title: Case-fatality of hand, foot and mouth disease associated with EV71: a systematic review and meta-analysis.
abstract: Hand, foot and mouth disease (HFMD) associated with enterovirus 71 (EV71) is a growing public health concern. This study aimed to estimate the case-fatality of HFMD associated with EV71 on the basis of a meta-analysis. We searched PubMed, Cochrane, Web of Science, Elsevier, CNKI, Wanfang, and VIP databases. Two authors independently selected relevant studies. The pooled estimate of case-fatality was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis and meta-regression. We identified 14 eligible studies with a total population of 112 546. The random-effects pooled case-fatality was 1·7% (95% confidence interval 1·2-2·4). The funnel plot was asymmetrical. The estimate of case-fatality was highest in mainland China (1·8%). Removal of eight local Chinese studies decreased the original estimate. The pooled case-fatality in the period of 1998-2007 (1·5%) was lower than that in the period 2008-2012 (1·8%). Control measures for HFMD associated with EV71 are essential because of the increased case-fatality over time, especially in East Asia.
authors.affiliation: Department of Epidemiology and Health Statistics,School of Public Health, Southeast University,Nanjing,China.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology and Health Statistics,School of Public Health, Southeast University,Nanjing,China.
authors.forename: H
authors.initials: H
authors.lastname: Jin
authors.affiliation: Jiangsu Provincial Center for Disease Control and Prevention,China.
authors.forename: X F
authors.initials: XF
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics,School of Public Health, Southeast University,Nanjing,China.
authors.forename: B
authors.initials: B
authors.lastname: Wang
mesh_terms: D029821:Enterovirus A, Human / Q000302:isolation & purification*; D006232:Hand, Foot and Mouth Disease / Q000401:mortality* / Q000821:virology*; D006801:Humans; D009026:Mortality
keywords: Case-fatality; HFMD; enterovirus 71; meta-analysis