Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 11, 2024
Date Accepted: Oct 29, 2024
The influence of the EV71 vaccine and COVID-19 epidemic on hand, foot and mouth disease in China based on counterfactual models
ABSTRACT
Background:
Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness. Understanding the long-term trends of HFMD incidence and the epidemic characteristics under the circumstances of the vaccination program and the outbreak of the novel coronavirus disease is crucial for effective disease surveillance and control.
Objective:
To evaluate the impact of the vaccination program and the COVID-19 pandemic on HFMD.
Methods:
Using official surveillance data, we described long-term incidence trends, severity rates of HFMD, and the variation of enterovirus proportion among cases. The actual incidences were compared with the counterfactual prediction by the Autoregressive Integrated Moving Average (ARIMA) of time series analysis.
Results:
The annual incidence fluctuated between 25.6 cases per 100,000 population in 2008 and 221.5 cases per 100,000 population in 2018 overtime. Semiannual peaks were observed for monthly incidence each year. The actual incidence of HFMD was constantly lower than the counterfactual prediction after the implementation of vaccination, with negative absolute percentage errors (APEs) ranging from -11% to -229% from January 2017 to April 2018. In the meantime, the proportion of EV71 among the enteroviruses causing HFMD decreased significantly, and the proportion is highly correlated (r=0.727, P=0.004) with the severity rate. After the onset of the COVID-19 outbreak in 2020, the actual incidence consistently maintained a lower magnitude compared to the counterfactual predictions from February to September, with considerable negative APEs (ranging from -31% to -2248%).
Conclusions:
Vaccination alleviated severe HFMD cases and altered epidemiological trends. The HFMD may also benefit from non-pharmaceutical interventions (NPIs) during the COVID-19 epidemic. Further development of a multivalent virus vaccine is crucial for effectively controlling HFMD outbreaks. Policymakers should implement NPIs and emphasize personal hygiene for routine prevention when appropriate. Clinical Trial: NA
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