Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Li, Xingwang; Ni, Xin; Qian, Suyun; Wang, Quan; Jiang, Rongmeng; Xu, Wenbo; Zhang, Yucai; Yu, Guangjun; Chen, Qiang; Shang, Yunxiao; Zhao, Cunyou; Yu, Hui; Zhang, Ting; Liu, Gang; Deng, Huiling; Gao, Jie; Ran, Xian-Gui; Yang, Qian; Xu, Bingying; Huang, Xueyong; Wu, Xingdong; Bao, Yongxing; Chen, Yiping; Chen, Zhi-Hai; Liu, Qingquan; Li, Guoping; Liu, Chunfeng; Wang, Rongbing; Zhang, Guoliang; Gu, Fang; Xu, Hongmei; Li, Ying; Tao, Yang

doi:10.1007/s12519-018-0189-8

Cited by 108 publications

(119 citation statements)

References 30 publications

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“…The criteria for clinical HFMD diagnosis was consistent with Chinese guidelines for the diagnosis and treatment of HFMD [1]. Mild HFMD cases were defined as patients having oral ulcers and maculopapular or vesicular rashes on their hands, feet, and buttocks, with or without fever.…”

Section: Case Definitions and Classificationmentioning

confidence: 99%

“…Hand, foot, and mouth disease (HFMD), a common contagious disorder in children under 5 years of age, is characterised by a brief, generally mild, febrile illness with multiple oral ulcers, and eruption of vesiculo-papular rashes over the hands, feet, mouth, and buttocks [1][2][3]. Some cases can develop severe neurological and systemic complications, such as aseptic meningitis, acute flaccid paralysis, encephalitis, cardiorespiratory failure, and severe pulmonary oedema, and can even lead to death [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

Xie

Yang

et al. 2020

BMC Infect Dis

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Background: Hand, foot, and mouth disease (HFMD) is a common infectious disease occurring in children under 5 years of age worldwide, and Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA-16) are identified as the predominant pathogens. In recent years, Coxsackievirus A6 (CVA-6) and Coxsackievirus A10 (CVA-10) have played more and more important role in a series of HFMD outbreaks. This study aimed to understand the epidemic characteristics associated with HFMD outbreak in Guangzhou, 2018. Methods: The clinical and laboratory data of 1220 enterovirus-associated HFMD patients in 2018 were analysed in this study. Molecular diagnostic methods were performed to identify its serotypes. Phylogenetic analyses were depicted based on the complete VP1 gene. Results: There were 21 enterovirus serotypes detected in Guangzhou in 2018. Three serotypes of enterovirus, CVA-6 (364/1220, 29.8%), CVA-10 (305/1220, 25.0%), and CVA-16 (397/1220, 32.5%), were identified as the causative pathogens and accounted for 87.3% among all 1220 HFMD patients. In different seasons, CVA-6 was the predominant pathogen of HFMD during autumn, and CVA-10 as well as CVA-16 were more prevalent in summer. Patients infected by CVA-6, CVA-10 or CVA-16 showed similar clinical features and laboratory characteristics, and the ratios of severe HFMD were 5.8, 5.9, and 1.5% in the three serotypes. Phylogenetic analyses of VP1 sequences showed that the CVA-6, CVA-10, and CVA-16 sequences belonged to the sub-genogroup E2, genogroup E, and genogroup B1, respectively. Conclusions: CVA-6, CVA-10, and CVA-16 were the predominant and co-circulated serotypes in Guangzhou China, 2018, which should be the new target for prevention and control of HFMD. Our findings provide useful information for diagnosis, treatment, and prevention of HFMD.

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Section: Case Definitions and Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

Xie

Yang

et al. 2020

BMC Infect Dis

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“…There is no specific treatment for the disease. Only a minority of severe cases need hospitalization, as a result of uncommon neurological complications such as meningitis, brain stem encephalitis, acute flaccid paralysis or pulmonary oedema/haemorrhage, which can be lethal, particularly to those aged less than 5 years [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China from 2008-2013.

Liu¹,

Qi²,

Zhan³

et al. 2020

Preprint

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Therapeutic strategies for severe hand, foot and mouth disease (HFMD) are currently either inconsequent or deficient in evidence. We retrospectively surveyed HFMD outbreaks in Xiangyang from June 2008 to December 2013. FHMD is staged form I to V according to clinical severity and the case with central nervous system involvement is defined as a severe one. Most severe cases were investigated to analyse risk factors for fatality and to compare the efficiency and outcome of some therapies by binary logistic regression. The overall HFMD cases included 637 (1.26%) severe cases, 38 fatal cases (0.75‰). Analysis indicates that age (<3 y), enterovirus 71 (+), autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP (>40 mg/L) and cardiac troponin I (>0.04 ng/mL) are risk factors for fatality (all P < 0.05). Intravenous immunoglobulin (IVIG) and mechanical ventilation applied in early stage IV significantly improved HFMD progression (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10), respectively. Methylprednisolone and milrinone administered in any stage, and all therapies applied in stage III made no significant difference on mortality (all P > 0.05). Precise recognition of the severe HFMD cases in early stage IV and timely IVIG and mechanical ventilation application may decrease mortality. Mechanical ventilation training programs and dispatching specialists to county-level or district hospitals when there is no chance for severe HFMD cases to be transferred to superior hospitals are two key successful administrative initiatives.

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“…In the current issue of World Journal of Pediatrics, we published English version of three pediatric clinical practice guidelines in China including assessment and provision of nutrition support therapy in critically ill children [2], management of acute infectious diarrhea in Chinese children [3], and diagnosis and treatment of hand, foot and mouth disease [4].…”

mentioning

confidence: 99%

“…The guideline summarizes the epidemic changes of hand, foot and mouth disease and the progress of diagnosis and treatment in recent years. It is the guiding plan for the diagnosis and treatment of hand, foot and mouth disease [4].…”

mentioning

confidence: 99%

Pediatric clinical practice guidelines in China: still a long way to go

Chen

2018

World J Pediatr

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Clinical practice guidelines provide optimal patient care recommendations, which are important tools for promoting the equality of health care services and saving healthcare resources in China [1]. The evidence-based clinical guidelines are specific to clinical problems and are developed through systematic reviewing to help clinicians and patients make appropriate decisions. Chen et al. revealed several limitations in adoption and adaptation of Chinese Guidelines including (1) rarely using systematic review to support recommendations, (2) lacking information in conflict of interest, and (3) low adherence rate of clinicians to guidelines [1]. The overall quality of China's clinical guidelines still needs improvement compared with the European and American guidelines. China currently lacks capacity for evidence-based guideline development and coordination by a central agency. Most Chinese guideline users rely on recommendations developed by professional groups that lack demonstration of transparency, including conflict of interest management and evidence synthesis, and quality. Taking into account the development of the guidelines at the national level, the Standards Division of the National Health Commission of China commissioned the Evidence-Based Medical Center of Fudan University to develop China's guideline evaluation criteria in 2017. Chinese experts are expected to familiarize themselves with the rules for developing guidelines, and use evidence-based medicine methods to standardize the development of high-quality guidelines. I think that the quality of the clinical guidelines will be improved in the near future.The English version of the guidelines not only shows the world the epidemiological data, medical evidence and diagnosis and treatment models with Chinese characteristics, but also plays an important role in promoting international dialogue and expanding academic influences on a global scale.

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Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Cited by 108 publications

References 30 publications

Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China from 2008-2013.

Pediatric clinical practice guidelines in China: still a long way to go

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