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

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


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.

MeSH terms

  • Age Distribution
  • Child, Preschool
  • China / epidemiology
  • Disease Notification / statistics & numerical data*
  • Enterovirus / classification*
  • Enterovirus / isolation & purification*
  • Enterovirus A, Human
  • Enterovirus Infections / epidemiology*
  • Female
  • Hand, Foot and Mouth Disease / epidemiology*
  • Hand, Foot and Mouth Disease / etiology*
  • Humans
  • Infant
  • Male
  • Seasons
  • Serogroup*
  • Sex Distribution