Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 19:12:1472944.
doi: 10.3389/fpubh.2024.1472944. eCollection 2024.

Trend of hand, foot and mouth disease before, during, and after China's COVID control policies in Zhejiang, China

Zheyuan Ding  1 , Qinbao Lu  1 , Haocheng Wu  1 , Chen Wu  1 , Junfen Lin  1 , Xinyi Wang  1 , Tianying Fu  1 , Ke Yang  1 , Queping Song  2
Affiliations

Trend of hand, foot and mouth disease before, during, and after China's COVID control policies in Zhejiang, China

Zheyuan Ding et al. Front Public Health. .

Abstract

Objective: To describe the trends in the incidence of hand, foot and mouth disease (HFMD) before, during, and after China's Coronavirus Disease (COVID) control policies, and to interpret the influence on HFMD incidence at different control stages in Zhejiang Province.

Methods: We collected data on HFMD cases in Zhejiang between 2014 and 2023. We compared the constituent ratios of cases at different COVID control stages by sex, age, child groups, and pathogens and weekly seasonal indices to observe seasonal variations in the incidence of HFMD. An interrupted time-series segmented regression analysis was applied to estimate the influence on HFMD incidence at different control stages. Stratified and sensitivity analyses were conducted to validate the findings.

Results: A considerable proportion of cases occurred among children living separately. The proportions of children in kindergartens or nurseries and children aged 2-4 years were relatively low at the strict control stage compared to the other three stages. Enteroviruses other than enterovirus 71 and coxsackie virus A16 were the dominant HFMD pathogens, and the proportion showed an increasing trend. The usual spring-summer peak in HMFD incidence did not occur in 2020, and the periodicity of the biennial peak was disrupted for a year. The summer peak in 2023 was higher than that in the other years, and was delayed by 3 weeks. The trend changes in weekly HFMD cases during the strict control and regular control stages were - 15% (IRR: 0.85, 95% CI: 0.81-0.89) and 17% (IRR: 1.17, 95% CI: 1.12-1.23), respectively. However, the change was not statistically significant during the reopening stage (IRR: 1.41, 95% CI: 0.34-5.88). The expected number of cases increased by 1.12 times (95% CI: 243.17, 53.45%) during the reopening stage compared to what would have occurred if the zero-COVID policy had continued in 2023.

Conclusion: Non-pharmaceutical interventions (NPIs) for COVID-19 control can mitigate HFMD. However, after the dynamic zero-COVID policy ended, the HFMD incidence returned to historical levels. Strict NPIs such as traffic restrictions and kindergarten closures cannot be sustained long-term. NPIs such as improving personal hygiene for routine prevention are highly recommended.

Keywords: COVID-19; foot and mouth disease; hand; interrupted time-series; non-pharmaceutical interventions; seasonal index.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Timelines of COVID-19 and main non-pharmaceutical interventions in Zhejiang, 2014–2023.
Figure 2
Figure 2
Trend in weekly hand, foot and mouth disease cases in Zhejiang, China, 2014–2023. The black dots represent observed cases. The green line represents the fitted value by the model. The red dashed line represents the estimated cases on counterfactual scenario that COVID-19 never occurred. The orange dashed line represents the estimated cases on counterfactual scenario where the reopening policy was not implemented. The white, dark grey, medium grey, and light grey zones represent the pre-COVID, strict control, regular control, and reopening stages, respectively. HFMD, hand, foot and mouth disease.
Figure 3
Figure 3
Weekly seasonal indices in hand, foot and mouth disease in Zhejiang, China, 2014–2023.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Xing W, Liao Q, Viboud C, Zhang J, Sun J, Wu JT, et al. . Hand, foot, and mouth disease in China, 2008-12: an epidemiological study. Lancet Infect Dis. (2014) 14:308–18. doi: 10.1016/S1473-3099(13)70342-6, PMID: - DOI - PMC - PubMed
    1. Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, et al. . The epidemiology of hand, foot and mouth disease in Asia: a systematic review and analysis. Pediatr Infect Dis J. (2016) 35:e285–300. doi: 10.1097/INF.0000000000001242, PMID: - DOI - PMC - PubMed
    1. Zhuang ZC, Kou ZQ, Bai YJ, Cong X, Wang LH, Li C, et al. . Epidemiological research on hand, foot, and mouth disease in mainland China. Viruses. (2015) 7:6400–11. doi: 10.3390/v7122947, PMID: - DOI - PMC - PubMed
    1. Du Z, Huang Y, Lawrence WR, Xu J, Yang Z, Lu J, et al. . Leading enterovirus genotypes causing hand, foot, and mouth disease in Guangzhou, China: relationship with climate and vaccination against EV71. Int J Environ Res Public Health. (2021) 18:292. doi: 10.3390/ijerph18010292, PMID: - DOI - PMC - PubMed
    1. Wu H, Xue M, Wu C, Lu Q, Ding Z, Wang X, et al. . Trend of hand, foot, and mouth disease from 2010 to 2021 and estimation of the reduction in enterovirus 71 infection after vaccine use in Zhejiang Province, China. PLoS One. (2022) 17:e0274421. doi: 10.1371/journal.pone.0274421, PMID: - DOI - PMC - PubMed

LinkOut - more resources