Epidemiological Features of Hand, Foot and Mouth Disease Outbreaks among Chinese Preschool Children: A Meta-analysis
AbstractAbstractBackground: Hand-foot-mouth disease (HFMD) is a widespread communicable disease and has caused large epidemics in many countries. This meta-analysis aimed to analyze and evaluate the epidemiological features of HFMD outbreaks in Chinese preschools.Methods: Literature review was based on PubMed, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases from 2008 to 2015. The temporal, spatial and demographic parameters were summarized and analyzed.Results: Overall, 19 studies with a total of 11269 HFMD cases were selected for data synthesis and analysis. April, May, June and July were detected as the peak months of HFMD outbreaks, with the pooled rate of 21% (95% CI: 12%-34%), 23% (95% CI: 19%-27%), 20% (95% CI: 17%-24%) and 11% (95% CI: 7%-15%). Urban areas were at a higher risk of suffering from HFMD outbreaks than rural areas, with the pooled rate of 65% (95% CI: 48%-78%) and 35% (95% CI: 22%-52%) respectively. The constituent ratio of children aged 37-48 months is the highest, accounting for 46% (95% CI: 39%-53%) of the total cases during HFMD outbreaks. The pooled rate of male cases (60%) was higher than that of female cases (40%).Conclusion: Month, residence, age, and gender may be early risk factors for potential HFMD outbreaks. Before the advent of peak months from Apr to Jul each year, measures should be taken to prevent the HFMD outbreaks among preschool children in China. Preschools located in urban areas should take priority over special prevention. HFMD surveillance should preferentially focus on children aged 37-48 months, especially boys in preschools.
World Health Organization (2011). A Guide to Clinical Management and Public Health Response for Hand, Foot and Mouth Disease (HFMD). Geneva: WHO Press. www.wpro.who.int/emerging_diseases/documents/HFMDGuidance/en/
Pathinayake PS, Hsu AC, Wark PA (2015). Innate Immunity and Immune Evasion by Enterovirus 71. Viruses, 7(12): 6613-30.
Xie YH, Chongsuvivatwong V, Tan Y et al (2015). Important roles of public play-grounds in the transmission of hand, foot, and mouth disease. Epidemiol Infect, 143(7): 1432-41.
Hosoya M, Kawasaki Y, Sato M, et al (2006). Genetic diversity of enterovirus 71 asso-ciated with hand, foot and mouth disease epidemics in Japan from 1983 to 2003. Pediatr Infect Dis J, 25(8): 691-4.
Chan LG, Parashar UD, Lye MS et al (2000). Deaths of children during an out-break of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and patho-logical characteristics of the disease. Clin Infect Dis, 31(3): 678-83.
Chan K, Goh K, Chong C et al (2003). Ep-idemic hand, foot and mouth disease caused by human enterovirus 71. Emerg Infect Dis, 9(1): 78-85.
Geoghegan JL, Tan le V, Kühnert D et al (2015). Phylodynamics of Enterovirus A71-Associated Hand, Foot, and Mouth Disease in Viet Nam. J Virol, 89(17): 8871-9.
Chen Q, Lin J, Li Y, Wei L, Zhuang JL (2014). Analysis of the epidemiological characteristics of hand-foot-mouth dis-ease epidemics in Beixinjing，Changning district of Shanghai during 2010 to 2012. Capital Journal of Public Health, 8(2): 65-67.
Zhuang ZC, Kou ZQ, Bai YJ, et al (2015). Epidemiological Research on Hand, Foot, and Mouth Disease in Mainland China. Viruses, 7(12): 6400-11.
Xing W, Liao Q, Viboud C, et al (2014). Hand, foot, and mouth disease in China, 2008-12: an epidemiological study. Lancet Infect Dis, 14(4): 308-18.
National Health and Family Planning Com-mission of China (2016). National inci-dence and death cases of notifiable communicable diseases. www.nhfpc.gov.cn/jkj/pgzdt/list.shtml
Xu HM, Zhu WP, Wan Y (2014). Investiga-tion on influencing factors of cluster on-set of hang-foot-and-mouth disease in kindergartens of Pudong New Area in Shanghai city. Chin Matern Child Health J, 29: 4130-3.
Ministry of Health of the People’s Republic of China (2009). Hand, foot, and mouth disease prevention and control guideline. www.gov.cn/gzdt/2009-06/04/content_1332078.htm
Stroup DF, Berlin JA, Morton SC et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA, 283(15): 2008-12.
Peng RR, Wang AL, Li J et al (2011). Molec-ular typing of Treponema pallidum: a sys-tematic review and meta-analysis. PLoS Negl Trop Dis, 5(11): e1273.
Han TJ, Li JS, Wang L, Xv H (2016). Coffee and the Risk of Lymphoma: A Meta-analysis Article. Iran J Public Health, 45(9): 1126-35.
Li M, Zhao Y, Duan K (2012). Epidemio-logical characteristics of clustering cases of hand, foot and mouth disease in child care settings in Licheng, Jinan. Dis Surveil, 2(7): 524-6.
Kong ZF (2014). Epidemiological character-istics of clustering and clusters of hand-foot-mouth disease in child care institu-tions in Ninghai, Zhejiang during 2012. Modern Prev Med, 41(13): 2372-4.
Wang RQ, Li HT, Cai X et al (2013). Retro-spective analysis of HFMD clusters in preschools in Changping district. Pract Prev Med, 20(8): 963-4.
Zhang ZW, Yang QD, Huang XH et al (2014). Epidemiological analysis on 7 clusterss of hand, foot and mouth dis-ease in Kindergartens in Dongguan City. Pract Prev Med, 21(6): 678-80.
Li Z, Xu HR, Cheng HQ (2013). Epidemio-logical analysis of hand-foot-mouth dis-ease clustering among Jinan kindergar-tens in 2012. Chin J Sch Health, 34(7): 851-2.
Tian L, Zhu RY, Fan JH et al (2011). Epi-demiological analysis of hand-foot-mouth disease clustered cases in kinder-gartens in Shanghai during 2009. Chin J Sch Health, 32(5): 596-8.
Wang LJ, Gao H, Wang J (2013). Epidemio-logical analysis and control measure of 27 gathering epidemics of HFMD. Modern Prev Med, 40(9): 1601-4.
Ye ZW, Ruan F, Zhang XB et al (2014). Analysis of epidemiological features of hand, foot and mouth disease (HFMD) in nurseries of Zhuhai city. Chin Trop Med, 14(4): 414-6.
Xv JJ, He F, Yang SH et al (2013). Epidemic characteristics of HFMD in nurseries of Yandu district of Yancheng city. Occup and Health, 29(23): 3126-8.
Chen HQ, Xu HR, Chang CY (2010). Epi-demiological investigation of 5 clusters of hand foot mouth disease (HFMD) at the nurseries or kindergartens of Jinan. Chin J Sch Health, 31(7): 828-9.
Gu YG, Duan SB (2010). Analysis on the epidemic of Hand-foot-mouth Disease among kindergartens of Shizhong dis-trict, Jining city. Prev Med Trib, 16(8): 735-7.
Hu QP, Wang XQ, Yin W et al (2015). In-fluence on cases clustering of hand, foot and mouth disease of initial case in kin-dergartens in Pudong district of Shang-hai. Chin Prev Med, 16(2): 108-11.
Wang J, Xu MG, Li EG, Zhou Z (2013). Analysis of the epidemiological character-istics of hand-foot-mouth disease clus-tered cases in Zhabei district of Shanghai. Modern Prev Med, 40(14): 2577-80.
Zhang CD, Ying L (2013). Epidemiological characteristics of hand foot and mouth disease clusters in Lianyungang during 2010-2011. Jiangsu J Prev Med, 24(1): 23-5.
Zhao ZR, Yao WL, Chen J, Cheng XF (2013). Analysis of the epidemiological characteristics of clustered cases of hand, foot and mouth disease in Maanshan from 2010 to 2011. J Patho Biolo, 8(2): 164-6.
Xiong JG, Liu YZ, Zeng YM et al (2012). Analysis on the epidemic situation of hand foot and mouth disease in Dongguan. J Trop Med, 12(4): 486-9.
Li JY, Mai BG, Cao XO et al (2012). Analy-sis of hand foot and mouth disease clus-ters and emergency response in Nanhai district of Foshan City. Chin Prev Me, 13(9): 706-7.
Wang JP, Du DF, Xu XC (2013). Analysis of infectious disease clusters among schools and nurseries in Yidu city in 2010. J Prev Med Inf, 29(1): 71-2.
Liu Y, Qin L, Teng YZ, Meng XH (2015). Analysis on aggregation clusterss of hand-foot-mouth disease in kindergar-tens of Dandong city from 2009 to 2013. Occup and Health, 31(3): 390-2.
Hii YL, Rocklov J, Ng N (2011). Short term effects of weather on hand, foot and mouth disease. PLoS One, 6(2): e16796.
Centers for Disease Control and Prevention (CDC) (2012). Notes from the field: se-vere hand, foot, and mouth disease asso-ciated with coxsackievirus A6-Alabama, Connecticut, California, and Nevada, November 2011-February 2012. MMWR Morb Mortal Wkly Rep, 61(12): 213-4.
Chen KT, Chang HL, Wang ST et al (2007). Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998–2005. Pe-diatrics, 120(2): e244-52.
Urashima M, Shindo N, Okabe N (2003). Seasonal models of herpangina and hand-foot-mouth disease to simulate an-nual fluctuations in urban warming in Tokyo. Jpn J Infect Dis, 56(2): 48-53.
Druyts-Voets E (1997). Epidemiological fea-tures of entero non-poliovirus isolations in Belgium 1980-94. Epidemiol Infect, 119(1): 71-7.
Yin MM, Yang JX, Yang Y et al (2015). Analysis on the epidemiological charac-teristics of hand-foot-mouth disease clus-tered cases in hongkou district of Shang-hai. Chinese Primary Health Care, 29(5): 89-90.
Qiaoyun F, Xiongfei J, Lihuan L, Angao X (2013). Epidemiology and etiological characteristics of hand, foot and mouth disease in Huizhou City between 2008 and 2011. Arch Virol, 158(4): 895-9.
Xu M, Yu W, Tong S et al (2015). Non-Linear Association between Exposure to Ambient Temperature and Children's Hand-Foot-and-Mouth Disease in Bei-jing, China. PLoS One, 10(5): e0126171.
Zeng M, Pu D, Mo X et al (2013). Children of rural-to-urban migrant workers in China are at a higher risk of contracting severe hand, foot and mouth disease and EV71 infection: a hospital-based study. Emerg Microbes Infect, 2(10): e72.
Huang J, Wang J, Bo Y et al (2014). Identifi-cation of health risks of hand, foot and mouth disease in China using the geo-graphical detector technique. Int J Environ Res Public Health, 11(3): 3407-23.
Hu M, Li Z, Wang J et al (2012). Determi-nants of the incidence of hand, foot and mouth disease in China using geograph-ically weighted regression models. PLoS One, 7(6): e38978.
Ge Y, Zheng Y, Pan H et al (2015). Epide-miological surveillance of hand, foot and mouth disease in Shanghai, 2010-2014. Zhonghua Er Ke Za Zhi, 53(9): 676-83.
Ruan F, Yang T, Ma H et al (2011). Risk fac-tors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics, 127(4): e898-904.
Ooi EE, Phoon MC, Ishak B et al (2002). Seroepidemiology of human enterovirus 71, Singapore. Emerg Infect Dis, 8(9): 995-7.
NikNadia N, Sam IC, Rampal S et al (2016). Cyclical Patterns of Hand, Foot and Mouth Disease Caused by Enterovirus A71 in Malaysia. PLoS Negl Trop Dis, 10(3): e0004562.
Chen SC, Chang HL, Yan TR et al (2007). An eight-year study of epidemiologic fea-tures of enterovirus 71 infection in Tai-wan. Am J Trop Med Hyg, 77(1): 188-91.
Ma E, Chan KC, Cheng P et al (2010). The enterovirus 71 epidemic in 2008--public health implications for Hong Kong. Int J Infect Dis, 14(9): e775-80.
Huang X, Wei H, Wu S et al (2015). Epide-miological and etiological characteristics of hand, foot, and mouth disease in He-nan, China, 2008-2013. Sci Rep, 5:8904.
Wang X, Wu X, Jia L et al (2014). Estimat-ing the number of hand, foot and mouth disease amongst children aged under-five in Beijing during 2012, based on a tele-phone survey of healthcare seeking be-havior. BMC Infect Dis, 14:437.
Ang LW, Koh BK, Chan KP et al (2009). Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singapore, 38(2): 106-12.
Chen SP, Huang YC, Li WC et al (2010). Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Tai-wan, 2008: a children's hospital experi-ence. J Microbiol Immunol Infect, 43(2): 99-104.