Hand foot and mouth disease (HFMD) has been well established in tropical Singapore with major outbreaks from 2000 onwards. Influenza occurs year-round with peaks in the middle and end of the year. This was a retrospective analysis of hospital attendances for febrile seizures and epilepsy and surveillance data on HFMD and respiratory virus data from 2003 – 2012 to determine the temporal relationship between febrile seizures or epilepsy and HFMD or respiratory cases.
We conducted a retrospective time series analysis of 3 sets of existing databases from 2003-2012 : Emergency department (ED) attendance and hospitalizations of children for febrile seizures (FS) and epilepsy at KK Women’s and Children Hospital (KKH), HFMD cases notified to the Minsitry of Health and microbiology laboratory data of positive respiratory viruses. The temporal association of FS with circulating pathogens was estimated via the number of additional FS per hospitalised or ED consultation with that virus or syndrome (HFMD). Statistical tests using generalized linear models with negative binomial or quasi-Poisson outcomes and the log link function were used.
Contrary to expectations, HFMD was not associated with an increase in ED FS. The associations with extra FS were: 1 influenza A virus consultation with an extra 0.47 (95%CI: 0.39, 0.55) FS case, 1 case of influenza B virus with 0.32 (95%CI: 0.12, 0.51) extra FS, and 1 case of parainfluenza virus type 3 with 0.36 (95%CI: 0.17, 0.56) FS cases.
The 3 contributing viruses were then used to form a final multivariate model which demonstrated that the excess number of FS above average could mostly be explained by the presence of epidemics of influenza A, B and parainfluenza 3.
In contrast, RSV, Parainfluenza 1 and 2, and Adenovirus were not significantly contemporarily associated with FS. There was no association between epilepsy and any of the viruses.
Infuenza A and B, parainfluenza were associated with excess febrile seizures and not HFMD or other respiratory viruses. Children who are prone to febrile seizures may warrant routine seasonal Influenza vaccination.
C. Y. Chong,
A. Cook, None
H. L. Hanh, None
Y. Chen, None
N. Tee, None