Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 12, 2025
Date Accepted: Dec 31, 2025
Population-Level Impact of the Enterovirus A71 Vaccination Program on Hand, Foot, and Mouth Disease in Jiangsu Province, China: An Ecological Time-Series Study
ABSTRACT
Background:
The Enterovirus A71 (EV71) vaccination program was introduced in China in late 2016. However, evidence regarding its impact on the reduction of EV71-associated hand, foot, and mouth disease (HFMD) in Jiangsu Province remains limited.
Objective:
To evaluate the population-level effectiveness of the EV71 vaccination program in Jiangsu Province.
Methods:
We characterized the temporal distribution of EV71-related HFMD cases based on longitudinal surveillance data collected in Jiangsu Province from 2012 to 2019, and assessed the impact of vaccination using a Bayesian structural time series (BSTS) model.
Results:
EV71-associated HFMD cases showed a marked decline, with estimated numbers of 22,303, 9,796, and 3,900 in 2017, 2018, and 2019, respectively. We estimated that 30,117 EV71 cases (95% CI: -1,777, 93,601) were prevented by vaccination program during 2017-2019, corresponding to a reduction of 45.55% (95% CI: -5.19%, 72.22%). The effectiveness of vaccination increased annually, with reductions of -1.03% (95% CI: -94.85%, 48.29%) in 2017 and 82.28% (95% CI: 65.77%, 90.89%) in 2019. Children under 5 years old obtained greater benefits compared to those over 5 years.
Conclusions:
The sharp decline in EV71-associated HFMD cases following the implementation of the EV71 vaccination program suggests a potential causal relationship. Therefore, strengthening vaccine coverage remains a public health priority.
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