title: Predicting severe enterovirus 71 infection: Age, comorbidity, and parental behavior matter.
abstract: OBJECTIVE
  Enterovirus 71 (EV71) is one of the major pathogens that cause severe enteroviral infections. Our aim was to study the behavioral and household risk factors for its serious complications.
  
  
  METHODS
  Between May 2011 and November 2012, we enrolled children who had symptoms of EV71 infection from six hospitals in Taiwan. The caregivers of each patient were interviewed to determine their hand hygiene habits in relation to EV71 infection. The severity of EV71 infection was classified as follows: Stage 1, hand-foot-mouth disease or herpangina; Stage 2, meningitis or myoclonic jerk; Stage 3A, encephalitis; Stage 3B, cardiopulmonary failure. Stages 2 to 3B were defined as severe EV71 infection. Children with Stages 3A and 3B infection were designated as the critical group.
  
  
  RESULTS
  A total of 399 patients had laboratory-confirmed EV71 infection. Three risks factors were associated with the different degrees of severity in EV71 infection. Children <2 years old had much greater risks for severe EV71 infection [odds ratio (OR) 1.8; 95% confidence interval (CI), 1.2-2.8], delayed medical evaluation for critical infection (OR 9.4; 95% CI, 3.6-24.1), and developmental retardation for cardiopulmonary failure (OR 8.3; 95% CI, 2.0-33.7). Among all the habits and household factors, caregivers in the critical group had a significantly lower rate in terms of cleaning the faucet after washing their hands (OR 2.63; 95% CI, 1.14-6.08).
  
  
  CONCLUSIONS
  Children <2 years old, developmental retardation, and delayed medical intervention were associated with severe EV71 infection. Cleaning water faucets after hand washing was a protective habit that reduced the risk of complications.
authors: Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Wen-Chan
authors: WC
authors: Huang
authors: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Wei-Liang
authors: WL
authors: Shih
authors: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors: Shun-Cheng
authors: SC
authors: Yang
authors: Department of Pediatrics, Children's Hospital, China Medical University and Hospitals, Taichung, Taiwan.
authors: Ting-Yu
authors: TY
authors: Yen
authors: Department of Pediatrics, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
authors: Jian-Te
authors: JT
authors: Lee
authors: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Yi-Chuan
authors: YC
authors: Huang
authors: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Chung-Chen
authors: CC
authors: Li
authors: Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Yu-Chia
authors: YC
authors: Hsieh
authors: Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Tzou-Yin
authors: TY
authors: Lin
authors: Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: lychang@ntu.edu.tw.
authors: Luan-Yin
authors: LY
authors: Chang
authors: Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Li-Min
authors: LM
authors: Huang
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057210:Delayed Diagnosis; D029821:Enterovirus A, Human / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006761:Hospitals; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology
keywords: developmental delay; enterovirus 71; hand hygiene; hand–foot–mouth disease; herpangina; risk factors