Epidemiological and clinical characteristics of severe hand-foot-and-mouth disease (HFMD) among children: a 6-year population-based study

Abstract

Background: Hand-foot-and-mouth disease (HFMD) is considered to be self-limited, however, severe HFMD is a deadly threat for children worldwide, therefore, it is essential to define the clinical and epidemiologic characteristics of children with severe HFMD and identify the risk factors of death. Methods: Between 2013 and 2018, children who diagnosed with severe HFMD from Chongqing, China were enrolled in this population-based study. A total of 459 severe HFMD children cases were identified during the study period, including 415 survivors and 44 fatal cases. Demographic, geographical, epidemiological and clinical data of the cases were acquired and analyzed. Results: Risk factors of the death because of severe HFMD children included female, aged 1~3 years, enterovirus 71 infection, falling ill in winter, more than one children in home, being taken care of by grandparents, the caregivers' education not more than 9 years, having fever more than 3 days, consciousness disorders, general weakness, vomiting, general weakness, abnormal pupillary light reflex, repeated cough, tachypnea, moist rales, white frothy sputum, pink frothy sputum, and cyanosis on lips or the whole body, tachycardia, arrhythmia, cold limbs, pale complexion, weakened pulse. (all p < 0.05). Spatial-temporal analysis detected high-value clusters, the most likely cluster located at rural countries in the northern parts of Chongqing, from January, 2015 to July, 2017. (p < 0.01). Besides, some urban districts were also found high incidence of severe HFMD cases according to the incidence maps. Conclusions: The detection of clinical risk factors and the temporal, spatial and socio-demographic distribution epidemiological characteristics of severe HFMD contribute to the timely diagnosis and intervention, the results of this study can be the reference of further clinical and public health practice.

Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

“…This contrasts with other studies that describe the increase of its prevalence in HFMD cases since 2014. In fact, between 2017 and 2018 in Hangzhou, China [ 18 ], CVA10 was involved in HFMD to a greater extent than CVA6. With regard to EV-A71, this work confirms that this serotype is not prevalent in cutaneous infections in Spain, and it is more involved in the development of febrile illnesses in young children and neurological pathologies directly [ 22 , 26 , 33 , 34 ], as occurs in other European countries [ 21 , 23 , 35 ].…”

“…Up until a few years ago, there were no data about the EV serotypes circulating in Europe and causing HFMD, because there is no obligatory notification due to the benign course of infections, as most of them do not require hospitalization. However, the increasing circulation of the emerging types, such as CVA6, firstly detected in an outbreak in Finland during 2008 [ 16 ], along with the detection of more severe cases worldwide, and the appearance of accompanying symptoms, such as onychomadesis [ 15 , 16 , 17 , 18 , 19 , 20 ], suggests the necessity of a surveillance system of HFMD and its clinical evolution in Europe as well [ 21 , 22 , 23 ].…”

Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China

“…This would provide a deeper understanding of why severe HFMD cases are more likely to occur in specific regions, and then provide evidences on how to better control severe HFMD from a public health perspectives. To the best of our knowledge, rare studies have paid special attention to the associations between regional-level risk factors and severe HFMD [ 18 – 21 ]. Only a few studies sporadically reported higher population density [ 21 ], rural living [ 18 ], and lower socioeconomic status [ 18 ] would raise the epidemic of severe HFMD.…”

“…To the best of our knowledge, rare studies have paid special attention to the associations between regional-level risk factors and severe HFMD [ 18 – 21 ]. Only a few studies sporadically reported higher population density [ 21 ], rural living [ 18 ], and lower socioeconomic status [ 18 ] would raise the epidemic of severe HFMD. In fact, there were remaining other regional-level factors should be considered when estimating their impact on epidemic of severe HFMD, such as medical resource allocation, meteorological features, GDP, and population scale.…”

Inhibition of Enterovirus 71 by Picochlorum sp. 122 via AKT and ATM/ATR Signaling Pathways

“…[2] Generally, the HFMD is a self-limited disease, with the characterize of fever, oral ulcers, and skin rash on hands, feet, buttocks. [3] Unlike coxsackieviruses, EV71 infection is more occasionally to lead to severe complications, including cardiopulmonary failure, pulmonary haemorrhage, cephalitis, acute aseptic meningitis, acute accid paralysis, myocarditis and even to death. [2,4] EV71 makes HFMD an important health concern.…”