The Risk Factors of Acquiring Severe Hand, Foot, and Mouth Disease: A Meta-Analysis

Objectives The incidence of severe hand, foot, and mouth disease (HFMD) is not low, especially in mainland China in almost every year recently. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of severe HFMD to provide suggestions on prevention and controlling. Methods PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. Results We conducted a meta-analysis of 11 separate studies. Fever (odds ratio (OR) 7.396, 95% confidence interval (CI) 3.565–15.342), fever for more than 3 days (OR 5.773, 95% CI 4.199–7.939), vomiting (OR 6.023, 95% CI 2.598–13.963), limb trembling (OR 42.348, 95% CI 11.765–152.437), dyspnea (OR 12.869, 95% CI 1.948–85.017), contact with HFMD children (OR 5.326, 95% CI 1.263–22.466), rashes on the hips (OR 1.650, 95% CI 1.303–2.090), pathologic reflexes (OR 3057.064, 95% CI 494.409–19000), Lethargy (OR 31.791, 95% CI 3.369–300.020), convulsions (OR 23.652, 95% CI 1.973–283.592), and EV71 infection (OR 9.056, 95% CI 4.102–19.996) were significantly related to the risk of severe HFMD. We did not find an association between female sex (OR 0.918, 95% CI 0.738–1.142), scatter-lived children (OR 1.347, 95% CI 0.245–7.397), floating population (OR 0.847, 95% CI 0.202–3.549), rash on the hands (OR 0.740, 95% CI 0.292–1.874), rash on the foot (OR 0.905, 95% CI 0.645–1.272), the level of the clinic visited first (below the country level) (OR 5.276, 95% CI 0.781–35.630), breast feeding (OR 0.523, 95% CI 0.167–1.643), and the risk of severe HFMD. Conclusions Fever, fever for more than 3 days, vomiting, limb trembling, dyspnea, contact with HFMD children, rashes on the hips, pathologic reflexes, lethargy, convulsions, and EV71 infection are risk factors for severe HFMD.