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Outcomes following severe hand foot and mouth disease: A systematic review and meta-analysis

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Fecha
2018
Autores
Bazo-Alvarez J.C.
Chen Q.
Jones E.
Li Y.
Liao Q.
Liu F.
Luo L.
Pillay T.D.
Rogier van Doorn H.
Sabanathan S.
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W.B. Saunders Ltd
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Background. Hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) is associated with acute neurological disease in children. This study aimed to estimate the burden of long-term sequelae and death following severe HFMD. Methods. This systematic review and meta-analysis pooled all reports from English and Chinese databases including MEDLINE and Wangfang on outbreaks of clinically diagnosed HFMD and/or laboratory-confirmed EV-A71 with at least 7 days' follow-up published between 1st January 1966 and 19th October 2015. Methods.This systematic review and meta-analysis pooled all reports from English and Chinese databases including MEDLINE and Wangfang on outbreaks of clinically diagnosed HFMD and/or laboratory-confirmed EV-A71 with at least 7 days' follow-up published between 1st January 1966 and 19th October 2015.Two independent reviewers assessed the literature.We used a random effects meta-analysis to estimate cumulative incidence of neurological sequelae or death. Studies were assessed for methodological and reporting quality. Findings. 43 studies were included in the review, and 599 children from 9 studies were included in the primary analysis. Estimated cumulative incidence of death or neurological sequelae at maximum follow up was 19.8% (95% CI:10.2%, 31.3%). Heterogeneity (Iˆ2) was 88.57%, partly accounted for by year of data collection and reporting quality of studies. Incidence by acute disease severity was 0.00% (0.00, 0.00) for grade IIa; 17.0% (7.9, 28.2) for grade IIb/III; 81.6% (65.1, 94.5) for grade IV (p = 0.00) disease.
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HRvD and SS were funded by the Wellcome Trust of Great Britain ( 089276/Z/09/Z and 106680/Z/14/Z ) and a Li Ka Shing Foundation–University of Oxford Global Health Program strategic award ( LG17 ). JCBA has been awarded a doctoral scholarship by CIENCIACTIVA, an initiative of the Peruvian National Council of Science, Technology and Technological Innovation (CONCYTEC); grant contract number 231-2015-FONDECYT. HY was supported by the National Science Fund for Distinguished Young Scholars ( No.81525023 ), the National Natural Science Foundation of China ( No. 81473031 ), the Li Ka Shing Oxford Global Health Programme ( No.B9RST00-B900.57 ).
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