title: The population-based health effect of hand, foot and mouth disease in children in Shanghai.
abstract: BACKGROUND
  An effective enterovirus 71 (EV71) vaccine is needed to control the annual outbreaks of hand, foot and mouth disease (HFMD) in China. Adequate epidemiologic data relating to HFMD are needed to make decisions about appropriate public health interventions and implementation of the new EV71 vaccine.
  
  
  METHODS
  We analyzed the population-based epidemiologic characteristics, clinical outcome and laboratory investigation of the 2011 HFMD outbreak in children based on the citywide surveillance system in Shanghai.
  
  
  RESULTS
  The incidence rate of HFMD was 25.8 per 1000 in children <10 years of age in Shanghai in 2011, ranging from 2.5 per 1000 in the age group 7 to 9.9 years to 48.4 per 1000 in the age group 3 to 3.9 years. Children 1 to 1.9 years were at the highest risk of developing severe complications and most susceptible to HFMD. Boys and migrant children had significantly increased risks of contracting HFMD and developing severe disease. More institutional clusters/outbreaks occurred in the winter peak months than in the summer peak months. Migrant young children played a central role in the spread of HFMD in the community. EV71 was identified in 39.7% of mild HFMD outpatients, 47.4% of hospitalized patients, 92.1% of severe inpatients with complications, 50% of outbreaks and 38.8% of clusters in institutions.
  
  
  CONCLUSIONS
  HFMD and EV71 infections have a significant health effect on Shanghai children.
authors.affiliation: From the *Department of Infectious Diseases, Children's Hospital of Fudan University; †Department of Infectious Diseases, Minhang District Center For Disease Control and Prevention; ‡Institut Pasteur Shanghai, Chinese Academy of Sciences; and §Department of Infectious Diseases and Control, Shanghai Municipal Center For Disease Control and Prevention, Shanghai, China.
authors.forename: Zhiyin
authors.initials: Z
authors.lastname: Xu
authors.forename: Huiguo
authors.initials: H
authors.lastname: Shen
authors.forename: Zhonglin
authors.initials: Z
authors.lastname: Wang
authors.forename: Ralf
authors.initials: R
authors.lastname: Altmeyer
authors.forename: Aimei
authors.initials: A
authors.lastname: Xia
authors.forename: Shenghua
authors.initials: S
authors.lastname: Mao
authors.forename: Yaxu
authors.initials: Y
authors.lastname: Zhen
authors.forename: Weixi
authors.initials: W
authors.lastname: Li
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhao
authors.forename: Hualin
authors.initials: H
authors.lastname: Su
authors.forename: Longwen
authors.initials: L
authors.lastname: Zhan
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Wang
authors.forename: Hao
authors.initials: H
authors.lastname: Pan
authors.forename: Jiayu
authors.initials: J
authors.lastname: Hu
authors.forename: Mei
authors.initials: M
authors.lastname: Zeng
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012621:Seasons; D012737:Sex Factors; D014171:Transients and Migrants