The reinfection cases were defined as patients who were infected with HFMD at least twice from to , and the non-reinfection cases were defined as patients who were infected with HFMD only once. Categorical variables are presented as numbers and percentages, and continuous variables as median and interquartile range IQR. The chi-square test was used to stratify comparisons of reinfection rate, and the chi-square test for trend was applied to analyse the incidence of infection with respect to age.
Independent risk factors of HFMD reinfection were assessed using logistic regression analysis. Variables significant in the univariate analysis were included in a multivariate model.
Analyses were performed with SPSS version Of the , cases of HFMD reported from to in Wuxi, cases were identified as reinfections.
The reinfection rate was 6. Of all the non-reinfection HFMD cases, were classified as severe, with five deaths. On the other hand, of the reinfection HFMD cases were severe, but no deaths were reported. The reinfection rates in different groups are presented in Table 1. The reinfection rates in male and female patients were 6. The reinfection rate in children aged under 1 year of age was 9.
The reinfection rate in children younger than 4 years of age was significantly higher than that in children over 4 years of age, with children under 4 years of age accounting for For the different status, the reinfection rate was highest in the scattered children 7. The reinfection rate was higher in urban areas 6.
The reinfection rate was 7. The seasonal distributions of the primary infection, secondary infection, and non-reinfection cases were similar. There were two peaks, which occurred in the seasonal months of May to July and November to December annually Fig. In patients who were infected twice, the median time interval between the two infections was 13 IQR 7—24 months. In patients who were infected four times, the median time intervals were 9.
In patients who were infected five times, the median time intervals of reinfection were 5, 16, 2, and 12 months respectively. For the different age groups 0, 1, 2, 3, 4, and 5 years , the proportions of cases in which the time interval between the primary and secondary infections was within 2 years were Sex, age, status, residence, and clinical classification were relevant factors for HFMD reinfection Table 1.
The detailed results are listed in Table 2. Of all the reinfection cases, were classified as severe. Among these, 65 severe cases occurred during the second infection.
The case-severity rate in the primary infection cases 1. Of all the reinfection cases, were laboratory-diagnosed cases, of which were tested during only the primary infection, cases during only the second infection, and 19 cases during both infections. The proportion of patients infected with CoxA16 in the primary infection cases However, the proportion of patients infected with other enteroviruses in the primary infection cases Of the 19 patients who had both primary and secondary laboratory test results Table 5 , two were infected with EV71 and three with CoxA16 in both infections.
Both patients who were infected with EV71 were aged 1 year, with infections occurring in April and July and in June and January , respectively. Of three patients who were infected with CoxA16, the first was a 2-year-old boy, with infections occurring in August and April The second and third were 4-year-old-boys, with the infections occurring in March and June and in September and August , respectively. The HFMD reinfection rate was 6.
Regional differences and a longer investigation period in Wuxi may have accounted for the discrepancy. However, our results are similar to a study in Fujian Province [ 15 ]. Most of the reinfection cases were patients who were infected twice Our results also demonstrated that the HFMD reinfection rate in boys was higher than that in girls, which is in accordance with the incidence of HFMD [ 16 ]. This may be attributed to the more active lifestyle of boys compared with girls, making them prone to touching objects polluted by infected children [ 14 ].
The present study revealed the reinfection rate decreased with increasing age, and the reinfection rate in children younger than 4 years was significantly higher than that in children over 4 years, with children under 4 years of age accounting for Ji et al.
Moreover, we found the median time interval between reinfection was 13 IQR 7—24 months, and therefore, children under 4 years of age were more prone to reinfection within 1—2 years after the first HFMD infection. Descriptive analysis revealed that HFMD reinfection mainly existed in scattered and kindergarten children, with the reinfection rate in the scattered children being higher than that in the other statuses. One possible reason was that the scattered children were young and had not yet developed proper personal hygiene, suggesting the need for families, and particularly caretakers, to pay attention to the personal and environmental hygiene of children.
In addition, we observed that the reinfection rate was higher in urban areas, which may be attributed to the high population density and increased floating population in these urban areas. Unless symptoms become severe, or your child is unable to swallow fluids, this uncomfortable illness simply must run its course. A little extra effort to keep things clean can go a long way toward minimizing the risk of your child having an infection.
While it is true that HFMD typically causes the signature blisters on the hands, feet, and mouth of an infected person, other parts of the body are normally affected, too. We understand the difficulty of watching your child struggle through an illness.
Our caring professionals are available to help you nurse your child or yourself back to health. Call one of our offices in either Schererville, Indiana, or Chicago, Illinois, or book online with us today. Telehealth is a new revolution in healthcare, and many doctors are taking advantage of these systems to provide prompt care to patients.
Care at home HFMD is a viral infection that rarely causes further complications. HFMD will get better on its own, but there are ways you can care for your child at home: If your child is in pain or is uncomfortable, give them pain relief, such as paracetamol or ibuprofen. Do not give aspirin. See our fact sheet Pain relief for children. Give your child frequent sips of water or an oral rehydration solution to stop them becoming dehydrated.
Leave blisters to dry naturally. Do not pierce or squeeze them. If your child is unwell with a fever and a skin rash small bright red spots or purple spots or unexplained bruises that does not turn to skin-colour blanch when you press on it, this may be a sign of meningococcal infection see our fact sheet Meningococcal infection.
Key points to remember HFMD is a mild illness that will get better on its own. Two types of viruses cause HFMD, and the rash depends on which virus your child has. HFMD is spread easily from one person to another. HFMD is not known to pose a risk to pregnant women or their unborn babies. My child still has blisters. Speak to a GP or your midwife if you have been in contact with someone with hand, foot and mouth disease.
Page last reviewed: 12 February Next review due: 12 February Hand, foot and mouth disease. Check if it's hand, foot and mouth disease The first signs of hand, foot and mouth disease can be: a sore throat a high temperature not wanting to eat After a few days mouth ulcers and a rash will appear. Ulcers appear in the mouth and on the tongue. These can be painful and make it difficult to eat or drink.
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