Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009–2015

Abstract

BackgroundHand, Foot, and Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the epidemiology of HFMD can help develop and better target interventions, including the use of pediatric EV-A71 vaccination.MethodsWe obtained data from the national surveillance system for HFMD cases with onset dates from 2009 to 2015. We defined probable cases as patient with skin papular or vesicular rashes on the hands, feet, mouth, or buttocks and confirmed cases as patients with the above symptoms along with laboratory-based enterovirus detection. We generated overall and age-specific annual incidence rates and described the temporal variability and seasonality of HFMD in Qinghai Province. We identified spatial clustering of HFMD incidence at the county level using the Local Indicator of Spatial Associationand an alpha level of 0.05.ResultsDuring the study period, 14,480 HFMD probable or confirmed cases were reported in Qinghai Province. Of the 2158 (14.9%) with laboratory confirmation, 924 (42.6%) were caused by CV-A16 and 830 (38.2%) were caused by EV-A71. The majority (89%) of all case-patients were ≤ 5 years of age and male (61.5%). The overall mean annual HFMD incidence rate was 36.4 cases per 100,000 populations, while the incidence rate for children ≤5 years of age was 379.5 cases per 100,000. Case reports peaked during the months of May through July. HFMD was predominantly caused by EV-A71, except in 2010 and 2014 when CV-A16 was the predominant causative agent. High incidence rates of HFMD were clustered (Moran’s I = 0.59, P < 0.05) in the eastern region of the province.ConclusionHFMD remains an important cause of childhood disease in Qinghai Province, occurring in an acyclical pattern of increased incidence, primarily due to CV-A16 circulation every three years. Incidence is also seasonal and tends to spatially cluster in the eastern region of the province. Since approximately 40% of confirmed HFMD cases were due to EV-A71, EV-A71 vaccination is likely to have a positive impact on the HFMD disease burden. Routine analysis of local surveillance data is crucial for describing disease occurrence and changes in etiology.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3509-7) contains supplementary material, which is available to authorized users.

Surveillance and outbreak response of hand - foot - mouth disease in Haiphong Children’s Hospital, Vietnam

“…The age group of HFMD patients was mainly concentrated in the age group under 36 months; the age group from 12 to 24 months accounted for the highest proportion (45.1%). This figure was entirely consistent with the study of Xu L et al (2018) in Qinghai, China. In that study, 67% of children with HFMD were under 36 months of age (Xu et al, 2018).…”

“…This ratio was in keeping with the previous reports from outbreaks in Taiwan, Singapore, southern Vietnam, and China. Those previous reports showed a male/female ratio ranging from 1.5:1 to 2.5:1 (Chan et al, 2003;Chen et al, 2007;Van Hoang et al, 2019;Xu et al, 2018). The proportion of patients with HFMD living in rural areas (45.7%) was lower than patients living in urban areas (54.3%).…”

Epidemiological characteristics and spatial-temporal clusters of hand, foot, and mouth disease in Qingdao City, China, 2013-2018

“…Although EV71 and CA16 were the most common etiological pathogens in many HFMD cases around the world [37,38], our study showed that other EV was the major pathogens of HFMD in Qingdao during 2013-2018 except 2017. Notably, some other studies showed that other EV, such as CA6 and CA10, was going to become the important causative agents for HFMD in China, Finland, France, and Japan [39][40][41].…”

“…It was worth noting that there were many "villages within cities" in urban-rural fringe areas with large number of migrant workers, backward municipal facilities, weak health awareness and poor health environment in China. Some studies indicated that many migrant workers lived with their children, most of whom were under 5 years old and not at school, which leaded to high incidence of HFMD in urban-rural fringe areas [38]. Moreover, the space-time scanning results indicated that the tendency of HFMD in Qingdao City spreaded from urban area to rural area.…”

Nonlinear effect of temperature on hand, foot, and mouth disease in Lanzhou, China

“…Hand, foot, and mouth disease (HFMD), a common childhood infectious disease, is mostly caused by Enterovirus 71 (EV-A71) or Coxsackievirus A16 (CV-A16) and frequently occurs in East and Southeast Asia including China. [ 1 ] HFMD poses a significant threat to public health and was classified as a C-class notifiable communicable disease in China in 2008. The main patient groups susceptible to HFMD are infants and children under 5 years of age.…”