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

Abstract Background Therapeutic strategies of severe hand, foot and mouth disease (HFMD) are inconsequent or deficient in evidence by now. Methods We have retrospectively analyzed HFMD outbreaks in Xiangyang from June 2008 to December 2013. All severe cases were enrolled to analyze the risk factors causing mortality and to compare the efficiency and outcome of some therapies by binary logistic regression. Results The HFMD involved 637 (1.26%) severe cases and 38 were fatal (0.75‰). Analysis indicate that age (<3y), EV71 (+), autonomic nervous system (ANS) dysregulation, pulmonary edema/haemorrhage, CRP (>40mg/L) and cardiac troponin I (cTnI) (>0.04ng/mL) are significant predictors of outcome for severe HFMD (all P < 0.05). IVIG and mechanic ventilation can significantly improve outcome of HFMD at early stage III (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 at any stage did not make any significant differences on mortality (all P > 0.05). All therapies had no statistical significance on outcome at stage I and II (all P > 0.05). Conclusions Exactly recognition of the sever HFMD cases in early stage III and timely IVIG and mechanic ventilation application can significantly decrease mortality. Mechanic ventilation training program, and dispatching experts to county-level or district hospital when there are severe HFMD cases who lost transfer opportunity are two key successful administrative experience.