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. 2019 Nov 26;19(1):995.
doi: 10.1186/s12879-019-4560-8.

Onychomadesis and Potential Association With HFMD Outbreak in a Kindergarten in Hubei Province, China, 2017

Free PMC article

Onychomadesis and Potential Association With HFMD Outbreak in a Kindergarten in Hubei Province, China, 2017

Dan Li et al. BMC Infect Dis. .
Free PMC article


Background: In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the outbreak.

Methods: The case definition was that a child with onychomadesis or transverse ridging (Beau's line) in fingernails and toenails without previous traumatic or systemic disease in kindergarten H from Sep. 1st to Nov. 30th, 2017. A retrospective cohort study was carried out to analyze the epidemiological relationship between onychomadesis and the hand-foot-mouth disease (HFMD) in Primary Class #2, kindergarten H. We also performed a serological survey for neutralizing antibodies against coxsackie virus A6 (CVA6), coxsackie virus A10 (CVA10) among 15 cases and six healthy children in the kindergarten. Meanwhile, some children were carried out with routine blood, fungal microscopic and microelement tests. Indoor environment examinations had been done for all classes.

Results: A total of 20 cases were identified in Kindergarten H. Seventy-five percent (15/20) cases occurred in Primary Class #2. Fifty-five percent of the cases (11/20) had suffered from HFMD within two months. The median time between onychomadesis and HFMD was 45 days (ranging from 31 to 58 days). A retrospective cohort study in Primary Class #2 showed the attack rate was 90.0% among 10 children who suffered from HFMD in the past two months compared to 30.0% among 20 children who didn't (Rate Ratio [RR] =3.0, 95% Confidence Interval [CI] =1.5-6.0). The positive rates of neutralizing antibodies were 66.7% for CVA6 and 26.7% for CVA10 in tested cases. The result of routine blood, fungal microscopic, microelements tests were normal in cases. The indicators of environment were within the normal range.

Conclusion: The results of this study suggested that the outbreak of onychomadesis in Hubei province was probably associated with HFMD epidemic within two months.

Keywords: Food and mouth disease; Hand; Onychomadesis; Outbreak.

Conflict of interest statement

The authors declare that they have no competing interests.


Fig. 1
Fig. 1
The epidemic curve of the onychomadesis outbreak in Kindergarten H, Hubei province, 2017
Fig. 2
Fig. 2
The onset time of the onychomadesis and HFMD from Sep to Nov in Kindergarten H, Hubei province, 2017
Fig. 3
Fig. 3
The time interval between the onset time of onychomadesis and HFMD in Kindergarten H, Hubei province, 2017

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