{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:49:29Z","timestamp":1780098569943,"version":"3.54.0"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2016,6,18]],"date-time":"2016-06-18T00:00:00Z","timestamp":1466208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Guangzhou city science and technology plan-the Pearl River New Star special Project","award":["201506010072"],"award-info":[{"award-number":["201506010072"]}]},{"name":"the Natural Science Foundation of China","award":["81473064"],"award-info":[{"award-number":["81473064"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Epidemics of hand, foot and mouth disease (HFMD) among children have caused concern in China since 2007. We have conducted a retrospective study to investigate risk factors associated with HFMD. In this non-matching case-control study, 99 HFMD patients and 126 control from Guangdong Province were enlisted as participants. Data comprising demographic, socio-economic, clinical and behavior factors were collected from children\u2019s parents through face-to-face interviews by trained interviewers using a standardized questionnaire. Results of the primary logistic regression analyses revealed that age, history of cold food consumption, hand-washing routines, and airing out bedding were significantly associated with HFMD cases. Results of further multivariate analysis indicated that older age (OR = 0.44, 95% CI: 0.34\u20130.56) and hand-washing before meals (OR = 0.3, 95% CI: 0.13\u20130.70) are protective factors, whereas airing out bedding more than thrice a month (OR = 4.55, 95% CI: 1.19\u201317.37) was associated with increased risk for HFMD. Therefore, hand-washing should be recommended to prevent HFMD, and the potential threat of airing out bedding should be carefully considered. However, further studies are needed to examine other possible risk factors.<\/jats:p>","DOI":"10.3390\/ijerph13060610","type":"journal-article","created":{"date-parts":[[2016,6,20]],"date-time":"2016-06-20T12:51:28Z","timestamp":1466427088000},"page":"610","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Hand-Washing: The Main Strategy for Avoiding Hand, Foot and Mouth Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"Dingmei","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangjian","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pi","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanzhong","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Yuebei People\u2019s Hospital, Shaoguan 512026, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Prevention and Health Care, Shijie Hospital of Dongguan, Dongguan 523290, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaokun","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Prevention and Health Care, Shijie Hospital of Dongguan, Dongguan 523290, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Peng","sequence":"additional","affiliation":[{"name":"Baoan Center for Disease Control and Prevention of Shenzhen, Shenzhen 518101, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Deng","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuantao","family":"Hao","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1586\/14787210.2015.1058156","article-title":"Coxsackievirus A6: A new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide","volume":"13","author":"Bian","year":"2015","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/1469-0691.12468","article-title":"Hand, foot and mouth disease in guangdong, China, in 2013: New trends in the continuing epidemic","volume":"20","author":"Lu","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_3","unstructured":"CDC Hand, Foot, and Mouth Disease (HFMD), Available online: http:\/\/www.cdc.gov\/hand-foot-mouth\/about\/index.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1056\/NEJM199909233411302","article-title":"Neurologic complications in children with enterovirus 71 infection","volume":"341","author":"Huang","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_5","unstructured":"WPRO Hand, Foot and Mouth Disease. Available online: http:\/\/www.wpro.who.int\/mediacentre\/factsheets\/fs_10072012_HFMD\/en\/."},{"key":"ref_6","unstructured":"WHO Hand, Foot and Mouth Disease in China: Evaluating an Automated System for the Detection of Outbreaks. Available online: http:\/\/www.wpro.who.int\/china\/topics\/hand_foot_mouth_disease\/en\/."},{"key":"ref_7","unstructured":"National Notifiable Disease Situation, Available online: http:\/\/en.nhfpc.gov.cn\/diseases.html."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Deng, T., Huang, Y., Yu, S.C., Gu, J., Huang, C.R., Xiao, G.X., and Hao, Y.T. (2013). Spatial-temporal clusters and risk factors of hand, foot, and mouth disease at the district level in Guangdong province, China. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0056943"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1016\/S0140-6736(13)61049-1","article-title":"Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: A multicentre, randomised, double-blind, placebo-controlled, phase 3 trial","volume":"381","author":"Zhu","year":"2013","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6177","DOI":"10.1016\/j.vaccine.2014.08.064","article-title":"Prospect and challenges for the development of multivalent vaccines against hand, foot and mouth diseases","volume":"32","author":"Liu","year":"2014","journal-title":"Vaccine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hii, Y.L., Rocklov, J., and Ng, N. (2011). Short term effects of weather on hand, foot and mouth disease. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0016796"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/INF.0b013e3182127782","article-title":"Effects of public health interventions in reducing transmission of hand, foot, and mouth disease","volume":"30","author":"Ma","year":"2011","journal-title":"Pediat. Inf. Dis. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1017\/S0950268814002301","article-title":"Important roles of public playgrounds in the transmission of hand, foot, and mouth disease","volume":"143","author":"Xie","year":"2015","journal-title":"Epidemiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e898","DOI":"10.1542\/peds.2010-1497","article-title":"Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing","volume":"127","author":"Ruan","year":"2011","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lin, H., Sun, L., Lin, J., He, J., Deng, A., Kang, M., Zeng, H., Ma, W., and Zhang, Y. (2014). Protective effect of exclusive breastfeeding against hand, foot and mouth disease. BMC Infect. Disease., 14.","DOI":"10.1186\/s12879-014-0645-6"},{"key":"ref_16","unstructured":"The Ministry of Health of the People\u2019s Republic of China (2010). Guideline for the Diagnosis and Treatment of Hand Foot and Mouth Disease."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (roc) curve","volume":"143","author":"Hanley","year":"1982","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/BF01315616","article-title":"Effect of acid pH, salts, and temperature on the infectivity and physical integrity of enteroviruses","volume":"52","author":"Salo","year":"1976","journal-title":"Arch. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/S1473-3099(10)70194-8","article-title":"Virology, epidemiology, pathogenesis, and control of enterovirus 71","volume":"10","author":"Solomon","year":"2010","journal-title":"Lancet Infect. Disease."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0140-6736(05)66912-7","article-title":"Effect of handwashing on child health: A randomised controlled trial","volume":"366","author":"Luby","year":"2005","journal-title":"Lancet"},{"key":"ref_21","unstructured":"Washing Hands Frequently, Eating Cooked Food, Drinking Boiled Water, Better Ventilation and Sun Exposure Can Be Effective in Preventing Infectious Disease, Available online: http:\/\/www.gov.cn\/zxft\/ft109\/content_958671.htm."},{"key":"ref_22","first-page":"167","article-title":"Duration of enterovirus shedding in stool","volume":"34","author":"Chung","year":"2001","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3192","DOI":"10.1128\/JCM.00628-08","article-title":"Molecular epidemiology of human enterovirus 71 in the united kingdom from 1998 to 2006","volume":"46","author":"Bible","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","first-page":"32","article-title":"Oxidative inactivation of adenovirus","volume":"19","author":"Lund","year":"1996","journal-title":"Arch. Virol."},{"key":"ref_25","unstructured":"Hand, Foot and Mouth Disease\u2014Daily Prevention. Available online: http:\/\/www.szcdc.net\/rdzt\/szkbzt\/zyzz\/201408\/t20140807_2542801.htm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4103\/0970-0218.94016","article-title":"Beliefs regarding diet during childhood illness","volume":"37","author":"Benakappa","year":"2012","journal-title":"Indian J. Community Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/6\/610\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:25:43Z","timestamp":1760210743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/6\/610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,18]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,6]]}},"alternative-id":["ijerph13060610"],"URL":"https:\/\/doi.org\/10.3390\/ijerph13060610","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6,18]]}}}