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. 2017 Dec;22(50):16-00824.
doi: 10.2807/1560-7917.ES.2017.22.50.16-00824.

Epidemiology of hand, foot and mouth disease in China, 2008 to 2015 prior to the introduction of EV-A71 vaccine

Bingyi Yang  1   2 , Fengfeng Liu  2   3 , Qiaohong Liao  2   3 , Peng Wu  1 , Zhaorui Chang  3 , Jiao Huang  3   4 , Lu Long  5 , Li Luo  3 , Yu Li  3 , Gabriel M Leung  1 , Benjamin J Cowling  1   6 , Hongjie Yu  3   6   7
Affiliations

Epidemiology of hand, foot and mouth disease in China, 2008 to 2015 prior to the introduction of EV-A71 vaccine

Bingyi Yang et al. Euro Surveill. 2017 Dec.

Abstract

Introduction: Hand, foot and mouth disease (HFMD) is usually caused by several serotypes from human enterovirus A species, including enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16). Two inactivated monovalent EV-A71 vaccines have been recently licensed in China and monovalent CV-A16 vaccine and bivalent EV-A71 and CV-A16 vaccine are under development.

Methods: Using notifications from the national surveillance system, we describe the epidemiology and dynamics of HFMD in the country, before the introduction of EV-A71 vaccination, from 2008 through 2015.

Results: Laboratory-identified serotype categories, i.e. CV-A16, EV-A71 and other enteroviruses, circulated annually. EV-A71 remained the most virulent serotype and was the major serotype for fatal cases (range: 88.5-95.4%) and severe cases (range: 50.7-82.3%) across years. Except for 2013 and 2015, when other enteroviruses were more frequently found in mild HFMD (48.8% and 52.5%), EV-A71 was more frequently detected from mild cases in the rest of the years covered by the study (range: 39.4-52.6%). The incidence rates and severity risks of HFMD associated with all serotype categories were the highest for children aged 1 year and younger, and decreased with increasing age.

Discussion/conclusion: This study provides baseline epidemiology for evaluation of vaccine impact and potential serotype replacement.

Keywords: HFMD; case-fatality; epidemiology; periodicity.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Schematic model framework to illustrate estimation of serotype-specific notifications of hand, foot and mouth disease and risks of severe events, mainland China, 2008–2015
Figure 2
Figure 2
Notifications of probable and laboratory-confirmed hand, foot and mouth disease (HFMD) in mainland China, 2008–2015
Figure 3
Figure 3
Wavelet analyses for time series of serotype-specific notifications of hand, foot and mouth disease in mainland China, 2009–2015
Figure 4
Figure 4
Annual incidence rates of notified hand, foot and mouth disease in mainland China, 2008–2015
Figure 5
Figure 5
Age-specific incidence rate (Panel A), case-severity risk (Panel B), case-fatality risk (Panel C) and severity-fatality risk (Panel D) of notified hand, foot and mouth disease cases by serotype in mainland China, 2008–2015
See this image and copyright information in PMC

References

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