Impact of the coronavirus disease 2019 interventions on the incidence of hand, foot, and mouth disease in mainland China

Abstract

Background In early 2020, non-pharmaceutical interventions (NPIs) were implemented in China to reduce and contain the coronavirus disease 2019 (COVID-19) transmission. These NPIs might have also reduced the incidence of hand, foot, and mouth disease (HFMD). Methods The weekly numbers of HFMD cases and meteorological factors in 31 provincial capital cities and municipalities in mainland China were obtained from Chinese Center for Disease Control and Prevention (CCDC) and National Meteorological Information Center of China from 2016 to 2020. The NPI data were collected from local CDCs. The incidence rate ratios (IRRs) were calculated for the entire year of 2020, and for January–July 2020 and August–December 2020. The expected case numbers were estimated using seasonal autoregressive integrated moving average models. The relationships between kindergarten closures and incidence of HFMD were quantified using a generalized additive model. The estimated associations from all cities were pooled using a multivariate meta-regression model. Findings Stringent NPIs were widely implemented for COVID-19 control from January to July 2020, and the IRRs for HFMD were less than 1 in all 31 cities, and less than 0·1 for 23 cities. Overall, the proportion of HFMD cases reduced by 52·9% (95% CI: 49·3−55·5%) after the implementation of kindergarten closures in 2020, and this effect was generally consistent across subgroups. Interpretation The decrease in HFMD incidence was strongly associated with the NPIs for COVID-19. HFMD epidemic peaks were either absent or delayed, and the final epidemic size was reduced. Kindergarten closure is an intervention to prevent HFMD outbreaks. Funding This research was supported by the National Natural Science Foundation of China (81973102 & 81773487), Public Health Talents Training Program of Shanghai Municipality (GWV-10.2-XD21), the Shanghai New Three-year Action Plan for Public Health (GWV-10.1-XK16), the Major Project of Scientific and Technical Winter Olympics from National Key Research and Development Program of China (2021YFF0306000), 13th Five-Year National Science and Technology Major Project for Infectious Diseases (2018ZX10725-509) and Key projects of the PLA logistics Scientific research Program (BHJ17J013).

Impact of public health and social measures on hand-foot-mouth disease transmission and prediction of upcoming season after relaxation of COVID-19 control measures

“…Changes in host susceptibility and extrinsic factors such as school holidays, PHSMs, and rainy seasons have been identi ed as driving factors for HFMD transmission in the community [9,11]. However, after adjustment for the rainy season, the ndings of our study showed that summer school holidays during an HFMD epidemic season had a minor impact on HFMD transmission.…”

Hand, foot, and mouth disease outbreak by Coxsackievirus A6 during COVID-19 pandemic in 2021, São Paulo, Brazil.

“…In 2020, there were no reports of HFMD outbreaks in Brazil. NPIs helped control the source of infection, prevented transmission and protected susceptible people; they might have also had an important effect on other communicable diseases such as HFMD in addition to COVID-19, consequently leading to a greater susceptibility to infections in children [ 9 , 10 ]. This phenomenon has also been observed in other countries such as recently reported outbreak of HFMD in France in September 2021, respiratory syncytial virus (RSV) infections in Japan in July 2021 and Europe, which was substantially larger and earlier compared with previous years [10] .…”

The resurfacing of hand, foot, and mouth disease: Are we on the verge of another epidemic?

“…HFMD has a substantial impact on young children. In the early stages of the COVID-19 outbreak, SARS-CoV-2 infections among children were considered rare due to lower exposure [ 5 ]. However, children are at increased risk of infection due to the recent new virus variation [ 5 ].…”

“…There was a strong association between the non-pharmaceutical interventions against COVID-19 and the decrease in HFMD incidence. As a result, the peak of the HFMD epidemic either did not occur or was delayed [ 5 ].…”

“…However, the vaccine does not protect against other viruses that cause the disease [ 4 ]. HFMD outbreaks can be prevented by closing kindergartens [ 5 ]. Surveillance programs are needed to identify the causes behind this surge.…”