Prolonged exclusive breastfeeding, autumn birth and increased gestational age are associated with lower risk of fever in children with hand, foot, and mouth disease

Abstract

Epidemics of hand, foot, and mouth disease (HFMD) have been emerging and reemerging in recent years. This study aims to investigate whether breastfeeding and other factors may affect the profile of fever and disease course in children with HFMD. Three hundred seventy-two preschool children with HFMD were included. The demographics, environmental factors, and delivery- and feeding-associated factors in the children were obtained and their effects on the profile of fever and disease course were analyzed. Of the 372 children, 139 (37.37%) had fever during the disease course. Gender, breastfeeding pattern, birth season and gestational age were significantly different between the children with and without fever (p = 0.034, p < 0.0001, p = 0.035 and p = 0.013, respectively). After multivariate-adjusted analysis, prolonged exclusive breastfeeding (p = 0.001, OR 0.401, 95% CI 0.229-0.704), autumn birth (p = 0.007, OR 0.409, 95% CI 0.214-0.784) and higher gestational age (p = 0.029, OR 0.089, 95% CI 0.010-0.781) were protective factors for the incidence of fever.

Protective effect of exclusive breastfeeding against hand, foot and mouth disease

“…Our finding of the protective effect of exclusive breastfeeding against HFMD was consistent with a few previous studies, which also found a beneficial effect of exclusive breastfeeding for infectious diseases [18,[27][28][29][30][31][32][33]. A study in Xi'an, China including 372 HFMD cases found that exclusive breastfeeding was negatively associated with severity of HFMD [12]. One study from UK estimated that about half of hospitalizations for diarrhea and 27% of lower respiratory tract infections could be prevented if all infants were exclusively breastfed [27].…”

The effect of meteorological factors on adolescent hand, foot, and mouth disease and associated effect modifiers

“…Visual inspection of the temperature–HFMD curve suggested that the relative risk increased sharply below 10°C and became relatively flat at 10–20°C with a moderate increase trend afterwards. In the sensitivity analyses, we changed df (4, 5, 7, 8) for calendar time to control for seasonality and long-term trend, which gave similar results.…”

“…HFMD is primarily transmitted via fecal–oral route and respiratory droplets, contact with blister fluid of infected individuals, or close contact with infected individuals (3). There is no specific drug or vaccine available for HFMD so far, so preventive measures remain the only effective way to prevent its transmission, such as avoiding direct contacts with infective patients, disinfection of contaminated environment, and good personal hygiene habits (4, 5). …”

Protective effect of exclusive breastfeeding against hand, foot and mouth disease

“…There is no specific drug or effective vaccine available for HFMD, so preventive measures such as avoiding direct contact with infective persons, disinfection of viral contaminated environment, and good personal hygiene habits remain the only effective way to prevent its transmission [ 10 ],[ 11 ]. However, few studies have been conducted to examine the underlying risk factors of this disease [ 12 ],[ 13 ]. In Taiwan, a case–control study suggested that age, attendance at kindergartens/children care centers, contacts with HFMD cases, greater number of children in a family were risk factors of this illness among pre-school children [ 14 ].…”

“…And in some countries, exclusive breastfeeding during the first 6 months has been reported to have a protective effect against gastrointestinal tract infections in infancy [ 18 ],[ 19 ]. One recent study examined the effect of exclusive breastfeeding on fever occurrence in HFMD patients, showing that children HFMD patients with exclusive breastfeeding had a lower risk of fever in Xi’an, China [ 12 ].…”