The Risk Factors of Acquiring Severe Hand, Foot, and Mouth Disease: A Meta-Analysis

OBJECTIVES: The incidence of severe hand, foot, and mouth disease (HFMD) is not low, especially in mainland China in almost every year recently. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of severe HFMD to provide suggestions on prevention and controlling. METHODS: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. RESULTS: We conducted a meta-analysis of 11 separate studies. Fever (odds ratio (OR) 7.396, 95% confidence interval (CI) 3.565-15.342), fever for more than 3 days (OR 5.773, 95% CI 4.199-7.939), vomiting (OR 6.023, 95% CI 2.598-13.963), limb trembling (OR 42.348, 95% CI 11.765-152.437), dyspnea (OR 12.869, 95% CI 1.948-85.017), contact with HFMD children (OR 5.326, 95% CI 1.263-22.466), rashes on the hips (OR 1.650, 95% CI 1.303-2.090), pathologic reflexes (OR 3057.064, 95% CI 494.409-19000), Lethargy (OR 31.791, 95% CI 3.369-300.020), convulsions (OR 23.652, 95% CI 1.973-283.592), and EV71 infection (OR 9.056, 95% CI 4.102-19.996) were significantly related to the risk of severe HFMD. We did not find an association between female sex (OR 0.918, 95% CI 0.738-1.142), scatter-lived children (OR 1.347, 95% CI 0.245-7.397), floating population (OR 0.847, 95% CI 0.202-3.549), rash on the hands (OR 0.740, 95% CI 0.292-1.874), rash on the foot (OR 0.905, 95% CI 0.645-1.272), the level of the clinic visited first (below the country level) (OR 5.276, 95% CI 0.781-35.630), breast feeding (OR 0.523, 95% CI 0.167-1.643), and the risk of severe HFMD. CONCLUSIONS: Fever, fever for more than 3 days, vomiting, limb trembling, dyspnea, contact with HFMD children, rashes on the hips, pathologic reflexes, lethargy, convulsions, and EV71 infection are risk factors for severe HFMD.