Risk Factors for Hand, Foot and Mouth Disease Reinfection in Qingdao, China, from 2014 to 2022
-
Xueling Xin
,
Jing Jia
,
Hongrui Zhai
,
Wencheng Wang
,
Zhaohai Meng
,
Litao Sun
,
Xia Wang
,
Liyan Dong
Abstract
Background: Hand, foot and mouth disease (HFMD) is a common infection disease among children, which is caused by human enterovirus (EV) family. The absence of cross-protection against different EV sub-types, makes HFMD reinfection common. Thus, we aimed to explore the epidemiological characteristics and influencing factors of HFMD reinfection in Qingdao City.
Methods: Data on HFMD cases from 2014 to 2022 were obtained from National Infectious Surveillance System. Logistic regression analysis was used to assess the independent risk factors of HFMD reinfection.
Results: A total of 78422 HFMD cases were enrolled. Of these, 2041 cases were classified as reinfection, corresponding to the reinfection rate of 2.60%. The median time interval between the primary infection and secondary infection was 12.75 (IQR=12.24) months. The seasonal peak of reinfection occurred from June to August each year. Multivarite logistic analysis showed that male, younger age, scattered children, severe cases, hospitalization, and EV71 infection were risk factors for HFMD reinfection. The proportion of patients infected with EV71 in the primary infection cases was higher than that in non-reinfection cases (OR=1.83, 95%CI=1.29-2.60).
Conclusion: Boys aged 5 years and below, especially those with severe cases and first infected with EV71 are more prone to reinfection. Therefore, authorities should implement targeted health education and intervention strategies to reduce the reinfection rate among vulnerable population.
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26. Wu PC, Huang LM, Kao CL, et al (2010). An outbreak of coxsackievirus A16 infection: comparison with other enteroviruses in a preschool in Taipei. J Microbiol Immunol Infect, 43 (4): 271-7.
27. Yang Y, You E, Wu J, et al (2018). Effects of relative humidity on childhood hand, foot, and mouth disease reinfection in Hefei, China. Sci Total Environ, 630: 820-826.
28. Xin X, Hu X, Zhai L, et al (2023). The effect of ambient temperature on hand, foot and mouth disease in Qingdao, China, 2014-2018. Int J Environ Health Res, 33 (11): 1081-1090.
29. Ma E, Lam T, Wong C, et al (2010). Is hand, foot and mouth disease associated with meteorological parameters? Epidemiol Infect, 138 (12): 1779-88.
30. Cheng Q, Bai L, Zhang Y, et al (2018). Ambient temperature, humidity and hand, foot, and mouth disease: A systematic review and meta-analysis. Sci Total Environ, 625:828-836.
2. Kimmis BD, Downing C, Tyring S (2018). Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. Cutis, 102 (5): 353-356.
3. Tseng FC, Huang HC, Chi CY, et al (2007). Epidemiological survey of enterovirus infections occurring in Taiwan between 2000 and 2005: analysis of sentinel physician surveillance data. J Med Virol, 79 (12): 1850-60.
4. Huang CC, Liu CC, Chang YC, et al (1999). Neurologic complications in children with enterovirus 71 infection. N Engl J Med, 341 (13): 936-42.
5. Koh WM, BogicT, Siegel K, et al (2016). The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J, 35 (10): e285-300.
6. Zeng, M, Li YF, Wang XH, et al (2012). Epidemiology of hand, foot, and mouth disease in children in Shanghai 2007-2010. Epidemiol Infect, 140 (6): 1122-30.
7. Zhang Y, Tan XJ, Wang HY, et al (2009). An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China. J Clin Virol, 44 (4): 262-7.
8. Zhang Y, Zhu Z,Yang W, et al (2010). An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of hand foot and mouth disease in Fuyang city of China. Virol J, 7: 94.
9. Liu SL, Pan H, Liu P, et al (2015). Comparative epidemiology and virology of fatal and nonfatal cases of hand, foot and mouth disease in mainland China from 2008 to 2014. Rev Med Virol, 25 (2): 115-28.
10. Zhu L, Yuan Z, Wang x, et al (2015). The Impact of Ambient Temperature on Childhood HFMD Incidence in Inland and Coastal Area: A Two-City Study in Shandong Province, China. Int J Environ Res Public Health, 12 (8): 8691-704.
11. Liu CC, Chow YH, Chong P, et al (2014). Prospect and challenges for the development of multivalent vaccines against hand, foot and mouth diseases. Vaccine, 32 (47): 6177-82.
12. Chen GP, Wu JB, Wang JJ, et al (2016). Epidemiological characteristics and influential factors of hand, foot and mouth disease (HFMD) reinfection in children in Anhui province. Epidemiol Infect, 144 (1): 153-60.
13. Zhong X, Wang H, Chen C, et al (2022). Epidemiological Characteristics of Hand, Foot and Mouth Disease Reinfection in Guangzhou, Southern China from 2012 to 2017. Iran J Public Health, 51 (9): 2078-2088.
14. Huang J, Liao Q,. Ooi MH, et al (2018). Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008-2015. Emerg Infect Dis, 24 (3):432-442.
15. National Health Commission of the People's Republic of China. Diagnosis and Treatment Guidelines for Hand, Foot and Mouth Disease. http://www.nhc.gov.cn, 2018.
16. Shi C, Liu J, Shi P, et al (2018). Epidemiological characteristics and influential factors of hand, foot, and mouth disease reinfection in Wuxi, China, 2008-2016. BMC Infect Dis, 18 (1): 472.
17. Xie YH, Chongsuvivatwong V, Tan Y, et al (2015). Important roles of public playgrounds in the transmission of hand, foot, and mouth disease. Epidemiol Infect, 143 (7): 1432-41.
18. Ji H, Li L, Liu Y, et al (2012). Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province, China. Virol J, 9:248.
19. Zhang D, Chen Y, Chen X, et al (2017). Enterovirus 71 Neutralizing Antibodies Seroepidemiological Research among Children in Guangzhou, China between 2014 and 2015: A Cross-Sectional Study. Int J Environ Res Public Health, 14 (3): 319.
20. Zhang D, Li Z, Zhang W, et al (2016). Hand-Washing: The Main Strategy for Avoiding Hand, Foot and Mouth Disease. Int J Environ Res Public Health, 13 (6): 610.
21. Zhao D, Wang L, Cheng J, et al (2017). Impact of weather factors on hand, foot and mouth disease, and its role in short-term incidence trend forecast in Huainan City, Anhui Province. Int J Biometeorol, 61 (3): 453-461.
22. Zhang Q, Zhou M, Yang Y, et al (2019). Short-term effects of extreme meteorological factors on childhood hand, foot, and mouth disease reinfection in Hefei, China: A distributed lag non-linear analysis. Sci Total Environ, 653: 839-848.
23. Solomon T, Lewthwaite P, Perera D, et al (2010). Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis, 10 (11): 778-90.
24. Trakulsrichai S, Watcharananan SP, Chantratita W (2012). Influenza A (H1N1) 2009 reinfection in Thailand. J Infect Public Health, 5 (2): 211-4.
25. Jia J, Kong F, Xin X, et al (2021). Epidemiological Characteristics of Hand, Foot, and Mouth Disease Outbreaks in Qingdao, 2009-2018. Iran J Public Health, 50 (5): 999-1008.
26. Wu PC, Huang LM, Kao CL, et al (2010). An outbreak of coxsackievirus A16 infection: comparison with other enteroviruses in a preschool in Taipei. J Microbiol Immunol Infect, 43 (4): 271-7.
27. Yang Y, You E, Wu J, et al (2018). Effects of relative humidity on childhood hand, foot, and mouth disease reinfection in Hefei, China. Sci Total Environ, 630: 820-826.
28. Xin X, Hu X, Zhai L, et al (2023). The effect of ambient temperature on hand, foot and mouth disease in Qingdao, China, 2014-2018. Int J Environ Health Res, 33 (11): 1081-1090.
29. Ma E, Lam T, Wong C, et al (2010). Is hand, foot and mouth disease associated with meteorological parameters? Epidemiol Infect, 138 (12): 1779-88.
30. Cheng Q, Bai L, Zhang Y, et al (2018). Ambient temperature, humidity and hand, foot, and mouth disease: A systematic review and meta-analysis. Sci Total Environ, 625:828-836.
| Files | ||
| Issue | Vol 54 No 9 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19859 | |
| Keywords | ||
| Hand Foot and mouth disease Reinfection Epidemiology | ||
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How to Cite
1.
Xin X, Jia J, Zhai H, Wang W, Meng Z, Sun L, Wang X, Dong L. Risk Factors for Hand, Foot and Mouth Disease Reinfection in Qingdao, China, from 2014 to 2022. Iran J Public Health. 2025;54(9):1917-1925.
