AUTHOR=Li Peiqing , Huang Yuge , Zhu Danping , Yang Sida , Hu Dandan 

TITLE=Risk Factors for Severe Hand-Foot-Mouth Disease in China: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.716039

DOI=10.3389/fped.2021.716039

ISSN=2296-2360

ABSTRACT=<p><bold>Background:</bold> This study aimed to identify potential risk factors for severe hand-foot-mouth disease (HFMD).</p><p><bold>Methods:</bold> The PubMed, Embase, the Cochrane Library, Sinomed, WanFang, CNKI, and VIP databases were searched (up to August 2021).</p><p><bold>Results:</bold> 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, <italic>p</italic> &lt; 0.001). Being home-raised (OR = 1.99, 95%CI: 1.59–2.50, <italic>p</italic> &lt; 0.001), higher number of children in the family (OR = 2.09, 95%CI: 1.93–2.27, <italic>p</italic> &lt; 0.001), poor hand hygiene (OR = 2.74, 95%CI: 1.78–4.23, <italic>p</italic> &lt; 0.001), and no breastfeeding (OR = 2.01, 95%CI: 1.45–2.79, <italic>p</italic> &lt; 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, <italic>p</italic> &lt; 0.001) and diagnosis of HFMD at baseline (OR = 0.17, 95%CI: 0.13–0.24, <italic>p</italic> &lt; 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 <italic>p</italic> &lt; 0.05), while rash was not.</p><p><bold>Conclusions:</bold> 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.</p>