title: Risk factors for death in children with severe hand, foot, and mouth disease in Hunan, China.
abstract: BACKGROUND
  In recent years, outbreaks of hand, foot, and mouth disease (HFMD) have increased throughout East and Southeast Asia, especially in mainland China. The disease now presents as an increasingly serious public health threat in China.
  
  
  METHODS
  A case-control study was designed to examine risk factors associated with death from severe HFMD. A total of 553 severe HFMD cases were collected from the National Surveillance System.
  
  
  RESULTS
  Multifactorial logistic regression was used to analyse independent associations between potential influence factors and death from severe HFMD. We found that the migrants were more likely to die from severe HFMD than the resident population (OR = 3.07, 95%CI: 1.39-8.32). Additionally, the children whose first visit was to a village-level clinic had a high risk of death from severe HFMD. Patients with EV71 infection or symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting had an increased risk of death from severe HFMD. While breastfeeding children, having a confirmed diagnosis at the first visit to the hospital and with symptom of hyperarousal were identified as protective factors for death from severe HFMD.
  
  
  CONCLUSIONS
  To reduce the mortality from severe HFMD, doctors and health care providers need to pay attention to the patients with EV71 infection or with symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting. Health administration departments should pay more attention to the rational allocation of health resources. Furthermore, they should increase financial support and manpower in village-level health institutions.
authors.affiliation: a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China ;
authors.forename: Lu
authors.initials: L
authors.lastname: Long
authors.affiliation: b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China ;
authors.forename: Li-Dong
authors.initials: LD
authors.lastname: Gao
authors.affiliation: b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China ;
authors.forename: Shi-Xiong
authors.initials: SX
authors.lastname: Hu
authors.affiliation: b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China ;
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Luo
authors.affiliation: c Department of Microbiology Laboratory , Chengdu Municipal Center for Disease Control and Prevention , Sichuan , China ;
authors.forename: Zhen-Hua
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: d Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , United Kingdom ;|e Department of Epidemiology and Biostatistics, West China School of Public Health , Sichuan University , Sichuan , China.
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
authors.affiliation: a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China ;
authors.forename: Ding-Lun
authors.initials: DL
authors.lastname: Zhou
authors.affiliation: a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China ;
authors.forename: Ya-Jia
authors.initials: YJ
authors.lastname: Lan
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D029821:Enterovirus A, Human / Q000302:isolation & purification; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis
keywords: Children; foot and mouth disease; hand; risk factor