Abstract
Background
Hand, foot, and mouth disease (HFMD) is a viral disease caused by human enteroviruses. Although HFMD reinfection is common, studies investigating this phenomenon are insufficient.
Methods
The present study focused on HFMD reinfection in Wuxi from 2008 to 2016 using surveillance system data.
Results
Of 107,677 cases included in the study, 6470 cases were classified as reinfections. The overall reinfection rate was 6.01% (6.37% male and 5.48% female patients), which decreased with increasing age (χ2 = 1125.477, p < 0.001). The rate was 6.17 and 5.79% in urban and rural areas, respectively, and 7.83 and 5.98% of the cases were severe and mild, respectively. Multivariate logistic regression analysis showed that male sex, younger age, residence in an urban area, and severe disease were risk factors for HFMD reinfection. The case-severity rate in secondary infection cases was lower than that in non-reinfection cases (odds ratio 0.675, 95% confidence interval 0.526–0.866).
Conclusions
Boys younger than 4 years of age living in urban areas were more prone to reinfection. Specific health education and intervention should be developed to protect these susceptible populations.
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Background
Hand, foot, and mouth disease (HFMD) is a common viral disease usually affecting infants and children, but it can also affect adults. It is characterised by fever, mouth ulcers, and vesicles on the hands, feet, or hips [1, 2]. HFMD is a highly contagious disease caused by a group of human enteroviruses; enterovirus 71 (EV71) and coxsackievirus A16 (CoxA16) are considered the primary pathogens [3, 6], and in patients infected with genogroup B or C EV71 virus, cross-protection against genogroup A is not guaranteed [23]. Therefore, cross-infection among patients with the different genogroups of EV71 or Cox A16 virus is possible.
In the present study, 2–5% of patients underwent laboratory testing; therefore, laboratory results for both infections were available for only a few reinfection cases. Moreover, the samples of two patients infected with the same virus subtype in both infections could not be collected for sequence analysis. Further research emphasising key strata theory is warranted.
Conclusion
This study indicated that the reinfection rate of HMFD in Wuxi from 2008 to 2016 was 6.01%. The population susceptible to HFMD reinfection was boys younger than 4 years of age who live in urban areas. It is important that administrations develop targeted health education and interventions to reduce the reinfection rate in susceptible populations.
Abbreviations
- CI:
-
Confidence interval
- CoxA16:
-
Coxsackievirus A16
- EV71:
-
Enterovirus 71
- HFMD:
-
Hand, foot, and mouth disease
- IQR:
-
Interquartile range
- OR:
-
Odds ratio
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Acknowledgements
The authors are thankful for the support from Wuxi People’s Hospital.
Funding
This research was supported by the National Natural Science Foundation of China (No. 81402732), Wuxi project of Science and Technology (No. CSE31N1515), Jiangsu Project of Preventive Medicine (No. Y2015006), Wuxi Key Medical Disciplines (No.ZDXK009), Wuxi Project of Key Medical Talents (No. ZDRC003), and Wuxi Project of Young Medical Talents (No. QNRC008).
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CS coordinated field epidemiology, all data analysis, and manuscript writing. CS and JL analysed the data and wrote the manuscript. PS and HJ conducted field investigation and data collection. CS, JL and HJ performed the statistical analysis. CS, JL, and PS revised the paper and improved the technical quality of the manuscript. YS and YHQ were the project coordinator, responsible for the project design and implementation, and supervised all aspects of fieldwork, laboratory activities and data analysis. All authors approved the final version of the paper.
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This investigation was conducted by public health agencies as part of their legally authorised mandate and was therefore considered minimal-risk research and was exempted from ethical approval by the Institutional Review Board-Wuxi Center for Disease Control and Prevention.
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Shi, C., Liu, J., Shi, P. et al. Epidemiological characteristics and influential factors of hand, foot, and mouth disease reinfection in Wuxi, China, 2008–2016. BMC Infect Dis 18, 472 (2018). https://doi.org/10.1186/s12879-018-3385-1
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DOI: https://doi.org/10.1186/s12879-018-3385-1