Epidemiological characteristics of severe cases of hand, foot, and mouth disease in Guangdong, China

ABSTRACT Hand, foot, and mouth disease (HFMD) has become a major public health issue in China, especially in Guangdong. The burden of severe cases deserves further attention. We hereby explored the epidemiological features of severe HFMD in Guangdong. Patients who were from rural areas (OR = 2.03, 95% CI: 1.86–2.21), males (OR = 1.17, 1.07–1.28), aged ≤3 years old (2.48, 1.68–3.68, and 1.63, 1.10–2.41, for ≤1 and 2–3 years, respectively), and/or infected with EV71 (6.69, 5.98–7.49) tended to progress to severe status. Cases from rural areas tended to have a longer interval from onset to diagnosis (p < .001; i.e. the proportions of each interval (≤1, ∼2, ∼3, ∼4, and >4 days) for rural and urban areas in 2009 were 14%, 13%, 14%, 8%, 51%, and 21%, 21%, 15%, 11%, 31%, respectively). The spatial pattern of the epidemics clarified by the flexible scan statistic showed that the clusters of severe cases were observed to be expanding from the Pearl River Delta Region to the Eastern Region and the Mountainous Region. Overall, the relative risk of the most likely clusters ranged from 5.548 to 15.558 (all p < .001). Our results were particularly practical and important for developing severe HFMD-targeted control programs in the context of disease surveillance. Abbreviations: CA16: Coxsackievirus A16; EV71: enterovirus 71; GDP: gross domestic product; HFMD: hand; foot and mouth disease.