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A case–control study of risk factors for severe hand–foot–mouth disease among children in Ningbo, China, 2010–2011

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Abstract

Background

A small fraction of hand–foot–mouth disease (HFMD) progression from the onset of severity to fatality may be remarkably rapid. Early recognition of children at risk of severity is critical to increase treatment effectiveness and reduce acute mortality.

Methods

A frequency-matched case–control study was conducted between January 2010 and June 2011 in Ningbo to identify risk factors associated with the occurrence of severity in children with HFMD. Data including demographic characteristics, clinical features, and laboratory test results were collected by trained interviewers through retrospective medical record review and/or face-to-face interviews with children’s parents using a standardized questionnaire.

Results

Eighty-nine cases with severe HFMD and 267 controls with mild HFMD were recruited in this study. Palm rashes (OR = 0.004, 95%CI = 0.000–0.039, p < 0.001), oral ulcers or herpes (OR = 0.001, 95%CI = 0.000–0.009, p < 0.001) were significantly associated with protection against severity, and an increased risk of severity was significantly associated with the presence of, e.g., a high fever of over 39°C for more than 3 days (OR = 2.217, 95%CI = 1.082–4.541, p = 0.030), leg trembling (OR = 29.008, 95%CI = 1.535–548.178, p = 0.025), papule rash (OR = 4.622, 95%CI = 1.110–19.252, p = 0.035), a raised WBC count > 10.8 × 109/L (OR = 4.495, 95%CI = 1.311–15.415, p = 0.017), and human enterovirus 71 infection (OR = 39.172, 95%CI = 9.803–156.522, p < 0.001).

Conclusion

Clinicians should pay increased attention to children diagnosed as HFMD with the independent risk factors above.

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Acknowledgments

The authors thank the children and their parents as well as the staff at the health centers in Ningbo, China. This work was supported by Ningbo Science and Technology Foundation (2009C50008).

Conflict of interest statement

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service, and/or company that could be construed as influencing the position presented in or the review of the manuscript.

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Authors and Affiliations

  1. Section of Communicable Diseases Prevention and Management, Ningbo Municipal Center for Disease Control and Prevention, No.237, Yongfeng Road, Ningbo, Zhejiang, 315010, China

    Tianchi Yang, Guozhang Xu, Hongjun Dong, Min Ye & Tianfeng He

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  1. Tianchi Yang
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  2. Guozhang Xu
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  3. Hongjun Dong
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Correspondence to Tianchi Yang.

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Yang, T., Xu, G., Dong, H. et al. A case–control study of risk factors for severe hand–foot–mouth disease among children in Ningbo, China, 2010–2011. Eur J Pediatr 171, 1359–1364 (2012). https://doi.org/10.1007/s00431-012-1731-7

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  • DOI: https://doi.org/10.1007/s00431-012-1731-7

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