Coxsackievirus 6 (CV‐A6) has been emerging as another predominant serotype for severe hand, foot, and mouth disease (HFMD) in China, after the introduction of enterovirus 71 inactivated vaccine (EV71 vaccine) for 3 years. Data on the risk factors for severe HFMD infected with CV‐A6 are limited. We interviewed the caregivers to collected data on HFMD patients who sought medical care in the People's Hospital of Baoan district, Shenzhen, from 2015 to 2017. Totally, 131 severe patients were frequency‐matched by age and gender with 174 mild patients infected with CV‐A6. Univariable and multivariable logistic regression analyses were conducted to analyze the risk factors for severe CV‐A6 HFMD. The average age was 20.62 ± 14.18 months and 20.52 ± 12.76 months for severe and mild patients, respectively. Multivariate analyses indicated complications at birth (odds ratio [OR], 4.18; 95% confidence interval [CI]: 1.64‐10.63), peak body temperature over 39°C (OR, 4.04; 95% CI: 2.29‐7.10) and first‐born child (OR, 2.17; 95% CI: 1.27‐3.70) increased the risk of severe HFMD infected with CV‐A6. Breastfeeding (OR, 0.52; 95% CI: 0.32‐0.87), and washing hands after playing frequently (OR, 0.58; 95% CI: 0.34‐0.97) were negatively associated with severe illness. Compared with HFMD with infection of EV‐A71, complications at birth and first‐born child were newly found to be associated with severe illness in HFMD patients infected with CV‐A6.

The article, from Journal of Medical Virology, “Prevalence and Management of Severe Hand, Foot, and Mouth Disease in Xiangyang, China from 2008‐2013” by Jian Liu and Jing Qi, published online on 16 June 2020 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the authors, the journal Editor Shou‐Jiang Gao and John Wiley and Sons, Inc. The withdrawal has been agreed following a request by Jing Qi because the paper had been submitted without approval of both authors.

Therapeutic strategies for severe hand, foot and mouth disease (HFMD) are currently either inconsequent or deficient in evidence. We retrospectively surveyed HFMD outbreaks in Xiangyang from June 2008 to December 2013. FHMD is staged form I to V according to clinical severity and the case with central nervous system involvement is defined as a severe one. Most severe cases were investigated to analyse risk factors for fatality and to compare the efficiency and outcome of some therapies by binary logistic regression. The overall HFMD cases included 637 (1.26%) severe cases, 38 fatal cases (0.75‰). Analysis indicates that age (<3 y), enterovirus 71 (+), autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP (>40 mg/L) and cardiac troponin I (>0.04 ng/mL) are risk factors for fatality (all P < 0.05). Intravenous immunoglobulin (IVIG) and mechanical ventilation applied in early stage IV significantly improved HFMD progression (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10), respectively. Methylprednisolone and milrinone administered in any stage, and all therapies applied in stage III made no significant difference on mortality (all P > 0.05). Precise recognition of the severe HFMD cases in early stage IV and timely IVIG and mechanical ventilation application may decrease mortality. Mechanical ventilation training programs and dispatching specialists to county-level or district hospitals when there is no chance for severe HFMD cases to be transferred to superior hospitals are two key successful administrative initiatives.