Hand, foot, and mouth disease in China, 2008-12_ an epidemiological study.pdf

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Hand, foot, and mouth disease in China, 2008-12_ an epidemiological study.pdf

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/infection Published online January 31, 2014 /10.1016/S1473-3099(13)70342-6 1 Articles Hand, foot, and mouth disease in China, 2008–12: an epidemiological study Weijia Xing*, Qiaohong Liao*, Cécile Viboud*, Jing Zhang*, Junling Sun, Joseph T Wu, Zhaorui Chang, Fengfeng Liu, Vicky J Fang, Yingdong Zheng, Benjamin J Cowling, Jay K Varma, Jeremy J Farrar, Gabriel M Leung, Hongjie Yu Summary Background Hand, foot, and mouth disease is a common childhood illness caused by enteroviruses. Increasingly, the disease has a substantial burden throughout east and southeast Asia. To better inform vaccine and other interventions, we characterised the epidemiology of hand, foot, and mouth disease in China on the basis of enhanced surveillance. Methods We extracted epidemiological, clinical, and laboratory data from cases of hand, foot, and mouth disease reported to the Chinese Center for Disease Control and Prevention between Jan 1, 2008, and Dec 31, 2012. We then compiled climatic, geographical, and demographic information. All analyses were stratifi ed by age, disease severity, laboratory confi rmation status, and enterovirus serotype. Findings The surveillance registry included 7 200 092 probable cases of hand, foot, and mouth disease (annual incidence, 1·2 per 1000 person-years from 2010–12), of which 267 942 (3·7%) were laboratory confi rmed and 2457 (0·03%) were fatal. Incidence and mortality were highest in children aged 12–23 months (38·2 cases per 1000 person-years and 1·5 deaths per 100 000 person-years in 2012). Median duration from onset to diagnosis was 1·5 days (IQR 0·5–2·5) and median duration from onset to death was 3·5 days (2·5–4·5). The absolute number of patients with cardiopulmonary or neurological complications was 82 486 (case-severity rate 1·1%), and 2457 of 82486 patients with severe disease died (fatality rate 3·0%); 1617 of 1737 laboratory confi rmed deaths (93%) were associated with enterovirus 71. Every year in June, hand, foot, and