Epidemiological characteristics of severe cases of hand, foot, and mouth disease in Guangdong, China

ABSTRACT

Hand, foot, and mouth disease (HFMD) has become a major public health issue in China, especially in Guangdong. The burden of severe cases deserves further attention. We hereby explored the epidemiological features of severe HFMD in Guangdong. Patients who were from rural areas (OR = 2.03, 95% CI: 1.86–2.21), males (OR = 1.17, 1.07–1.28), aged ≤3 years old (2.48, 1.68–3.68, and 1.63, 1.10–2.41, for ≤1 and 2–3 years, respectively), and/or infected with EV71 (6.69, 5.98–7.49) tended to progress to severe status. Cases from rural areas tended to have a longer interval from onset to diagnosis (p < .001; i.e. the proportions of each interval (≤1, ∼2, ∼3, ∼4, and >4 days) for rural and urban areas in 2009 were 14%, 13%, 14%, 8%, 51%, and 21%, 21%, 15%, 11%, 31%, respectively). The spatial pattern of the epidemics clarified by the flexible scan statistic showed that the clusters of severe cases were observed to be expanding from the Pearl River Delta Region to the Eastern Region and the Mountainous Region. Overall, the relative risk of the most likely clusters ranged from 5.548 to 15.558 (all p < .001). Our results were particularly practical and important for developing severe HFMD-targeted control programs in the context of disease surveillance.

Abbreviations: CA16: Coxsackievirus A16; EV71: enterovirus 71; GDP: gross domestic product; HFMD: hand; foot and mouth disease.

KEYWORDS:

• Hand, foot, and mouth disease (HFMD)
• severe cases
• epidemiological characteristics
• flexible scan statistic
• spatial pattern

Acknowledgements

The authors thank Professor Lin Xu for providing great assistance in polishing and revising the whole manuscript. They also thank the Chinese Center for Disease Control and Prevention for providing the data on notified hand, foot, and mouth disease cases. Zhicheng Du participated in the design, performed data analysis and interpretation, and drafted the manuscript. Dingmei Zhang and Shicheng Yu participated in the design and results interpretation, and helped to finalize the manuscript. Yuantao Hao and Wangjian Zhang participated in the design and supervised the study, participated in interpretation of results, and helped to finalize the manuscript. All authors have read and approved the contents of the final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Yuantao Hao http://orcid.org/0000-0001-8024-5312

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant number 81473064]; and the Guangzhou Science and Technology Program key projects [grant number 201506010072].

Notes on contributors

Zhicheng Du

Zhicheng Du is a doctoral candidate at the Department of Medical Statistics and Epidemiology in the Sun Yat-sen University.

Wangjian Zhang

Wangjian Zhang is a doctoral candidate at the Department of Medical Statistics and Epidemiology in the Sun Yat-sen University.

Dingmei Zhang

Dingmei Zhang is an associate professor at the Department of Medical Statistics and Epidemiology in the Sun Yat-sen University.

Shicheng Yu

Shicheng Yu is a professor at the Office of Epidemiology in the Chinese Center for Disease Control and Prevention.

Yuantao Hao

Yuantao Hao is a professor at the Department of Medical Statistics and Epidemiology in the Sun Yat-sen University.