Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71

Du, Zhicheng; Huang, Yong; Lawrence, Wayne R.; Xu, Jianxiong; Yang, Zhicong; Lu, Jianyun; Zhang, Zhoubin; Hao, Yuantao

doi:10.3390/ijerph18010292

Cited by 13 publications

(18 citation statements)

References 19 publications

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“…Previous studies found that meteorological factors − including temperature and humidity − can induce EV-A71 and CV-A16 to cause differing epidemic scales. 18 After the launch of the EV-A71 vaccine, the timing of the HFMD epidemic peak was delayed, regardless the serotypes of enterovirus. We think that the increased population immunity created by the EV-A71 vaccination program may disrupt the infection cycle.…”

Section: Discussionmentioning

confidence: 99%

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

Hong

Liu

et al. 2022

The Lancet Regional Health - Western Pacific

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Background Hand, foot, and mouth disease (HFMD) is an important public health problem. A monovalent EV-A71 vaccine was launched in China in 2016. Previous studies showed that inactivated monovalent EV-A71 vaccines were highly efficient against HFMD associated with EV-A71 but not against HFMD with other etiologies, leading to a hypothesis that the introduction of EV-A71 vaccines might change the pathogen spectrum and epidemiological trend of HFMD. In this study, we described for the first time the changing epidemiological characteristics of HFMD after the launch of the EV-A71 vaccine.Methods We extracted individual-based epidemiological data on HFMD cases reported to the Chinese Center for Disease Control and Prevention between January 2013 and December 2019. We described the changing epidemiological characteristics of HFMD before and after vaccine launch according to the distribution of diseases characteristics (demographic, temporal, and geographical) and evaluated the potential changes in risk factors of severe patients. All analyses were stratified by the phase before and after vaccine launch, and by enterovirus serotype.Findings During 2013À2019, 15,316,710 probable cases of HFMD were reported. Of these, 787,197 (5¢1%) were laboratory confirmed and 76,982 (0¢5%) were severe. After the launch of the EV-A71 vaccine, the median age of HFMD patients infected with EV-A71 increased from 2¢24 years (IQR:1¢43, 3¢56) to 2¢81 years (IQR:1¢58, 4¢01). The proportion of patients less than 3 years of age decreased while the proportion of patients 3À5 years of age increased. There was a large decrease (60¢7%) in the proportion of severe cases as well as a decline (28¢3%) in HFMD patients infected with EV-A71. After the launch of the EV-A71 vaccine, the severe illness rate and mortality rate of HFMD patients in all age groups has decreased sharply, 62¢20% and 83¢78% respectively. The timing of the HFMD epidemic peak was delayed (1-2 months) . After the launch of EV-A71 vaccine, the risk of becoming a severe case for EV-A71 serotype was decreased, whereas that risk was instead increased for CV-A16 (from 0¢17 (95% CI:0¢16, 0¢18) to 0¢23 (95% CI:0¢21, 0¢25)) and other enterovirus compared to EV-A71 (from 0¢38 (95% CI:0¢37, 0¢39) to 0¢58 (95% CI:0¢56, 0¢61)). The longer the time from onset to diagnosis, the higher was the risk of being a severe case, but the effect size was decreased.Interpretation The introduction of the EV-A71 vaccine has effectively reduced the proportion of severe HFMD cases and mortality, but changes to the dominant serotypes should be closely monitored. Development of multivalent vaccines to avoid an increased case burden due to other enteroviruses is greatly needed.

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Section: Discussionmentioning

confidence: 99%

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

Hong

Liu

et al. 2022

The Lancet Regional Health - Western Pacific

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“…The two peak patterns were not changed by the introduction of the EN71 vaccine. Climatological factors including temperature and humidity, can induce EV71 and CV-A16 to cause differing epidemic scales [ 25 ]. Lager scales of the autumn peaks were detected in 2018 and 2019 in our study.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics of hand, foot, and mouth disease in Yunnan Province, China, 2008–2019

Jiang

Tian

et al. 2021

BMC Infect Dis

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Background Since 2016, enterovirus 71 (EV71) vaccines have been approved for market entry, and little is known about how the epidemiology of hand, foot, and mouth disease (HFMD) has been affected by the introduction of the vaccines in Yunnan Province. The study describes the epidemiological characteristics of HFMD before and after the introduction of EV71 vaccination in Yunnan Province. Methods Surveillance data collected between 2008 and 2019 were analyzed to produce epidemiological distribution on cases, etiologic composition, and EV71 vaccination coverage, as well as to compare these characteristics before and after EV71 vaccination. Results A total of 1,653,533 children received EV71 vaccines from 2016 through 2019 in Yunnan. The annual EV71 vaccination coverage rate ranged from 5.53 to 15.01% among children ≤5 years old. After the introduction of EV71 vaccines, the overall incidence of HFMD increased and reached over 200 cases per 100,000 population-years in 2018 and 2019. However, the case severity and case fatality rate decreased and remained lower than 1 and 0.005% after 2016, respectively. EV71-associated mild, severe and fatal cases sharply decreased. The predominant viral serotype changed to non-EV71/non-CV-A16 enteroviruses which were detected across the whole province. Conclusions Non-EV71/non-CV-A16 enteroviruses became the predominant strain and led to a higher incidence in Yunnan. Expanding EV71 vaccination and strengthening laboratory-based surveillance could further decrease the burden of severe HFMD and detect and monitor emerging enteroviruses.

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“…Socioeconomic data including gross domestic product (GDP), population density and road network density, were obtained from the Urumqi Statistical Bulletin and Urumqi Statistical Yearbook [26]. Meteorological data, including temperature, precipitation and wind speed, were analyzed [27] from the China Climate Data Sharing Service System (http://data.cma.cn/ (accessed on 2 February 2021) and National Meteorological Information Center [28].…”

Section: Data Acquisitionmentioning

confidence: 99%

Spatial and Temporal Characteristics of Hand-Foot-and-Mouth Disease and Their Influencing Factors in Urumqi, China

Gao

Wang

et al. 2021

IJERPH

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Hand, foot, and mouth disease (HFMD) remains a serious health threat to young children. Urumqi is one of the most severely affected cities in northwestern China. This study aims to identify the spatiotemporal distribution characteristics of HFMD, and explore the relationships between driving factors and HFMD in Urumqi, Xinjiang. Methods: HFMD surveillance data from 2014 to 2018 were obtained from the China Center for Disease Control and Prevention. The center of gravity and geographical detector model were used to analyze the spatiotemporal distribution characteristics of HFMD and identify the association between these characteristics and socioeconomic and meteorological factors. Results: A total of 10,725 HFMD cases were reported in Urumqi during the study period. Spatially, the morbidity number of HFMD differed regionally and the density was higher in urban districts than in rural districts. Overall, the development of HFMD in Urumqi expanded toward the southeast. Temporally, we observed that the risk of HFMD peaked from June to July. Furthermore, socioeconomic and meteorological factors, including population density, road density, GDP, temperature and precipitation were significantly associated with the occurrence of HFMD. Conclusions: HFMD cases occurred in spatiotemporal clusters. Our findings showed strong associations between HFMD and socioeconomic and meteorological factors. We comprehensively considered the spatiotemporal distribution characteristics and influencing factors of HFMD, and proposed some intervention strategies that may assist in predicting the morbidity number of HFMD.

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Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71

Cited by 13 publications

References 19 publications

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

Epidemiological characteristics of hand, foot, and mouth disease in Yunnan Province, China, 2008–2019

Spatial and Temporal Characteristics of Hand-Foot-and-Mouth Disease and Their Influencing Factors in Urumqi, China

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