title: Risk factors for severe hand foot and mouth disease.
abstract: BACKGROUND
  Hand foot and mouth disease (HFMD) and herpangina are enteroviral infectious diseases caused mainly by Coxsackie virus A (CA) or enterovirus 71 (EV71). From 2000 to 2002, many complicated cases were reported in Japan, therefore a nationwide questionnaire survey was carried out to assess the situation. The subjects were patients with HFMD or herpangina, or other enterovirus infection from 2000 to 2002, who were either hospitalized over 24 h or who died. The response rates were 41.3% in 2000 and 2001 and 31.6% in 2002. The survey period included the year 2000, when HFMD epidemics due to EV71 occurred. To examine risk factors causing complications of enterovirus infection, severe cases of HFMD were focused on.
  
  
  METHODS
  HFMD cases in 2000 were divided into two groups according to severity: 'more severe' and 'less severe'. 'More severe' was defined as 'fatal, involving sequelae, or involving hospitalization for 7 days or longer'. Statistical analyses were conducted with Epi info version 3.3 and the association between risk factors and severity was estimated.
  
  
  RESULTS
  The number of patients with more severe and less severe cases was 96 and 103, respectively. There was no difference in sex, age, having siblings and family history between the two groups. There was a significant association between attending child care center and severe HFMD.
  
  
  CONCLUSIONS
  It is not clear why attending child care centers was associated with HFMD severity. Further study is needed.
authors: Field Epidemiology Training Program, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo. ysuzupd@dnh.twmu.ac.jp
authors: Yoko
authors: Y
authors: Suzuki
authors: Keiko
authors: K
authors: Taya
authors: Kazutoshi
authors: K
authors: Nakashima
authors: Takaaki
authors: T
authors: Ohyama
authors: John M
authors: JM
authors: Kobayashi
authors: Yasushi
authors: Y
authors: Ohkusa
authors: Nobuhiko
authors: N
authors: Okabe
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires