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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (3): 491-497. doi: 10.19723/j.issn.1671-167X.2021.03.009

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Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019)

LIU Li-li1,LIU Zhi-ke1,ZHANG Liang2,Δ(),LI Ning2,FANG Ting2,Dong-ZHANG Liang2,XU Guo-zhang2,ZHAN Si-yan1,Δ()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
  • Received:2021-02-08 Online:2021-06-18 Published:2021-06-16
  • Contact: Liang ZHANG,Si-yan ZHAN E-mail:zhangl@nbcdc.org.cn;siyan-zhan@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81973146);National Key Research and Development Program of China(2018ZX10201002-3-8)

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Abstract:

Objective: To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019). Methods: A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval. Results: From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing. Conclusion: The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.

Key words: Hand, foot and mouth disease, Epidemiological characteristics, Etiology, Vaccination

CLC Number: 

  • R572.5

Table 1

Basic demographic characteristics of children aged 5 and younger in Ningbo from 2016 to 2019"

Items Year Total
2016 2017 2018 2019
Person-years 609 972 695 095 697 738 648 277 2 651 081
Male, n (%) 368 691 (53.39) 414 963 (53.17) 437 102 (53.06) 407 732 (52.85) 561 323 (53.24)
Age/years*, $\bar{x} \pm s$ 2.94±1.69 2.96±1.63 3.00±1.65 3.05±1.65 -
Pathogen detection, n 903 876 1 071 898 3 748
Person-years by region
Yinzhou 140 669 156 958 154 433 141 177 593 237
Cixi 103 585 118 296 120 350 113 346 455 577
Yuyao 78 645 88 494 90 284 82 126 339 549
Beilun 64 104 72 663 71 432 65 998 274 197
Ninghai 42 363 49 975 50 543 49 085 191 966
Haishu 36 943 45 826 51 493 50 375 184 637
Zhenhai 37 924 42 856 42 293 40 760 163 833
Xiangshan 37 144 41 749 40 812 36 534 156 239
Jiangbei 35 306 40 282 38 956 34 789 149 333
Fenghua 33 019 37 858 37 260 34 376 142 513

Table 2

The number of patients for new cases of hand, foot and mouth disease and medical visits per case among children aged 5 years and younger in Ningbo from 2016 to 2019"

Items Number of patients, n (%) Total b
2016 2017 2018 2019
Number of new cases a
1 28 919 (95.84) 12 557 (97.84) 38 144 (95.85) 15 631 (97.50) 84 875 (90.85)
2 1 231 (4.08) 275 (2.14) 1 611 (4.05) 393 (2.45) 8 077 (8.65)
3- 23 (0.08) 3 (0.02) 39 (0.10) 7 (0.05) 469 (0.50)
Medical visits per casea
1 21 931 (67.95) 8 786 (65.67) 27 239 (63.56) 11 497 (68.51) 69 771 (66.06)
2 5 905 (18.29) 2 740 (20.48) 8 959 (20.90) 3 436 (20.47) 21 040 (19.92)
3- 4 441 (13.76) 1 853 (13.85) 6 658 (15.54) 1 849 (11.02) 14 801 (14.02)

Table 3

The incidence of hand, foot and mouth disease among children aged 5 years and younger in Ningbo from 2016 to 2019"

Years Cases, n Severe cases, n (‰) Incidence density/(/100 000 person-years), 95%CI
2016 31 452 396 (12.59) 5 156.14 (5 100.92, 5 211.92)
2017 13 116 226 (17.23) 1 886.94 (1 855.21, 1 919.19)
2018 41 484 101 (2.43) 5 945.50 (5 890.25, 6 001.23)
2019 16 420 88 (5.35) 2 532.87 (2 494.90, 2 571.40)
Total/average 102 471 811 (7.92) 3 865.25 (3 842.12, 3 888.52)

Figure 1

Distribution of onset time of hand, foot and mouth disease among children aged 5 years and younger under in Ningbo from 2016 to 2019"

Table 4

Distribution of the incidence of hand, foot and mouth disease among children aged 5 years and younger in Ningbo from 2016 to 2019 by gender and age"

Items Incidence density in each year/(/100 000 person-years) Average incidence density/
(/100 000 person-years)
2016 2017 2018 2019
Gender
Male 5 654.20 2 041.34 6 524.64 2 823.57 4 245.22
Female 4 582.21 1 710.31 5 289.37 2 206.37 3 432.92
Age/years
0- 1 289.81 567.45 2 319.37 736.70 1 215.41
1- 5 374.33 2 067.47 7 695.56 2 722.49 4 517.73
2- 4 197.13 1 670.71 5 090.32 2 170.45 3 293.99
3- 4 731.18 1 977.48 5 381.78 2 536.00 3 643.02
4- 2 800.85 1 169.28 3 255.17 2 233.71 2 380.35
5- 1 304.39 565.96 1 687.35 863.96 1 100.23

Figure 2

Regional distribution of the incidence of hand, foot and mouth disease among children aged 5 years and younger in Ningbo from 2016 to 2019"

Figure 3

Distribution of pathogen composition of hand, foot and mouth disease among children aged 5 years and younger in Ningbo from 2016 to 2019(A); cumulative EV-A71 vaccination rate for children aged 5 and under in different birth years in Ningbo from 2016 to 2019 (B)"

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