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. 2019 Aug 12;9(1):11662.
doi: 10.1038/s41598-019-48259-1.

The Clinical and Epidemiological Study of Children with Hand, Foot, and Mouth Disease in Hunan, China from 2013 to 2017

Jun Qiu  1 , Haipeng Yan  2 , Nianci Cheng  2 , Xiulan Lu  2 , Xia Hu  2 , Lijuan Liang  2 , Zhenghui Xiao  3 , Lihong Tan  4
Affiliations

The Clinical and Epidemiological Study of Children with Hand, Foot, and Mouth Disease in Hunan, China from 2013 to 2017

Jun Qiu et al. Sci Rep. .

Abstract

Hand, foot, and mouth disease (HFMD) is endemic in the Pacific region, especially in mainland China. The case-fatality ratio of HFMD is increasing steadily. Knowledge of the changing epidemiology of HFMD in different regions is necessary for implementing appropriate intervention strategies. In this study, we describe the clinical and epidemiological characteristics of HFMD in Hunan Children's Hospital between 2013 and 2017. A total of 7203 patients with HFMD were admitted, with complication and mortality rates of 35.62% and 0.78%, respectively. The total number of children with HFMD, proportion of severely ill children, and HFMD mortality rate were the highest in 2014. The number of cases caused by EV-A71 and CV-A16 decreased continuously, while the number of cases caused by 'other enteroviruses' increased yearly since 2014, suggesting that other enteric viruses will gradually replace EV-A71 and CV-A16 as the main pathogenic HFMD agents. Furthermore, EV-A71 and mixed infections accounted for the high case fatality rates in children with severe HFMD, among whom EV-A71 infection resulted in the highest complication and mortality rates; the mild form of the disease was dominated by 'other enteroviruses'. In conclusion, the changing etiological pattern highlights the need to improve pathogen surveillance and vaccine strategies for HFMD control.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Complication rates and case fatality rates in different age groups.
Figure 2
Figure 2
Distribution of virus types in children with hand, foot, and mouth disease from 2013–2017.
Figure 3
Figure 3
Proportion of different virus types, complication rates, and mortality rates in mild HFMD and severe HFMD. (a) Composition of virus types in mild HFMD. (b) Composition of virus types in severe HFMD. (c) Difference in severity of disease with different virus types. (d) Complication rates with different virus types. (e) Mortality rates with different virus types. HFMD: hand, foot, and mouth disease.
See this image and copyright information in PMC

References

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