+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan



Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan



Pediatrics 109(6): E88



In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness. Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations. A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to age-specific periepidemic mortality rates (r = -0.82) or severe case rates (r = -0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r = 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4-29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9-3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3-2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2-2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1-1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2-1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children. An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 047276665

Download citation: RISBibTeXText

PMID: 12042582

DOI: 10.1542/peds.109.6.e88


Related references

Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics 120(2): E244-E252, 2007

Enterovirus detection status of patients with herpangina and hand, foot and mouth disease in epidemic season 2007 Kanagawa Prefecture, Japan. 2007

Enterovirus detection status of patients with herpangina and hand, foot and mouth disease in epidemic season 2007, Kanagawa Prefecture, Japan. Japanese Journal of Infectious Diseases 61(2): 162-163, 2008

Comparison of Nonpolio Enteroviruses in Children With Herpangina and With Hand, Foot and Mouth Disease in Taiwan. Pediatric Infectious Disease Journal 2019, 2019

Hand, foot and mouth disease and herpangina caused by enterovirus A71 infections: a review of enterovirus A71 molecular epidemiology, pathogenesis, and current vaccine development. Revista do Instituto de Medicina Tropical de Sao Paulo 60: E70, 2018

Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics 127(4): E898-E904, 2011

Epidemic of hand, foot and mouth disease associated with enterovirus 71 infection. Intervirology 9(1): 60-63, 1978

Detection and characterization of enterovirus associated with herpangina and hand, foot, and mouth disease in Seoul, Korea. Clinical Laboratory 57(11-12): 959-967, 2012

Prevalence of Human Enterovirus Among Patients with Hand, Foot, and Mouth Disease and Herpangina in Thailand, 2013. Southeast Asian Journal of Tropical Medicine and Public Health 46(6): 1013-1020, 2016

Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring. Epidemiology and Infection 144(07): 1512-1519, 2016

Enterovirus detection status from patients with herpangina and hand, foot and mouth disease in Kanagawa Prefecture, Japan. Japanese Journal of Infectious Diseases 60(1): 63-64, 2007

Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring. Epidemiology and Infection 144(7): 1512-1519, 2017

Prevalence of enterovirus from patients with herpangina and hand, foot and mouth disease in Nagano Prefecture, Japan, 2007. Japanese Journal of Infectious Diseases 61(3): 247-248, 2008

Enterovirus-related diarrhoea in Guangdong, China: clinical features and implications in hand, foot and mouth disease and herpangina. Bmc Infectious Diseases 16: 128, 2016

A large-scale epidemic of hand, foot and mouth disease associated with enterovirus 71 infection in Japan in 1978. Japanese Journal of Medical Science and Biology 34(3): 191-196, 1981