Fengfeng Liu , Yao Yi , Yang Song , Xiyu Zhang , Tiancheng Xie , Yanzhe Liu , Yucun Chen , Siping Huang , Jie Zhang , Yanping Zhang , Zhaorui Chang , Fuqiang Cui
{"title":"中国大陆在获得EV-A71疫苗之前和期间手足口病暴发流行病学:2011 - 2023年暴发监测数据分析","authors":"Fengfeng Liu , Yao Yi , Yang Song , Xiyu Zhang , Tiancheng Xie , Yanzhe Liu , Yucun Chen , Siping Huang , Jie Zhang , Yanping Zhang , Zhaorui Chang , Fuqiang Cui","doi":"10.1016/j.lanwpc.2025.101603","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Hand, foot, and mouth disease is a common contagious illness of childhood that causes a heavy disease burden in China's mainland. There are three enterovirus A71 (EV-A71) vaccines licensed and used in China since 2016. Our study describes changes in epidemiological characteristics of HFMD outbreaks following EV-A71 vaccine introduction.</div></div><div><h3>Methods</h3><div>Using HFMD outbreak data notified to China CDC during 2011–2023, we compared characteristics of HFMD outbreaks before and after EV-A71 vaccine licensure and availability. We determined risk factors associated with outbreak size with a multivariate regression model and explored county-level patterns of outbreak clusters using local indicators of spatial association (Anselin Local Moran's <em>I</em>).</div></div><div><h3>Findings</h3><div>During 2011–2023, there were 2838 HFMD outbreaks reported with more than ten cases each that were included in our study. There were 53,958 HFMD cases and 17 deaths in the included outbreaks. The median attack rate was 0.07% (IQR = 0.04%–0.13%) and the median outbreak duration was 14 days (IQR = 9–21). Outbreaks began before school seasons started and peaked during weeks 16–25; most (87.95%) occurred in kindergartens, followed by primary or secondary schools (6.69%). Coxsackievirus A16 (CV-A16) caused 54.94% of the HFMD outbreaks, EV-A71 caused 19.77%, CV-A6 caused 8.99%, CV-A10 caused 0.53%, and other enteroviruses caused 15.76%. After EV-A71 vaccine was introduced into the market as a non-National Immunization Program (NIP) vaccine, the proportion of outbreaks caused by EV-A71 declined to 2.93% in the southern provinces and 4.84% in the northern provinces, and CV-A16, CV-A6, CV-A10, and other enteroviruses increased in proportion. Before EV-A71 vaccine availability, high-high clusters occurred in 37 counties of nine provinces, expanding to 117 counties of nine provinces after vaccine introduction, mainly into southern provinces.</div></div><div><h3>Interpretation</h3><div>After EV-A71 vaccine was introduced to the market in China, fewer HFMD outbreaks were caused by EV-A71 and more were caused by CV-A16, CV-A6, and CV-A10. The changes of spectrum for HFMD and expansion of outbreaks hotspots associated with vaccine introduction calls for multi-enterovirus vaccine development for controlling HFMD outbreaks.</div></div><div><h3>Funding</h3><div><span>Key Laboratory of Epidemiology of Major Diseases (Peking University)</span>, <span>Ministry of Education</span>; <span>Prevention and Control Mechanisms for Major Infectious Diseases</span> in the Cyber-Physical-Social Tri-Space (2023YFC2308702).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101603"},"PeriodicalIF":7.6000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Epidemiology of hand, foot, and mouth disease outbreaks before and during availability of EV-A71 vaccine in China's mainland: analysis of outbreak surveillance data from 2011 to 2023\",\"authors\":\"Fengfeng Liu , Yao Yi , Yang Song , Xiyu Zhang , Tiancheng Xie , Yanzhe Liu , Yucun Chen , Siping Huang , Jie Zhang , Yanping Zhang , Zhaorui Chang , Fuqiang Cui\",\"doi\":\"10.1016/j.lanwpc.2025.101603\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Hand, foot, and mouth disease is a common contagious illness of childhood that causes a heavy disease burden in China's mainland. There are three enterovirus A71 (EV-A71) vaccines licensed and used in China since 2016. Our study describes changes in epidemiological characteristics of HFMD outbreaks following EV-A71 vaccine introduction.</div></div><div><h3>Methods</h3><div>Using HFMD outbreak data notified to China CDC during 2011–2023, we compared characteristics of HFMD outbreaks before and after EV-A71 vaccine licensure and availability. We determined risk factors associated with outbreak size with a multivariate regression model and explored county-level patterns of outbreak clusters using local indicators of spatial association (Anselin Local Moran's <em>I</em>).</div></div><div><h3>Findings</h3><div>During 2011–2023, there were 2838 HFMD outbreaks reported with more than ten cases each that were included in our study. There were 53,958 HFMD cases and 17 deaths in the included outbreaks. The median attack rate was 0.07% (IQR = 0.04%–0.13%) and the median outbreak duration was 14 days (IQR = 9–21). Outbreaks began before school seasons started and peaked during weeks 16–25; most (87.95%) occurred in kindergartens, followed by primary or secondary schools (6.69%). Coxsackievirus A16 (CV-A16) caused 54.94% of the HFMD outbreaks, EV-A71 caused 19.77%, CV-A6 caused 8.99%, CV-A10 caused 0.53%, and other enteroviruses caused 15.76%. After EV-A71 vaccine was introduced into the market as a non-National Immunization Program (NIP) vaccine, the proportion of outbreaks caused by EV-A71 declined to 2.93% in the southern provinces and 4.84% in the northern provinces, and CV-A16, CV-A6, CV-A10, and other enteroviruses increased in proportion. Before EV-A71 vaccine availability, high-high clusters occurred in 37 counties of nine provinces, expanding to 117 counties of nine provinces after vaccine introduction, mainly into southern provinces.</div></div><div><h3>Interpretation</h3><div>After EV-A71 vaccine was introduced to the market in China, fewer HFMD outbreaks were caused by EV-A71 and more were caused by CV-A16, CV-A6, and CV-A10. 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Epidemiology of hand, foot, and mouth disease outbreaks before and during availability of EV-A71 vaccine in China's mainland: analysis of outbreak surveillance data from 2011 to 2023
Background
Hand, foot, and mouth disease is a common contagious illness of childhood that causes a heavy disease burden in China's mainland. There are three enterovirus A71 (EV-A71) vaccines licensed and used in China since 2016. Our study describes changes in epidemiological characteristics of HFMD outbreaks following EV-A71 vaccine introduction.
Methods
Using HFMD outbreak data notified to China CDC during 2011–2023, we compared characteristics of HFMD outbreaks before and after EV-A71 vaccine licensure and availability. We determined risk factors associated with outbreak size with a multivariate regression model and explored county-level patterns of outbreak clusters using local indicators of spatial association (Anselin Local Moran's I).
Findings
During 2011–2023, there were 2838 HFMD outbreaks reported with more than ten cases each that were included in our study. There were 53,958 HFMD cases and 17 deaths in the included outbreaks. The median attack rate was 0.07% (IQR = 0.04%–0.13%) and the median outbreak duration was 14 days (IQR = 9–21). Outbreaks began before school seasons started and peaked during weeks 16–25; most (87.95%) occurred in kindergartens, followed by primary or secondary schools (6.69%). Coxsackievirus A16 (CV-A16) caused 54.94% of the HFMD outbreaks, EV-A71 caused 19.77%, CV-A6 caused 8.99%, CV-A10 caused 0.53%, and other enteroviruses caused 15.76%. After EV-A71 vaccine was introduced into the market as a non-National Immunization Program (NIP) vaccine, the proportion of outbreaks caused by EV-A71 declined to 2.93% in the southern provinces and 4.84% in the northern provinces, and CV-A16, CV-A6, CV-A10, and other enteroviruses increased in proportion. Before EV-A71 vaccine availability, high-high clusters occurred in 37 counties of nine provinces, expanding to 117 counties of nine provinces after vaccine introduction, mainly into southern provinces.
Interpretation
After EV-A71 vaccine was introduced to the market in China, fewer HFMD outbreaks were caused by EV-A71 and more were caused by CV-A16, CV-A6, and CV-A10. The changes of spectrum for HFMD and expansion of outbreaks hotspots associated with vaccine introduction calls for multi-enterovirus vaccine development for controlling HFMD outbreaks.
Funding
Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education; Prevention and Control Mechanisms for Major Infectious Diseases in the Cyber-Physical-Social Tri-Space (2023YFC2308702).
期刊介绍:
The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.