What question did this study set out to answer?

This research aims to consolidate evidence on the reinfection rates and influencing factors of hand, foot and mouth disease (HFMD) in China.

January 10, 2026Pathogens0 citationsOpen Access

A Meta-Analysis of Influencing Factors for Reinfection of Hand, Foot and Mouth Disease in China, Based on Adjusted Effect Estimates

AGAnmin GeZhengzhou University WCWeihong CuiShandong University of Traditional Chinese Medicine SQSiyu QuCenter for Disease Control

Key Result

The overall reinfection rate for hand, foot and mouth disease was 4.1%, with younger children and males identified as significant risk factors.

Key Points

This research aims to consolidate evidence on the reinfection rates and influencing factors of hand, foot and mouth disease (HFMD) in China.
Conducted a systematic review and meta-analysis of 9 articles on HFMD reinfection.
Calculated reinfection rates and adjusted odds/hazard ratios using 95% confidence intervals.
Performed literature searches across PubMed, Web of Science, and Embase.
The overall reinfection rate for HFMD was 4.1% (95% CI: 2.0–6.2%).
Males had a higher reinfection likelihood compared to females (overall effect = 1.256).
Younger children were at greater risk compared to older children (overall effect = 2.972).
Scattered children had significantly higher reinfection rates than enrolled students (overall effect: 4.017).
Non-EV71 enterovirus infections were identified as significant risk compared to EV71 infections (overall effect = 0.71).

Structured PICO

What are the reinfection rates and influencing factors for hand, foot and mouth disease in China?

Population

9 articles reporting on the epidemiology of hand, foot and mouth disease (HFMD) reinfection in China

Intervention

Risk factors including male gender, younger age, scattered children, and non-EV71 enteroviruses

Comparator

Females, older children, students, and EV71 enteroviruses

Outcome

HFMD reinfection rate and associated risk factors

The overall HFMD reinfection rate in China is 4.1%, with males, younger children, kindergarteners, and non-EV71 infections at higher risk.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Numerous studies have reported on the epidemiology of hand, foot and mouth disease (HFMD) reinfection and its potential influencing factors; however, findings regarding reinfection rates as well as determinants such as gender, age, residence, and pathogens remain inconsistent. Due to this heterogeneity in reported outcomes, a comprehensive systematic review and meta-analysis are warranted to consolidate existing evidence. Methods: Effect estimates were expressed as reinfection rates, odds ratio (OR)/hazard ratio (HR) and 95% confidence intervals (CI). When necessary, data were converted to ensure consistency across comparison groups. Results: A thorough search was carried out using the predetermined literature retrieval approach across the PubMed, Web of Science, and Embase databases. Finally, 9 articles met the inclusion criteria and were included in this study. The results indicated that the overall reinfection rate for HFMD was 4.1% (95% CI: 2.0–6.2%). Males compared to females (overall effect = 1.256, 95% CI: 1.176–1.341), younger compared to older children (overall effect = 2.972, 95% CI: 1.512–5.843), scattered children compared to students (overall effect: 4.017, 95% CI: 1.560–10.344), and enterovirus 71 (EV71) compared to non-EV71 enteroviruses (overall effect = 0.71, 95% CI: 0.59–0.86) were associated with the HFMD reinfection. Conclusions: The overall HFMD reinfection rate was 4.1% (95% CI: 2.0–6.2%). Male, younger age, kindergarten children, and infection with non-EV71 enteroviruses (compared to EV71), were identified as significant risk factors for recurrent HFMD. Targeted intervention strategies should be developed for these high-risk populations to effectively reduce the incidence of reinfection.

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