{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T05:34:08Z","timestamp":1768628048257,"version":"3.49.0"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,6,26]],"date-time":"2018-06-26T00:00:00Z","timestamp":1529971200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Journal of Infectious Diseases and Medical Microbiology"],"published-print":{"date-parts":[[2018,6,26]]},"abstract":"<jats:p><jats:italic>Objectives<\/jats:italic>. The incidence of severe hand, foot, and mouth disease (HFMD) is not low, especially in mainland China in almost every year recently. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of severe HFMD to provide suggestions on prevention and controlling. <jats:italic>Methods<\/jats:italic>. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. <jats:italic>Results<\/jats:italic>. We conducted a meta-analysis of 11 separate studies. Fever (odds ratio (OR) 7.396, 95% confidence interval (CI) 3.565\u201315.342), fever for more than 3 days (OR 5.773, 95% CI 4.199\u20137.939), vomiting (OR 6.023, 95% CI 2.598\u201313.963), limb trembling (OR 42.348, 95% CI 11.765\u2013152.437), dyspnea (OR 12.869, 95% CI 1.948\u201385.017), contact with HFMD children (OR 5.326, 95% CI 1.263\u201322.466), rashes on the hips (OR 1.650, 95% CI 1.303\u20132.090), pathologic reflexes (OR 3057.064, 95% CI 494.409\u201319000), Lethargy (OR 31.791, 95% CI 3.369\u2013300.020), convulsions (OR 23.652, 95% CI 1.973\u2013283.592), and EV71 infection (OR 9.056, 95% CI 4.102\u201319.996) were significantly related to the risk of severe HFMD. We did not find an association between female sex (OR 0.918, 95% CI 0.738\u20131.142), scatter-lived children (OR 1.347, 95% CI 0.245\u20137.397), floating population (OR 0.847, 95% CI 0.202\u20133.549), rash on the hands (OR 0.740, 95% CI 0.292\u20131.874), rash on the foot (OR 0.905, 95% CI 0.645\u20131.272), the level of the clinic visited first (below the country level) (OR 5.276, 95% CI 0.781\u201335.630), breast feeding (OR 0.523, 95% CI 0.167\u20131.643), and the risk of severe HFMD. <jats:italic>Conclusions<\/jats:italic>. Fever, fever for more than 3 days, vomiting, limb trembling, dyspnea, contact with HFMD children, rashes on the hips, pathologic reflexes, lethargy, convulsions, and EV71 infection are risk factors for severe HFMD.<\/jats:p>","DOI":"10.1155\/2018\/2751457","type":"journal-article","created":{"date-parts":[[2018,6,26]],"date-time":"2018-06-26T19:31:14Z","timestamp":1530041474000},"page":"1-12","source":"Crossref","is-referenced-by-count":29,"title":["The Risk Factors of Acquiring Severe Hand, Foot, and Mouth Disease: A Meta-Analysis"],"prefix":"10.1155","volume":"2018","author":[{"given":"Bai Jun","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Epidemiology, China Medical University, Shenyang, Liaoning 110000, China"},{"name":"Department of Infectious Disease, Shenyang Center for Disease Control and Prevention, Shenyang, Liaoning 110031, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Shenyang Center for Disease Control and Prevention, Shenyang, Liaoning 110031, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Shenyang Center for Disease Control and Prevention, Shenyang, Liaoning 110031, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang Dong","family":"An","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Shenyang Center for Disease Control and Prevention, Shenyang, Liaoning 110031, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5311-3880","authenticated-orcid":true,"given":"Bao Sen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, China Medical University, Shenyang, Liaoning 110000, 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