children promptly. Laboratory confirmation, even though from only one patient as shown in this study, can provide critical information regarding the causative agent of the outbreak. This method is easy to conduct and could be used for activating appropriate countermeasures.


CONCLUSION
We believe that the combination of the timeliness of a surveillance system at day care facility for children and the convenience of laboratory diagnosis of even one patient can detect the causative pathogen, and thus enable the activation of countermeasures before an outbreak become widespread.