Key result
EV71 infection was associated with a 4.44-fold increased odds of developing severe hand-foot-mouth disease compared to other etiologic agents.
Why the study?
The study was conducted to identify potential risk factors for severe hand-foot-mouth disease.
What are the risk factors for severe hand-foot-mouth disease in children in China?
Meta-Analysis (n=936,596)
What are the risk factors for severe hand-foot-mouth disease in children in China?
Odds Ratio: 4.44 (95% CI 3.12–6.33)
p-value: p=<0.001
EV71 infection, poor hygiene, and specific clinical symptoms are significant risk factors for severe HFMD in Chinese children, while early diagnosis at higher-level hospitals is protective.
May inform earlier referral and risk-flagging in China; confirms observational signals but leaves causality and generalizability open.
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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Li et al. (2021) conducted a meta-analysis in Hand-Foot-Mouth Disease (HFMD) (n=936,596). EV71 infection vs. Other etiologic agents was evaluated on Severe HFMD (OR 4.44, 95% CI 3.12-6.33, p=<0.001). EV71 infection was associated with a 4.44-fold increased odds of developing severe hand-foot-mouth disease compared to other etiologic agents.
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