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Our long-term vision is that children in developing countries are protected from or effectively treated for enteric and diarrheal diseases at the same rate as children in developed countries. a number of low-cost interventions exist and are effective for reducing child deaths due to these diseases, but today they are not available for many people in developing countries. For those aspects of diarrheal disease that lack evidence- based solutions, we are investing in the research and development of new tools, and designing an integrated strategy for the delivery of both new and existing interventions (e.g., vaccines, oral rehydration solution with. | Pediatrics International 2010 52 203-207 doi 10.1111 j.1442-200X.2009.02937.x Original Article Risk factors for severe hand foot and mouth disease Yoko Suzuki 1 2 Keiko Taya 3 Kazutoshi Nakashima 3 Takaaki Ohyama 3 John M. Kobayashi 3 Yasushi Ohkusa3 and Nobuhiko Okabe3 xField Epidemiology Training Program infectious Disease Surveillance Center National Institute of Infectious Diseases and department of Pediatrics Tokyo Women s Medical University Medical Center East Tokyo Japan Abstract Background Hand foot and mouth disease HFMD and herpangina are enteroviral infectious diseases caused mainly by Coxsackie virus A CA or enterovirus 71 EV71 . From 2000 to 2002 many complicated cases were reported in Japan therefore a nationwide questionnaire survey was carried out to assess the situation. The subjects were patients with HFMD or herpangina or other enterovirus infection from 2000 to 2002 who were either hospitalized over 24 h or who died. The response rates were 41.3 in 2000 and 2001 and 31.6 in 2002. The survey period included the year 2000 when HFMD epidemics due to EV71 occurred. To examine risk factors causing complications of enterovirus infection severe cases of HFMD were focused on. Methods HFMD cases in 2000 were divided into two groups according to severity more severe and less severe . More severe was defined as fatal involving sequelae or involving hospitalization for 7 days or longer . Statistical analyses were conducted with Epi info version 3.3 and the association between risk factors and severity was estimated. Results The number of patients with more severe and less severe cases was 96 and 103 respectively. There was no difference in sex age having siblings and family history between the two groups. There was a significant association between attending child care center and severe HFMD. Conclusions It is not clear why attending child care centers was associated with HFMD severity. Further study is needed. Key words child care center complication .
