Abstract
BackgroundHand-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.MethodsBetween 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.ResultsRisk 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.ConclusionsThe 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.
Highlights
Hand-foot-and-mouth disease (HFMD) is considered to be self-limited, severe HFMD is a deadly threat for children worldwide, it is essential to define the clinical and epidemiologic characteristics of children with severe HFMD and identify the risk factors of death
HFMD is mainly caused by a group of enterovirus, mainly by enterovirus 71(EV71) and coxsackie virus Coxsackie virus A16 (A16) (Cox A16) [4, 6,7,8], it is characterized by fever, oral ulcers, and skin eruptions on hands, feet, buttocks [9,10,11], and transmission occurs through the direct contact with saliva, feces, vesicular fluid, or respiratory droplets of the infected individual, and indirectly by contaminated articles [12, 13]
Since Chongqing is one of the districts in China affected by the outbreaks of severe HFMD [1, 24] and studies have shown the incidence of HFMD in Chongqing was higher than the national incidence, as well as that in many countries or regions [24], the present study aimed to investigate the clinical and epidemiological characteristics of severe HFMD and identify risk factors of severe HFMD in our population by taking Chongqing as an example, which may provide theoretical support for further prevention, diagnosis and treatment of severe HFMD
Summary
Hand-foot-and-mouth disease (HFMD) is considered to be self-limited, severe HFMD is a deadly threat for children worldwide, it is essential to define the clinical and epidemiologic characteristics of children with severe HFMD and identify the risk factors of death. Many countries or regions have experienced pandemics of severe or fatal HFMD cases in recent years, especially Asia-Pacific countries [14,15,16,17,18]. For China, HFMD is a major public health problem, and the study of Xing W, et al showed that about 500 ~ 900 people in China died because of the severe HFMD every year, mainly in children [1], and the mortality rate among children with severe HFMD is high worldwide [19,20,21,22]. Severe HFMD poses a great threat to one’s health and life, especially the child, as well as bringing psychological and financial burden burdens for families, the research and investigation of severe HFMD are important
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