World Journal of Pediatrics

, Volume 14, Issue 5, pp 437–447 | Cite as

Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

  • Xing-Wang Li
  • Xin NiEmail author
  • Su-Yun Qian
  • Quan Wang
  • Rong-Meng Jiang
  • Wen-Bo Xu
  • Yu-Cai Zhang
  • Guang-Jun Yu
  • Qiang Chen
  • Yun-Xiao Shang
  • Cheng-Song Zhao
  • Hui Yu
  • Ting Zhang
  • Gang Liu
  • Hui-Ling Deng
  • Jie Gao
  • Xian-Gui Ran
  • Qiao-Zhi Yang
  • Bian-Li Xu
  • Xue-Yong Huang
  • Xing-Dong Wu
  • Yi-Xiao Bao
  • Yi-Ping Chen
  • Zhi-Hai Chen
  • Qing-Quan Liu
  • Guo-Ping Lu
  • Chun-Feng Liu
  • Rong-Bing Wang
  • Guo-Liang Zhang
  • Fang Gu
  • Hong-Mei Xu
  • Ying Li
  • Tao Yang
Review Article



Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treatments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed.


National Health Commission of China assembled an expert committee for a revision of the guidelines. The committee included 33 members who are specialized in diagnosis and treatment of HFMD.


Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia; (2) involvement of nervous system; (3) worsening respiratory rate and rhythm; (4) circulatory dysfunction; (5) elevated peripheral WBC count; (6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases.


The guidelines can provide systematic guidance on the diagnosis and management of HFMD.


Diagnosis Guidelines HFMD Treatment 



The Chinese version of this Guideline was published in the June issue of Chin J Infect Dis in 2018. We acknowledge the editing assistance of the English version of HFMD guidelines from Stephen Toovey, MD, PhD, and Jim Wu PhD, and also thank Mi Yao and Zhi-Jie Xu for translation support.

Author contributions

LXW, NX, QSY: contributed equally to this guideline. All the other authors confirmed the final version of the guideline.


The National Clinical Key Department of Infectious Diseases; The Key Medical Specialty Program of Sailing Plans organized by Beijing Municipal Administration of Hospitals (No. ZYLX201602)

Compliance with ethical standards

Ethical approval

Not required.

Conflict of interest

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.


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Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018

Authors and Affiliations

  • Xing-Wang Li
    • 1
  • Xin Ni
    • 2
    Email author
  • Su-Yun Qian
    • 3
  • Quan Wang
    • 3
  • Rong-Meng Jiang
    • 1
  • Wen-Bo Xu
    • 4
  • Yu-Cai Zhang
    • 5
  • Guang-Jun Yu
    • 6
  • Qiang Chen
    • 7
  • Yun-Xiao Shang
    • 8
  • Cheng-Song Zhao
    • 9
  • Hui Yu
    • 10
  • Ting Zhang
    • 11
  • Gang Liu
    • 9
  • Hui-Ling Deng
    • 12
  • Jie Gao
    • 13
  • Xian-Gui Ran
    • 14
  • Qiao-Zhi Yang
    • 15
  • Bian-Li Xu
    • 16
  • Xue-Yong Huang
    • 16
  • Xing-Dong Wu
    • 17
  • Yi-Xiao Bao
    • 18
  • Yi-Ping Chen
    • 19
  • Zhi-Hai Chen
    • 1
  • Qing-Quan Liu
    • 20
  • Guo-Ping Lu
    • 21
  • Chun-Feng Liu
    • 22
  • Rong-Bing Wang
    • 23
  • Guo-Liang Zhang
    • 24
  • Fang Gu
    • 25
  • Hong-Mei Xu
    • 26
  • Ying Li
    • 27
  • Tao Yang
    • 28
  1. 1.Infectious Disease Diagnosis and Treatment CenterBeijing Ditan Hospital Capital Medical UniversityBeijingChina
  2. 2.Otorhinolaryngology Head and Neck SurgeryBeijing Children’s Hospital, Capital Medical UniversityBeijingChina
  3. 3.Prediatric Intensive Care UnitBeijing Children’s Hospital of Capital Medical UniversityBeijingChina
  4. 4.National Institute For Viral Disease Control and PreventionChinese Center for Disease Control and PreventionBeijingChina
  5. 5.Pediatric Intensive Care UnitChildren’s Hospital of Shanghai Jiaotong UniversityShanghaiChina
  6. 6.Children’s Hospital of Shanghai Jiaotong UniversityShanghaiChina
  7. 7.Pneumology department, Jiangxi Provincial Children’s HospitalNanchangChina
  8. 8.Department of Pediatric PneumologyShengjing Hospital of China Medical UniversityShenyangChina
  9. 9.Department of Infectious DiseasesBeijing Children’s Hospital, Capital Medical UniversityBeijingChina
  10. 10.Department of Infectious DiseasesChildren’s Hospital of Fudan UniversityShanghaiChina
  11. 11.Digestive DepartmentChildren’s Hospital of Shanghai Jiaotong UniversityShanghaiChina
  12. 12.Department of Infectious DiseasesThe Children’s Hospital of Xi ‘anXi’anChina
  13. 13.Infection Control OfficeChildren’s Hospital of Shanghai Jiaotong UniversityShanghaiChina
  14. 14.Department of Respiratory MedicinePeople’s Hospital of Fuyang CityFuyangChina
  15. 15.Department of PediatricsPeople’s Hospital of Liaocheng CityLiaochengChina
  16. 16.Henan Provincial Center for Disease Control and PreventionZhengzhouChina
  17. 17.Department of PediatricsXiamen Maternal and Child Health Care HospitalXiamenChina
  18. 18.Pneumology DepartmentShanghai Children’s Medical Center of Shanghai Jiaotong University Medical SchoolShanghaiChina
  19. 19.Department of Pediatrics Infectious DiseasesThe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
  20. 20.Beijing Hospital of Traditional Chinese MedicineBeijingChina
  21. 21.Prediatric Intensive Care UnitChildren’s Hospital of Fudan UniversityShanghaiChina
  22. 22.Pediatric Intensive Care UnitShengjing Hospital of China Medical UniversityShenyangChina
  23. 23.Department of Integrated Traditional Chinese and Western MedicineBeijing Ditan Hospital Capital Medical UniversityBeijingChina
  24. 24.Department of Infectious DiseasesThe First Affiliated Hospital of Anhui University of Traditional Chinese MedicineHefeiChina
  25. 25.Pneumology Department, Baoding Hospital of Beijing Children’s HospitalBaodingChina
  26. 26.Department of Infectious DiseasesChildren’s Hospital of Chongqing Medical UniversityChongqingChina
  27. 27.Department of Infectious DiseasesTianjin Second People’s HospitalTianjinChina
  28. 28.Department of PediatricsYan’an Hospital of Kunming CityKunmingChina

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