Hand, Foot, and Mouth Disease in Hunan Province, China, 2009-2014: Epidemiology and Death Risk Factors

PLoS One. 2016 Nov 29;11(11):e0167269. doi: 10.1371/journal.pone.0167269. eCollection 2016.


Hand, foot, and mouth disease (HFMD) is an arising public health problem in Asia, including China. Epidemiological data is necessary to enable judicious public health responses and interventions. We analyzed the epidemiological and laboratory data of 759,301 HFMD cases reported to the Hunan Provincial Center for Disease Control and Prevention from 1 January 2009 to 31 December 2014. Univariate and multivariable conditional logistic regression analyses were used to identify risk factors of fatality in HFMD. The incidence of HFMD was highest among children aged 1-3 years, compared with other age groups. Of the total HFMD cases, 7,222 (0.95%) were considered severe and 338 (0.04%) were fatal. Enterovirus-A71 was the major cause of severe and fatal cases (65.75% and 88.78%, respectively). For severe cases, the median time from symptom onset to diagnosis was 0.5 days (interquartile range [IQR] 0-1.5 days); the median time from diagnosis to severe illness was 2 days (IQR 1-3 days). For fatal cases, the median time from symptom onset to diagnosis was 0.5 days (IQR 0-1.5 days); the median time from diagnosis to death was 1.5 days (IQR 0.5-2.5 days). In multivariable analysis, the abuse of antibiotic, glucocorticoid and pyrazolone in village clinics at basic medical institutions were identified as independent risk factors for HFMD fatal cases. In conclusion, our results suggest that the future direction to control and respond to HFMD is intensive surveillance of enterovirus-A71 and improving the ability to diagnose disease and treat patients, especially in basic medical institutions.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Child
  • Child, Preschool
  • China / epidemiology
  • Enterovirus A, Human / isolation & purification
  • Enterovirus A, Human / physiology*
  • Female
  • Glucocorticoids / therapeutic use
  • Hand, Foot and Mouth Disease / diagnosis
  • Hand, Foot and Mouth Disease / drug therapy
  • Hand, Foot and Mouth Disease / epidemiology*
  • Hand, Foot and Mouth Disease / virology
  • Humans
  • Incidence
  • Infant
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Pyrazolones / therapeutic use
  • Residence Characteristics
  • Risk Factors
  • Serogroup
  • Severity of Illness Index
  • Time Factors


  • Anti-Bacterial Agents
  • Glucocorticoids
  • Pyrazolones
  • pyrazolone

Grant support

This work was supported by the Chinese Preventive Medicine Association (Grant number: 20101801,http://www.cpma.org.cn/) and the Health and Family Planning Commission of Hunan Province (Grant number: C2015-62,http://www.hunanwst.gov.cn/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.