Abstract
Although it is an enteroviral infectious disease, recent studies suggest that respiratory transmission might play a role in the transmission of hand, foot, and mouth disease (HFMD). We evaluated the transmission modes (respiratory and fecal-oral transmission) of HFMD among children using a case-control study in Guangdong, China. Our analyses suggested that fecal-oral transmission might be the principal transmission mode of HFMD among children in the study area, and handwashing habits of the children and their parents should be emphasized to control this infection.
•The transmission modes (respiratory and fecal-oral transmission) of hand, foot, and mouth disease were compared.•Comparable effect sizes were found in playing in indoor and outdoor playgrounds, suggesting less importance on respiratory transmission.•Protective effects of handwashing habits suggested a greater importance on fecal-oral transmission.