Spatiotemporal cluster patterns of hand, foot, and mouth disease at the province level in mainland China, 2011–2018

Abstract

Although three monovalent EV-A71 vaccines have been launched in mainland China since 2016, hand, foot, and mouth disease (HFMD) still causes a considerable disease burden in China. Vaccines’ use may change the epidemiological characters of HFMD. Spatial autocorrelation analysis and space-time scan statistics analysis were used to explore the spatiotemporal distribution pattern of this disease at the provincial level in mainland China. The effects of meteorological factors, socio-economic factors, and health resources on HFMD incidence were analyzed using Geodetector. Interrupted time series (ITS) was used to analyze the impact of the EV-A71 vaccine on the incidence of HFMD. This study found that the median annual incidence of HFMD was 153.78 per 100,000 (ranging from 120.79 to 205.06) in mainland China from 2011 to 2018. Two peaks of infections were observed per year. Children 5 years and under were the main morbid population. The spatial distribution of HFMD was presented a significant clustering pattern in each year (P<0.001). The distribution of HFMD cases was clustered in time and space. The range of cluster time was between April and October. The most likely cluster appeared in the southern coastal provinces (Guangxi, Guangdong, Hainan) from 2011 to 2017 and in the eastern coastal provinces (Shanghai, Jiangsu, Zhejiang) in 2018. The spatial heterogeneity of HFMD incidence could be attributed to meteorological factors, socioeconomic factors, and health resource. After introducing the EV-A71 vaccine, the instantaneous level of HFMD incidence decreased at the national level, and HFMD incidence trended downward in the southern coastal provinces and increased in the eastern coastal provinces. The prevention and control policies of HFMD should be adapted to local conditions in different provinces. It is necessary to advance the EV-A71 vaccination plan, expand the vaccine coverage and develop multivalent HFMD vaccines as soon as possible.

Epidemiological characteristics and trends of hand-foot-mouth disease in Shanghai, China from 2011 to 2021

“…The common pathogens of HFMD in China are EV-A71, CV-A16 and some other enteroviruses (4,5). However, the proportion of CV-A6 infections has gradually increased in recent years in China and around the world (6)(7)(8).The median annual incidence of HFMD was 153.78 per 100,000 (ranging from 120.79 to 205.06) in mainland China from 2011 to 2018 (9). China accounted for 87% (9.8 million/11.3 million) of all hand, foot, and mouth disease (HFMD) cases reported to WHO during 2010-2014 (10).…”

Health-Related Quality of Life and Economic Burden Among Hospitalized Children with Hand, Foot, and Mouth Disease: A Multiregional Study in China

“…Numerous HFMD outbreaks and deaths have been reported in the Asia–Pacific region, including China [ 5 ]. From 2011 to 2018, children under 5 years old accounted for the largest proportion of all patients with HFMD in China, ranging from 92.76 to 95.32% [ 6 ]. According to a report of the Chinese Center for Disease Control and Prevention, the incidence and mortality rates of HFMD in China were 96.08 per 100,000 and 0.006 per 100,000 in 2021, respectively [ 7 ].…”

Spatiotemporal patterns and risk mapping of provincial hand, foot, and mouth disease in mainland China, 2014–2017

“…However, studies on spatiotemporal patterns that contain fully recorded incidence data on nationwide HFMD cases from 2012 to the present are limited. There was only one study regarding spatiotemporal cluster detection but no risk estimation (20). Therefore, it is necessary to estimate the smoothed map of HFMD risk in recent years to obtain the spatiotemporal risk of HFMD across the country and to observe whether changes have occurred in high-risk provinces.…”