{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:11:12Z","timestamp":1785859872283,"version":"3.56.0"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,4,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>Hygiene and social distancing are recommended control measures for hand, foot, and mouth disease (HFMD) and herpangina. However, empirical data to support this recommendation are limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>During an outbreak of HFMD and herpangina due to infection by the human enterovirus 71, we defined a case as a vesicular papular rash on the hands, feet, buttocks, or oral mucosa and onset from April 30 to June 26, 2008. We selected 176 HFMD and herpangina case-children and a stratified random sample of 201 asymptomatic control-children; frequency matched according to residency status. We administered a questionnaire to the parents about their children's exposures and hygienic behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Risk factors for HFMD and herpangina included playing with neighborhood children (odds ratio [OR]: 11 [95% confidence interval (CI): 6.2\u201317]), visiting an outpatient clinic for another reason \u2264 1 week before onset (OR: 20 [95% CI: 5.0\u201388]), and community exposures to crowded places (OR: 7.3 [95% CI: 4.1\u201313]). By using a score summarizing responses to 4 hand-washing questions, we found that 50% of the case-children and 2.5% of control-children had a poor score of 1 to 3, whereas 12% of the case-children and 78% of control-children had a good score of \u22657 (OR: 0.00069 [95% CI: 0.0022\u20130.022]) after we adjusted for residency, age, and community exposures by using logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Hand-washing by preschool-aged children and their caregivers had a significant protective effect against community-acquired HFMD and herpangina from the human enterovirus 71 infection.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2010-1497","type":"journal-article","created":{"date-parts":[[2011,3,22]],"date-time":"2011-03-22T04:06:20Z","timestamp":1300766780000},"page":"e898-e904","source":"Crossref","is-referenced-by-count":63,"title":["Risk Factors for Hand, Foot, and Mouth Disease and Herpangina and the Preventive Effect of Hand-washing"],"prefix":"10.1542","volume":"127","author":[{"given":"Feng","family":"Ruan","sequence":"first","affiliation":[{"name":"Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China;"},{"name":"ZhuHai Center for Disease Control and Prevention, ZhuHai, Guangdong, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yang","sequence":"additional","affiliation":[{"name":"Yuhang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilai","family":"Ma","sequence":"additional","affiliation":[{"name":"Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Jin","sequence":"additional","affiliation":[{"name":"Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China;"},{"name":"Urumqi Center for Disease Control and Prevention, Urumqi, Xinjiang, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shili","family":"Song","sequence":"additional","affiliation":[{"name":"Yuhang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Fontaine","sequence":"additional","affiliation":[{"name":"Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China;"},{"name":"Division of Public Health Systems and Workforce Development, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao-Ping","family":"Zhu","sequence":"additional","affiliation":[{"name":"Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, 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