Performance of hand, foot and mouth disease and enterovirus infections surveillance system in Nakhon Pathom Hospital, 2020

Abstract

In 2020, there was a significant decrease in reporting of hand, foot and mouth disease (HFMD) cases and no case report of enterovirus infections in Nakhon Pathom Hospital, a tertiary care facility in a province with population approximately 1 million. A descriptive cross-sectional study was conducted in order to investigate a performance of HFMD and enterovirus infections surveillance system in Nakhon Pathom Hospital from 1 January to 31 December 2020. A study of performance was composed of a description of a reporting process, quantitative attributes, namely sensitivity, positive predictive value, data quality, representativeness, and timeliness, as well as qualitative attributes, including simplicity, flexibility, stability, acceptability, and usefulness. Medical records regarding ICD-10 TM codes and laboratory testing for enteroviruses were reviewed and compared with a notifiable diseases surveillance system (R506). Data was analyzed using descriptive statistics. An in-depth interview was performed among key stakeholders. Of 990 medical records reviewed, 234 cases were met case definitions. A sensitivity and a positive predictive value (PPV) were 27.78% and 98.48%, respectively. A sensitivity, classified according to disease, was 53.75% for HFMD, 18.18% for herpangina, and 0% for enterovirus infections. PPV, classified according to disease, was 92.42% for HFMD and herpangina; however, PPV could not be evaluated for enterovirus infections. A sensitivity and PPV, classified according to diagnosis, were 38.51% and 93.94%, respectively. A data quality was 100% for gender and age, 97.02% for nationality, 95.52% for classification of patients, 86.57% for date of onset, and 97.02% for date of visit. A representativeness was good in gender, age, and month of onset except nationality. A timeliness showed 100%. Seven key stakeholders were interviewed. A surveillance system had an acceptable, simple, stable, and flexible flow. A surveillance data was organized to describe magnitude and utilize in outbreak investigation and disease control. To increase a sensitivity and PPV of a surveillance system, a case definition of enterovirus infections and herpangina should be informed and vigorously reported to an epidemiology unit among key stakeholders. ICD-10 TM codes of similar diseases should be searched for identifying additional cases. When an epidemiologist was absent, it should have additional staffs.