title: Children of rural-to-urban migrant workers in China are at a higher risk of contracting severe hand, foot and mouth disease and EV71 infection: a hospital-based study.
abstract: The incidence and severity of hand, foot and mouth disease have increased in mainland China since 2008. Therapies and vaccines are currently at different stages of development. This study aimed to determine the social factors associated with the outbreaks and severity of the disease in Chinese children. A multicentre, prospective, case-controlled study was conducted in Shanghai, Chongqing, Guangzhou and Shantou to identify the sociodemographic and behavioural risk factors for hand, foot and mouth disease. Children hospitalized for hand, foot and mouth disease were randomly enrolled from April to November 2011. Stool samples were collected to test for the presence of enterovirus 71 (EV71). A total of 443 children between 1.6 and 68 months of age were enrolled; 304 were uncomplicated cases and 139 were severe cases with central nervous system involvement. The overall detection rate of EV71 was 54.2%, and the positivity rate of EV71 was significantly higher in the severe group than in the uncomplicated group (82.0% versus 40.9%, odds ratio (OR): 8.35, P=0.000). The children of migrant workers (OR: 3.014, P=0.000) and children attending kindergarten (OR: 2.133, P=0.002) were significantly associated with a severe outcome of the disease (OR: 1.765, P=0.026). Our findings indicate that kindergarten attendance and migrant worker parents are the major risk factors associated with severe hand, foot and mouth disease in children <5 years of age. Future public health intervention vaccination campaigns should consider the particular difficulties of achieving high compliance with multiple-dose vaccination regimens in the children of migrant workers.
authors.affiliation: Department of Infectious Diseases, Children's Hospital of Fudan University , Shanghai 201102, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Zeng
authors.affiliation: Department of Infectious Diseases, Children's Hospital of Fudan University , Shanghai 201102, China.
authors.forename: Dongbo
authors.initials: D
authors.lastname: Pu
authors.affiliation: Institut Pasteur Shanghai, Chinese Academy of Sciences , Shanghai 200025, China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Mo
authors.affiliation: Department of Infectious Diseases & Gastroenterology, Children's Hospital of Chongqing Medical University , Chongqing 400014, China.
authors.forename: Chaomin
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Infectious Diseases, Guangzhou Women and Children's Medical Center , Guangzhou 510120, China.
authors.forename: Sitang
authors.initials: S
authors.lastname: Gong
authors.affiliation: Department of Infectious Diseases, Guangzhou Women and Children's Medical Center , Guangzhou 510120, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Pediatric Department of Shantou University Medical College , Shantou 515041, China.
authors.forename: Guangyu
authors.initials: G
authors.lastname: Lin
authors.affiliation: Pediatric Department of Shantou University Medical College , Shantou 515041, China.
authors.forename: Beiyan
authors.initials: B
authors.lastname: Wu
authors.affiliation: Pediatric Department of Shantou University Medical College , Shantou 515041, China.
authors.forename: Suli
authors.initials: S
authors.lastname: He
authors.affiliation: Pediatric Department of Shantou University Medical College , Shantou 515041, China.
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Jiao
authors.affiliation: Department of Infectious Diseases, Children's Hospital of Fudan University , Shanghai 201102, China.
authors.forename: Xiangshi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Children's Hospital of Fudan University , Shanghai 201102, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Institut Pasteur Shanghai, Chinese Academy of Sciences , Shanghai 200025, China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Institut Pasteur Shanghai, Chinese Academy of Sciences , Shanghai 200025, China.
authors.forename: Ralf
authors.initials: R
authors.lastname: Altmeyer
keywords: EV71; hand, foot and mouth disease; migrant children; risk factor