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Li P, Huang Y, Zhu D, Yang S, Hu D. Risk Factors for Severe Hand-Foot-Mouth Disease in China: A Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:716039. [PMID: 34858899 PMCID: PMC8631475 DOI: 10.3389/fped.2021.716039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: This study aimed to identify potential risk factors for severe hand-foot-mouth disease (HFMD). Methods: The PubMed, Embase, the Cochrane Library, Sinomed, WanFang, CNKI, and VIP databases were searched (up to August 2021). Results: Twenty-nine studies (9,241 and 927,355 patients with severe HFMD and controls, respectively; all from China) were included. EV71 was associated with higher odds of severe HFMD compared with other agents (OR = 4.44, 95%CI: 3.12-6.33, p < 0.001). Being home-raised (OR = 1.99, 95%CI: 1.59-2.50, p < 0.001), higher number of children in the family (OR = 2.09, 95%CI: 1.93-2.27, p < 0.001), poor hand hygiene (OR = 2.74, 95%CI: 1.78-4.23, p < 0.001), and no breastfeeding (OR = 2.01, 95%CI: 1.45-2.79, p < 0.001) were risk factors for severe HFMD. First consulting to a district-level or above hospital (OR = 0.34, 95%CI: 0.25-0.45, p < 0.001) and diagnosis of HFMD at baseline (OR = 0.17, 95%CI: 0.13-0.24, p < 0.001) were protective factors against severe HFMD. Fever, long fever duration, vomiting, lethargy, leukocytosis, tic, and convulsions were each associated with severe HFMD (all p < 0.05), while rash was not. Conclusions: EV71, lifestyle habits, frequent hospital visits, and symptoms are risk factors for severe HFMD in children in China, while early diagnosis and admission to higher-level hospitals are protective factors.
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Affiliation(s)
- Peiqing Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuge Huang
- Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Danping Zhu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Sida Yang
- Department of Pediatric Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dandan Hu
- Children's Health Section, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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2
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Liu J, Chen Y, Hu P, Gan L, Tan Q, Huang X, Ma Z, Lin C, Wu D, Zhu X, Zhang D. Caregivers: the potential infection resources for the sustaining epidemic of hand, foot, and mouth disease/herpangina in Guangdong, China? Arch Public Health 2021; 79:54. [PMID: 33892784 PMCID: PMC8063478 DOI: 10.1186/s13690-021-00574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although several measures have been taken to control hand foot and mouth disease (HFMD) and herpangina (HA), these two diseases have been prevalent in China for 10 years with high incidence. We suspected that adults' inapparent infection might be the cause of the continued prevalence of HFMD/HA infection in mainland China. METHODS To explore the role of adults (especially caregivers) in the transmission process of HFMD/HA among children, 330 HFMD/HA cases and 330 healthy children (controls) were selected for a case-control study. Then, data were analyzed by logistic regression. RESULTS Single-variable analyses revealed that caregivers who tested positive for enterovirus was a significant risk factor of HFMD/HA transmission to children (adjusted odds ratio (OR) = 9.22; 95% CI, 1.16 to 73.23). In the final multivariable model, caregiver behavior, such as cooling children's food with mouth (OR = 1.85; 95% CI, 1.11 to 3.08) and feeding children with their own tableware (OR = 2.19; 95% CI, 1.07 to 4.45), significantly increased the risk of transmitting HFMD/HA to children. On the contrary, washing hands before feeding children reduced such risk. CONCLUSIONS These results implied that the caregivers might be the infectious source or carriers of enterovirus. Therefore, preventing or treating the caregivers' enterovirus infection and improving their hygiene habits, especially when they are in contact with children, could provide a breakthrough for the effective control of HFMD/HA.
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Affiliation(s)
- Jundi Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Zhongshan Center for Diseases Prevention and Control, Zhongshan, China
| | - Yan Chen
- Medical College of Shaoguan University, Shaoguan, China
| | - Peipei Hu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Gan
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qimin Tan
- Yonghe Community Health Service Center, Yongning Street, Zengcheng District, Guangzhou, China
| | - Xinqiao Huang
- Yonghe Community Health Service Center, Yongning Street, Zengcheng District, Guangzhou, China
| | - Zhanzhong Ma
- Clinical Laboratory, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, China
| | - Cuiji Lin
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Dawei Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xun Zhu
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Dingmei Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
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3
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Wang K, Wang F, Li Y, Liang L, Cui P, Han S, Zhou Y, Qiu Q, Cheng Y, Guo C, Zeng M, Long L, Zhang T, Yu H. Association of Clinical Severity With Family Affluence-Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study. Open Forum Infect Dis 2021; 8:ofab150. [PMID: 34327251 PMCID: PMC8314950 DOI: 10.1093/ofid/ofab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The association between the clinical severity of hand, foot, and mouth disease (HFMD) inpatients and socioeconomic status (SES) is important for quantifying SES inequality in HFMD disease burden and informing decision-makers regarding medical subsidy and reimbursement policies. Here, this association was investigated using a quantitative SES measurement. Methods Laboratory-confirmed HFMD cases hospitalized at Henan Children's Hospital from February 15, 2017, to February 15, 2018, were invited. We utilized the revised Family Affluence Scale for family affluence-based SES measurement. Clinical severity was diagnosed based on central nervous system (CNS) complications, treatments, and length of stay. We applied logistic regression for association analyses and multiple imputation for missing data. Results A total of 1229 laboratory-confirmed HFMD inpatients responded. Adjusted by age, sex, rural residence, EV-A71 infection, and health-seeking behavior, CNS complications (odds ratio [OR], 2.72; 95% CI, 1.41-5.31), intensive care unit (ICU) admission (OR, 7.30; 95% CI, 2.21-25.97), and prolonged hospitalization (OR, 4.28; 95% CI, 2.44-7.58) were significantly associated with lower family affluence-based SES. These associations increased as the SES category descended. For EV-A71-infected inpatients, severe HFMD was significantly associated with low and intermediate SES. For non-EV-A71-infected inpatients, only the association of prolonged hospitalization with low SES increased significantly. Also, severe HFMD inpatients, especially those admitted to the ICU, incurred high hospitalization costs. Conclusions The clinical severity of HMFD inpatients was significantly associated with family affluence-based SES. Severe HFMD inpatients were more likely to have lower SES than nonsevere inpatients and suffered a heavy economic burden. Therefore, medical subsidy and reimbursement policies should offer sufficient monetary support to severe HFMD inpatients to alleviate economic burden in low-SES populations and reduce potential SES inequality.
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Affiliation(s)
- Kai Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Fang Wang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lu Liang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Shujuan Han
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yibing Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Chun Guo
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyao Zeng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.,NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Medical School, Fudan University, Shanghai, China
| | - Lu Long
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tianchen Zhang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Li Y, Xiong T, Meng Y, Zhao R, Yu G, Liu J, Xiao J, Wang K, Wu T, Wei S, Huang J. Risk factors for severe hand, foot, and mouth disease infected with Coxsackievirus A6: A hospital-based case-control study. J Med Virol 2020; 92:3144-3150. [PMID: 32706451 DOI: 10.1002/jmv.26343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Yanan Li
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tiantian Xiong
- Department for Infectious Disease Control and Prevention, Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Yu Meng
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongxian Zhao
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangqing Yu
- Department for Infectious Disease Control and Prevention, Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Jian Liu
- Deprtment of Pediatrics, People's Hospital of Baoan district, Shenzhen, China
| | - Jinrong Xiao
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Wang
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taishun Wu
- Department for Infectious Disease Control and Prevention, Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Sheng Wei
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Huang
- State Key Laboratory of Environmental Health (Incubating), Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Zhao Q, Li S, Cao W, Liu DL, Qian Q, Ren H, Ding F, Williams G, Huxley R, Zhang W, Guo Y. Modeling the Present and Future Incidence of Pediatric Hand, Foot, and Mouth Disease Associated with Ambient Temperature in Mainland China. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:047010. [PMID: 29681142 PMCID: PMC6071822 DOI: 10.1289/ehp3062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND There is limited evidence about the association between ambient temperature and the incidence of pediatric hand, foot, and mouth disease (HFMD) nationwide in China. OBJECTIVES We examined the childhood temperature-HFMD associations across mainland China, and we projected the change in HFMD cases due to projected temperature change by the 2090s. METHODS Data on daily HFMD (children 0-14 y old) counts and weather were collected from 362 sites during 2009-2014. Daily temperature by the 2090s was downscaled under the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. Temperature-HFMD associations were quantified using a two-stage Poisson regression with a distributed lag nonlinear model. The impact of changes in temperature on the incidence of HFMD was estimated by combining the fitted temperature-HFMD associations with projected temperatures under each scenario, assuming a constant population structure. Sensitivity analyses were performed to assess the influence of primary model assumptions. RESULTS During 2009-2014, >11 million HFMD cases were reported. In most regions, the temperature-HFMD association had an inverted U shape with a peak at approximately 20°C, but the association leveled off or continued to increase in the Inner Mongolia and Northeast regions. When estimates were pooled across all regions and the population size was held constant, the projected incidence of HFMD increased by 3.2% [95% empirical confidence interval (eCI): −13.5%, 20.0%] and 5.3% (95% eCI: −33.3%, 44.0%) by the 2090s under the RCP 4.5 and 8.5 scenarios, respectively. However, regional projections suggest that HFMD may decrease with climate change in temperate areas of central and eastern China. CONCLUSION Our estimates suggest that the association between temperature and HFMD varies across China and that the future impact of climate change on HFMD incidence will vary as well. Other factors, including changes in the size of the population at risk (children 0-14 y old) will also influence future HFMD trends. https://doi.org/10.1289/EHP3062.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wei Cao
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - De-Li Liu
- New South Wales Department of Primary Industries, Wagga Wagga, New South Wales, Australia
| | - Quan Qian
- Center for Disease Surveillance and Research, Institute for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Hongyan Ren
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Fan Ding
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gail Williams
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Wenyi Zhang
- Center for Disease Surveillance and Research, Institute for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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6
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Chen SM, Qiu L, Du ZH, Jin YM, Du JW, Chen Y, Watanabe C, Umezaki M. Spatial Clustering of Severe Hand-Foot-Mouth Disease Cases on Hainan Island, China. Jpn J Infect Dis 2017; 70:604-608. [PMID: 28890503 DOI: 10.7883/yoken.jjid.2016.407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of severe hand-foot-mouth disease (HFMD) in Southeast and East Asia has increased in recent years. This study explored spatial clusters of the incidence and proportion of severe HFMD cases on Hainan Island, where the prevalence and mortality of HFMD were the highest in China during 2011. A spatial autocorrelation statistic (Anselin's Local Moran I) was calculated for the Empirical Bayesian (EB)-smoothed dataset of severe HFMD cases. Significant spatial clusters were detected for both the incidence and proportion of severe HFMD cases. Population density was higher in spatial clusters with a high proportion of severe HFMD cases among total HFMD cases. We speculate that a higher proportion of severe HFMD cases were diagnosed in densely populated townships. This should be considered when analyzing the HFMD database of Hainan Island.
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Affiliation(s)
- Shao-Ming Chen
- Hainan Provincial Center for Disease Control and Prevention.,Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo
| | - Li Qiu
- Hainan Provincial Center for Disease Control and Prevention
| | - Zhong-Hua Du
- Hainan Provincial Center for Disease Control and Prevention
| | - Yu-Ming Jin
- Hainan Provincial Center for Disease Control and Prevention
| | - Jian-Wei Du
- Hainan Provincial Center for Disease Control and Prevention
| | - Yan Chen
- Hainan Provincial Center for Disease Control and Prevention
| | - Chiho Watanabe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo
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7
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Machine Learning Algorithms for Risk Prediction of Severe Hand-Foot-Mouth Disease in Children. Sci Rep 2017; 7:5368. [PMID: 28710409 PMCID: PMC5511270 DOI: 10.1038/s41598-017-05505-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/06/2017] [Indexed: 11/08/2022] Open
Abstract
The identification of indicators for severe HFMD is critical for early prevention and control of the disease. With this goal in mind, 185 severe and 345 mild HFMD cases were assessed. Patient demographics, clinical features, MRI findings, and laboratory test results were collected. Gradient boosting tree (GBT) was then used to determine the relative importance (RI) and interaction effects of the variables. Results indicated that elevated white blood cell (WBC) count > 15 × 109/L (RI: 49.47, p < 0.001) was the top predictor of severe HFMD, followed by spinal cord involvement (RI: 26.62, p < 0.001), spinal nerve roots involvement (RI: 10.34, p < 0.001), hyperglycemia (RI: 3.40, p < 0.001), and brain or spinal meninges involvement (RI: 2.45, p = 0.003). Interactions between elevated WBC count and hyperglycemia (H statistic: 0.231, 95% CI: 0-0.262, p = 0.031), between spinal cord involvement and duration of fever ≥3 days (H statistic: 0.291, 95% CI: 0.035-0.326, p = 0.035), and between brainstem involvement and body temperature (H statistic: 0.313, 95% CI: 0-0.273, p = 0.017) were observed. Therefore, GBT is capable to identify the predictors for severe HFMD and their interaction effects, outperforming conventional regression methods.
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8
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Nawas ZY, Tong Y, Kollipara R, Peranteau AJ, Woc-Colburn L, Yan AC, Lupi O, Tyring SK. Emerging infectious diseases with cutaneous manifestations: Viral and bacterial infections. J Am Acad Dermatol 2017; 75:1-16. [PMID: 27317512 DOI: 10.1016/j.jaad.2016.04.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/16/2022]
Abstract
Given increased international travel, immigration, and climate change, bacterial and viral infections that were once unrecognized or uncommon are being seen more frequently in the Western Hemisphere. A delay in diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. We review the epidemiology, cutaneous manifestations, diagnosis, and management of these emerging bacterial and viral diseases.
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Affiliation(s)
| | - Yun Tong
- Center for Clinical Studies, Houston, Texas
| | - Ramya Kollipara
- Department of Dermatology, Texas Tech Health Sciences Center, Lubbock, Texas
| | | | - Laila Woc-Colburn
- Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Albert C Yan
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Omar Lupi
- Federal University of the State of Rio de Janeiro and Policlinica Geral do Rio de Janeiro, Rio de Janerio, Brazil
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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9
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Luo KW, Gao LD, Hu SX, Zhang H, Deng ZH, Huang W, Sun QL, Zhang F, Zhang SY, Chen Y. Hand, Foot, and Mouth Disease in Hunan Province, China, 2009-2014: Epidemiology and Death Risk Factors. PLoS One 2016; 11:e0167269. [PMID: 27898715 PMCID: PMC5127556 DOI: 10.1371/journal.pone.0167269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 11/12/2016] [Indexed: 11/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is an arising public health problem in Asia, including China. Epidemiological data is necessary to enable judicious public health responses and interventions. We analyzed the epidemiological and laboratory data of 759,301 HFMD cases reported to the Hunan Provincial Center for Disease Control and Prevention from 1 January 2009 to 31 December 2014. Univariate and multivariable conditional logistic regression analyses were used to identify risk factors of fatality in HFMD. The incidence of HFMD was highest among children aged 1-3 years, compared with other age groups. Of the total HFMD cases, 7,222 (0.95%) were considered severe and 338 (0.04%) were fatal. Enterovirus-A71 was the major cause of severe and fatal cases (65.75% and 88.78%, respectively). For severe cases, the median time from symptom onset to diagnosis was 0.5 days (interquartile range [IQR] 0-1.5 days); the median time from diagnosis to severe illness was 2 days (IQR 1-3 days). For fatal cases, the median time from symptom onset to diagnosis was 0.5 days (IQR 0-1.5 days); the median time from diagnosis to death was 1.5 days (IQR 0.5-2.5 days). In multivariable analysis, the abuse of antibiotic, glucocorticoid and pyrazolone in village clinics at basic medical institutions were identified as independent risk factors for HFMD fatal cases. In conclusion, our results suggest that the future direction to control and respond to HFMD is intensive surveillance of enterovirus-A71 and improving the ability to diagnose disease and treat patients, especially in basic medical institutions.
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Affiliation(s)
- Kai-Wei Luo
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
- * E-mail:
| | - Li-Dong Gao
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Shi-Xiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Hong Zhang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Zhi-Hong Deng
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Wei Huang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Qian-Lai Sun
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Fan Zhang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Si-Yu Zhang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Yu Chen
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
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10
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Duong V, Mey C, Eloit M, Zhu H, Danet L, Huang Z, Zou G, Tarantola A, Cheval J, Perot P, Laurent D, Richner B, Ky S, Heng S, Touch S, Sovann L, van Doorn R, Tan Tran T, Farrar JJ, Wentworth DE, Das SR, Stockwell TB, Manuguerra JC, Delpeyroux F, Guan Y, Altmeyer R, Buchy P. Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia. Emerg Microbes Infect 2016; 5:e104. [PMID: 27651091 PMCID: PMC5113052 DOI: 10.1038/emi.2016.101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/03/2016] [Accepted: 07/25/2016] [Indexed: 02/08/2023]
Abstract
Human enterovirus 71 (EV-A71) causes hand, foot and mouth disease (HFMD). EV-A71 circulates in many countries and has caused large epidemics, especially in the Asia-Pacific region, since 1997. In April 2012, an undiagnosed fatal disease with neurological involvement and respiratory distress occurred in young children admitted to the Kantha Bopha Children's Hospital in Phnom Penh, Cambodia. Most died within a day of hospital admission, causing public panic and international concern. In this study, we describe the enterovirus (EV) genotypes that were isolated during the outbreak in 2012 and the following year. From June 2012 to November 2013, 312 specimens were collected from hospitalized and ambulatory patients and tested by generic EV and specific EV-A71 reverse transcription PCR. EV-A71 was detected in 208 clinical specimens while other EVs were found in 32 patients. The VP1 gene and/or the complete genome were generated. Our phylogenetic sequencing analysis demonstrated that 80 EV-A71 strains belonged to the C4a subgenotype and 3 EV-A71 strains belonged to the B5 genotype. Furthermore, some lineages of EV-A71 were found to have appeared in Cambodia following separate introductions from neighboring countries. Nineteen EV A (CV-A6 and CV-A16), 9 EV B (EV-B83, CV-B3, CV-B2, CV-A9, E-31, E-2 and EV-B80) and 4 EV C (EV-C116, EV-C96, CV-A20 and Vaccine-related PV-3) strains were also detected. We found no molecular markers of disease severity. We report here that EV-A71 genotype C4 was the main etiological agent of a large outbreak of HFMD and particularly of severe forms associated with central nervous system infections. The role played by other EVs in the epidemic could not be clearly established.
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MESH Headings
- Adolescent
- Adult
- Cambodia/epidemiology
- Child
- Child, Preschool
- Disease Outbreaks
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Enterovirus A, Human/isolation & purification
- Enterovirus A, Human/pathogenicity
- Epidemics
- Female
- Genome, Viral
- Genotype
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/mortality
- Hand, Foot and Mouth Disease/virology
- Hospitalization
- Humans
- Infant
- Male
- Phylogeny
- RNA, Viral/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Young Adult
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Affiliation(s)
- Veasna Duong
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | - Channa Mey
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | | | - Huachen Zhu
- State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lucie Danet
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | - Zhong Huang
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | - Gang Zou
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | | | | | | | | | - Beat Richner
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Santy Ky
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Sothy Heng
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Sok Touch
- Ministry of Health, Phnom Penh 12000, Cambodia
| | - Ly Sovann
- Ministry of Health, Phnom Penh 12000, Cambodia
| | - Rogier van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | - Thanh Tan Tran
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | - Jeremy J Farrar
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | | | - Suman R Das
- J. Craig Venter Institute, Rockville, MD 92037, USA
| | | | | | - Francis Delpeyroux
- Pasteur Institute, Paris 75724, France
- National Institute for Health and Medical Research, INSERM U994, Paris 75000, France
| | - Yi Guan
- State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ralf Altmeyer
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | - Philippe Buchy
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
- GlaxoSmithKline Vaccines R&D, Singapore 189720, Singapore
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