Risk Factors for Severe Hand-Foot-Mouth Disease in Children in Hainan, China, 2011-2012

The incidence of severe/fatal cases of hand-foot-mouth disease (HFMD) has increased in South Asia. In China, Hainan Province had the highest incidence of mortality associated with HFMD in 2011. This study investigated the risk factors for severe HFMD in Hainan. The HFMD survey database for Hainan Province for 2011 and 2012 was analyzed, and the biological and behavioral characteristics of severe (n = 980) and nonsevere (n = 1679) HFMD were compared. The association between each explanatory variable and the severity of HFMD was investigated using a logistic regression model after adjusting for confounders. Human enterovirus 71 infection, a peak body temperature >39 degrees C, living outside urban areas, visiting a village clinic, low birth weight, never breastfed, cared for by grandparents, and caregiver with <6 years of education were associated with severe HFMD. Individual characteristics that are generally shared by children in households of low socioeconomic status tended to increase the risk of severe HFMD.