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Background: The economic burden of respiratory syncytial virus (RSV) infection and its impact on health‐related quality of life (HRQoL) are not well‐understood in China. This study assessed total cost and HRQoL for children hospitalized with RSV in Central China. Methods: Based on a prospective case series study in Henan Province in 2020–2021, inpatients aged 0–59 months with RSV‐related acute respiratory infections (ARIs) were included into analysis. Total cost included direct medical cost (sum of medical cost before and during hospitalization), direct non‐medical cost, and indirect cost. Direct medical cost during hospitalization data were extracted from the hospital information system. Other costs and HRQoL status were obtained from a telephone survey conducted in the caregivers of the enrolled patients. Results: Among 261 RSV‐infected inpatients, caregivers of 170 non‐severe cases (65.1%, 170/261) were successfully interviewed. Direct medical cost per episode was 1055.3 US dollars (US$) (95% CI: 998.2–1112.5 US$). Direct non‐medical cost and indirect cost per episode were 83.6 US$ (95% CI: 77.5–89.7 US$) and 162.4 US$ (95% CI: 127.9–197.0 US$), respectively. Quality adjusted life years (QALY) loss for non‐severe RSV hospitalization was 8.9 × 10−3 (95% CI: 7.9 × 10−3–9.9 × 10−3). The majority of inpatients were <1 year of age comprising significantly higher cost and more QALY loss than older children. Conclusions: RSV‐associated hospitalization poses high economic and health burden in Central China particularly for children <1 year old. Our findings are crucial for determining the priority of interventions and allocation of health resources. [ABSTRACT FROM AUTHOR]

Background The association between the clinical severity of hand, foot, and mouth disease (HFMD) inpatients and socioeconomic status (SES) is important for quantifying SES inequality in HFMD disease burden and informing decision-makers regarding medical subsidy and reimbursement policies. Here, this association was investigated using a quantitative SES measurement. Methods Laboratory-confirmed HFMD cases hospitalized at Henan Children's Hospital from February 15, 2017, to February 15, 2018, were invited. We utilized the revised Family Affluence Scale for family affluence–based SES measurement. Clinical severity was diagnosed based on central nervous system (CNS) complications, treatments, and length of stay. We applied logistic regression for association analyses and multiple imputation for missing data. Results A total of 1229 laboratory-confirmed HFMD inpatients responded. Adjusted by age, sex, rural residence, EV-A71 infection, and health-seeking behavior, CNS complications (odds ratio [OR], 2.72; 95% CI, 1.41–5.31), intensive care unit (ICU) admission (OR, 7.30; 95% CI, 2.21–25.97), and prolonged hospitalization (OR, 4.28; 95% CI, 2.44–7.58) were significantly associated with lower family affluence–based SES. These associations increased as the SES category descended. For EV-A71-infected inpatients, severe HFMD was significantly associated with low and intermediate SES. For non-EV-A71-infected inpatients, only the association of prolonged hospitalization with low SES increased significantly. Also, severe HFMD inpatients, especially those admitted to the ICU, incurred high hospitalization costs. Conclusions The clinical severity of HMFD inpatients was significantly associated with family affluence–based SES. Severe HFMD inpatients were more likely to have lower SES than nonsevere inpatients and suffered a heavy economic burden. Therefore, medical subsidy and reimbursement policies should offer sufficient monetary support to severe HFMD inpatients to alleviate economic burden in low-SES populations and reduce potential SES inequality. [ABSTRACT FROM AUTHOR]

• The detection yield of a commercial EV-A71 IgM-capture ELISA kit increased with increasing time between symptom onset and sample collection. • The overall sensitivity, specificity, PPV and NPV of this commercial EV-A71 IgM-capture ELISA kit were 0.61, 0.94, 0.62 and 0.94, respectively. • First time found previous vaccination against EV-A71 was significantly associated with the diagnostic performance of anti EV-A71 IgM-capture ELISA Enterovirus A71 (EV-A71) is the main pathogen of severe hand, foot, and mouth disease (HFMD). Commercial enzyme-linked immunosorbent assays (ELISAs) are widely used in Chinese hospitals for the rapid diagnosis of acute EV-A71 infections. We present an evaluation of the diagnostic performance of a commercial anti-EV-A71 IgM-capture ELISA kit. A prospective, hospital-based HFMD cohort was established in Henan Children's Hospital (February 2017 - February 2018). Stool and blood specimens were collected from 1413 participants for diagnosing EVA71 by quantitative Real-Time Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) and anti-EV-A71 ELISA. Detection yields of EV-A71 IgM increased from 6.5 % (95 % CI:3.3 %–11.4 %) at 0∼24 h, to 42 % (95 % CI:28.3 %–57.8) at 120∼144 h from onset to sampling, and stabilized at ∼40 % after 144 h. With increased time from onset to sampling, the sensitivity of the commercial ELISA increased from 0.54 (95 % CI:0.25−0.81) to 0.74 (95 % CI:0.43−0.66), while specificity decreased from 0.97 (95 % CI:0.93−0.99) to 0.80 (95 % CI:0.69−0.89), and PPV decreased from 0.96 (95 % CI:0.92−0.99) to 0.84 (95 % CI:0.73−0.92). Multivariate analysis found age, EV-A71 vaccination, previous HFMD/Herpangina infection, disease severity, infection during peak EV-A71 season, and sampling time after symptom onset were significantly associated with the diagnostic performance of this anti-EV-A71 IgM-capture ELISA. Achieving satisfactory specificity and sensitivity scores, this commercial anti-EV-A71 IgM-capture ELISA kit is suitable for clinical EV-A71 diagnosis, particularly in resource-poor areas. However, clinicians should interpret results in the context of patient history and epidemiological setting. [ABSTRACT FROM AUTHOR]