Risk factors for death from hand-foot-mouth disease: a meta-analysis

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Hand-foot-mouth disease (HFMD) outbreaks, particularly in the Western Pacific Region, have affected millions of children, presenting a significant public health challenge.
• Identifying risk factors for mortality is crucial for improving clinical outcomes and public health interventions for HFMD.

Purpose of the Study:

• To quantitatively assess existing studies and identify significant risk factors associated with death in hand-foot-mouth disease (HFMD) cases.
• To provide evidence-based insights for the clinical management and prevention strategies for severe HFMD.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Medline, Embase, Cochrane Library).
• Seven case-control studies with a total of 1641 participants (634 deaths, 1007 survivors) were included in the meta-analysis.
• Heterogeneity and publication bias were assessed to ensure the robustness of the findings.

Main Results:

• Factors not significantly associated with HFMD death included Human enterovirus 71 infection, male sex, age ≤3 years, vomiting, cyanosis, convulsions, fever duration ≥3 days, atypical rashes, and abdominal distention.
• Significant risk factors for HFMD death were identified as lethargy (OR=6.62), pneumonoedema/pneumorrhagia (OR=4.09), seizures (OR=6.85), dyspnoea (OR=8.24), and coma (OR=3.76).
• Several identified risk factors demonstrated high statistical significance (P < 0.0001) and low heterogeneity (I²=0%) for mortality.

Conclusions:

• Lethargy, respiratory complications (pneumonoedema/pneumorrhagia, dyspnoea), neurological signs (seizures, coma) are critical indicators of increased mortality risk in HFMD.
• These findings highlight the importance of vigilant monitoring for these specific clinical signs in HFMD patients to facilitate timely and appropriate medical intervention.
• Further research may focus on the specific mechanisms linking these factors to HFMD fatality.