Objective: To understand the vaccination status of enterovirus type 71 (EV71) inactivated vaccines in China from 2017 to 2021 and provide evidence for making policy on immunization strategy against hand, foot and mouth disease (HFMD). Methods: Using the reported dose number of EV71 vaccination and birth cohort population data collected by the China immunizaiton program information system to estimate the cumulative coverage of EV71 vaccine by the end of 2021 among the birth cohorts since 2012 at national, provincial, and prefecture levels, and analyze the correlation between the vaccination coverage and the potential influencing factors. Results: As of 2021, the estimated cumulative vaccination coverage of the EV71 vaccine was 24.96% in birth cohorts since 2012. The cumulative vaccination coverage was between 3.09% and 56.59% in different provinces, between 0 and 88.17% in different prefectures. There was a statistically significant correlation between vaccination coverage in different regions and the region's previous HFMD prevalence and disposable income per capita. Conclusions: Since 2017, the EV71 vaccines have been widely used nationwide, but the coverage of EV71 vaccination varies greatly among regions. Vaccination coverage is higher in relatively developed regions, and the intensity of previous epidemic of HFMD may have a certain impact on the acceptance of the vaccine and the pattern of immunization service. The impact of EV71 vaccination on the epidemic of HFMD requires further studies.
Humans ; Enterovirus A, Human ; Hand, Foot and Mouth Disease/prevention & control* ; Vaccines, Inactivated ; Viral Vaccines ; Enterovirus ; Vaccination ; China/epidemiology*

Humans ; Beijing ; Hand, Foot and Mouth Disease/epidemiology* ; China/epidemiology*

Objective: To analyze the epidemiological characteristics of hand, foot and mouth disease (HFMD) among people ≥6 years old in Beijing from 2011 to 2020. Methods: The incidence data of HFMD cases from 2011 to 2020 were collected from the National Notifiable Infectious Disease Reporting System of China Information for Disease Control and Prevention and the etiological surveillance of HFMD in 29 sentinel hospitals from 16 districts of Beijing. Descriptive epidemiological methods were used to analyze the distributions, pathogen constituents, and changes of HFMD cases in Beijing people ≥6 years old. Results: From 2011 to 2020, a total of 38 183 cases of HFMD were reported among people ≥6 years old in Beijing, of which 46 (0.12%) cases were severe. The average annual reported incidence was 19.04/100 000. The ratio of males to females were 1.37∶1(22 064∶16 119). The proportion of HFMD in people ≥6 years old increased from 7.56%(2 606/34 488) in 2011 to 24.54% (546/2 225) in 2020. The average incidence of HFMD was higher in Shunyi district, Yanqing district, and Tongzhou district than in other districts in Beijing. The positive rate of enterovirus in sentinel surveillance was 66.78% (1 976/2 959), the proportion of enterovirus group A 71 (EV-A71) was 45.29% (101/223) in 2014, no EV-A71 positive was detected in 2020, and the proportion of Coxsackievirus A 6 (CV-A6) increased from 15.11% (34/225) in 2016 to 81.08% (60/74) in 2020. Conclusions: From 2011 to 2020, the proportion of cases with HFMD in people ≥6 years old in Beijing increased yearly, and the proportion of EV-A71 positive patients decreased basically. Since 2016, CV-A6 has gradually become the dominant pathogen. More attention should be paid to the epidemic situation and dynamic pathogen changes of hand foot mouth disease in people ≥6 years old.
Child ; China/epidemiology* ; Enterovirus ; Enterovirus A, Human ; Enterovirus Infections/epidemiology* ; Female ; Hand, Foot and Mouth Disease/epidemiology* ; Humans ; Infant ; Male

Hand, foot and mouth disease (HFMD) has been widespread in the world, and caused fever, rashes and other clinical symptoms of children, and sometimes inducing respiratory failure, brainstem encephalitis, and other complications, even death. The disease is mainly caused by enterovirus 71 (EV-A71) and coxsackievirus 16 (CV-A16). Since 2013, the proportion of HFMD cases caused by other enteroriruses has gradually increased, causing severe and even fatal cases. This paper summarizes the research progress in the epidemiological and etiological characteristics of HFMD in China since 2008.
Child ; China/epidemiology* ; Encephalitis ; Enterovirus ; Enterovirus A, Human ; Hand, Foot and Mouth Disease/epidemiology* ; Humans

China/epidemiology* ; Enterovirus ; Hand, Foot and Mouth Disease/epidemiology* ; Humans ; Infant ; Phylogeny ; Sequence Analysis, DNA

Objectives: Hand, foot and mouth disease (HFMD) is a widespread infectious disease that causes a significant disease burden on society. To achieve early intervention and to prevent outbreaks of disease, we propose a novel warning model that can accurately predict the incidence of HFMD. Methods: We propose a spatial-temporal graph convolutional network (STGCN) that combines spatial factors for surrounding cities with historical incidence over a certain time period to predict the future occurrence of HFMD in Guangdong and Shandong between 2011 and 2019. The 2011-2018 data served as the training and verification set, while data from 2019 served as the prediction set. Six important parameters were selected and verified in this model and the deviation was displayed by the root mean square error and the mean absolute error. Results: As the first application using a STGCN for disease forecasting, we succeeded in accurately predicting the incidence of HFMD over a 12-week period at the prefecture level, especially for cities of significant concern. Conclusions This model provides a novel approach for infectious disease prediction and may help health administrative departments implement effective control measures up to 3 months in advance, which may significantly reduce the morbidity associated with HFMD in the future.
China/epidemiology* ; Cities/epidemiology* ; Data Visualization ; Disease Outbreaks/statistics & numerical data* ; Forecasting/methods* ; Hand, Foot and Mouth Disease/prevention & control* ; Humans ; Incidence ; Neural Networks, Computer ; Reproducibility of Results ; Spatio-Temporal Analysis ; Time Factors

Objective: To analyze the epidemiology and spatial-temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Shanxi province. Methods: The data of HFMD in Shanxi province from 2009 to 2020 were collected from notifiable disease management information system of Chinese information system for disease control and prevention and analyzed by descriptive epidemiology, Joinpoint regression, spatial autocorrelation analysis and spatio- temporal scanning analysis. Results: A total of 293 477 HFMD cases were reported in Shanxi province from 2009 to 2020, with an average annual incidence of 67.64/100 000 (293 477/433 867 454), severe disease rate of 5.36/100 000 (2 326/433 867 454), severe disease ratio of 0.79%(2 326/293 477), mortality of 0.015/100 000 (66/433 867 454), and fatality rate of 22.49/100 000 (66/293 477). The reported incidence rate, severe disease rate, mortality rate and fatality rate of HFMD showed decreasing trends. The main high-risk groups were scattered children and kindergarten children aged 0-5. The incidence of HFMD had obvious seasonal variation, with two peaks every year: the main peak was during June-July, the secondary peak was during September-October and the peak period is from April to November. A total of 13 942 laboratory cases were confirmed, with a diagnosis rate of 4.75% (13 942/293 477), including 4 438 (35.11%, 4 438/293 477) Enterovirus A71 (EV-A71) positive cases, 4 609 (33.06%, 4 609/293 477) Coxsackievirus A16 (CV-A16) positive cases, and 4 895 (31.83%, 4 895/293 477) other enterovirus positive cases. There was a spatial positive correlation (Moran's I ranged from 0.12 to 0.58, all P<0.05) and the spatial clustering was obvious. High-risk regions were mainly distributed in Taiyuan in central Shanxi province, Linfen and Yuncheng in southern Shanxi province, and Changzhi in southeastern Shanxi province. Spatial-temporal scanning analysis revealed 1 the most likely cluster and 8 secondary likely clusters, of which the most likely cluster (RR=2.65, LLR=22 387.42, P<0.001) located in Taiyuan and Jinzhong city, Shanxi province, including 12 counties (districts), and accumulated from April 1, 2009 to November 30, 2018. Conclusions: There was obvious spatial-temporal clustering of HFMD in Shanxi province, and the epidemic situation was in decline. The key areas were the districts in urban areas and the counties adjacent to it. Meanwhile, the monitoring and classification of other enterovirus types of HFMD should be strengthened.
Child ; Humans ; Hand, Foot and Mouth Disease/epidemiology* ; Spatial Analysis ; Enterovirus Infections ; Spatio-Temporal Analysis ; Cluster Analysis

Objective: To analyze the spatiotemporal characteristics of hand,foot and mouth disease (HFMD) in China, explore the association of socioeconomic, population and health services factors with the incidence of HFMD in China, and provide information for the prevention and control of HFMD. Methods: Bayesian spatiotemporal model was used to fit the data of HFMD, evaluate the spatiotemporal variation of HFMD, and identify the potential association between the risk of HFMD and social, economic, population and health services. Results: From 2011 to 2018, a total of 17 118 050 HFMD cases, including 2 283 deaths, were reported in China. The reported incidence showed a fluctuating increase trend from 2011 to 2014, and a fluctuating decrease trend from 2014 to 2018. Meanwhile, there was a fluctuating decrease trend of mortality rate. The incidence of HFMD had spatial clustering, with the highest incidence in southern China with hot spot and high risk areas, and the lowest incidence in northwestern China where cold spot and low risk areas were found. The risk for HFMD was associated with GDP per capita (RR=3.54), number of industrial enterprises above designated size of 10 000 people (RR=1.61), urbanization rate (RR=3.00), birth rate (RR=2.36), number of beds in medical institutions per 10 000 people (RR=3.40), and green area in parks per capita (RR=0.57). Conclusions: The hotspot area for HFMD prevention and control in China was in the southeast coastal provinces from 2011 to 2018. In order to reduce the incidence of HFMD, it is necessary to increase the green area in parks per capita while accelerating urbanization process.
Humans ; Animals ; Bayes Theorem ; Foot-and-Mouth Disease ; China/epidemiology* ; Hand, Foot and Mouth Disease/epidemiology* ; Menthol

BACKGROUND: Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. METHODS: We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. RESULTS: We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. CONCLUSION Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.
Adolescent ; Child ; Child, Preschool ; China/epidemiology* ; Cities/epidemiology* ; Female ; Hand, Foot and Mouth Disease/virology* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Risk Factors

OBJECTIVE: To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019). METHODS: A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval. RESULTS: From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing. CONCLUSION The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.
Child ; Child, Preschool ; China/epidemiology* ; Enterovirus ; Enterovirus Infections ; Hand, Foot and Mouth Disease/epidemiology* ; Humans ; Incidence ; Infant ; Male ; Retrospective Studies