Hand, foot, and mouth disease in China, 2008-12: an epidemiological study

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• 作者：Weijia Xing ; PhD^a ; ^&dagger ; ; Qiaohong Liao ; MD^a ; ^&dagger ; ; Cé ; cile Viboud ; PhD^b ; ^&dagger ; ; Jing Zhang ; MD^a ; ^&dagger ; ; Junling Sun ; PhD^a ; Joseph T Wu ; PhD^c ; Zhaorui Chang ; MD^a ; Fengfeng Liu ; MD^a ; Vicky J Fang ; MPhil^c ; Yingdong Zheng ; PhD^d ; Benjamin J Cowling ; PhD^c ; Jay K Varma ; MD^e ; Prof Jeremy J Farrar ; PhD^f ; ^g ; ^h ; ⁱ ; Prof Gabriel M Leung ; MD^c ; ^{gmleung@hku.hk" class="auth_mail} ; Dr Hongjie Yu ; PhD^a ; ^{yuhj@chinacdc.cn" class="auth_mail}
• 刊名：The Lancet Infectious Diseases
• 出版年：April, 2014
• 年：2014
• 卷：14
• 期：4
• 页码：308-318
• 全文大小：3423 K

文摘

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Summary

Background

Hand, foot, and mouth disease is a common childhood illness caused by enteroviruses. Increasingly, the disease has a substantial burden throughout east and southeast Asia. To better inform vaccine and other interventions, we characterised the epidemiology of hand, foot, and mouth disease in China on the basis of enhanced surveillance.

Methods

We extracted epidemiological, clinical, and laboratory data from cases of hand, foot, and mouth disease reported to the Chinese Center for Disease Control and Prevention between Jan 1, 2008, and Dec 31, 2012. We then compiled climatic, geographical, and demographic information. All analyses were stratified by age, disease severity, laboratory confirmation status, and enterovirus serotype.

Findings

The surveillance registry included 7鈥?00鈥?92 probable cases of hand, foot, and mouth disease (annual incidence, 1路2 per 1000 person-years from 2010-12), of which 267鈥?42 (3路7%) were laboratory confirmed and 2457 (0路03%) were fatal. Incidence and mortality were highest in children aged 12-23 months (38路2 cases per 1000 person-years and 1路5 deaths per 100鈥?00 person-years in 2012). Median duration from onset to diagnosis was 1路5 days (IQR 0路5-2路5) and median duration from onset to death was 3路5 days (2路5-4路5). The absolute number of patients with cardiopulmonary or neurological complications was 82鈥堚€?86 (case-severity rate 1路1%), and 2457 of 82486 patients with severe disease died (fatality rate 3路0%); 1617 of 1737 laboratory confirmed deaths (93%) were associated with enterovirus 71. Every year in June, hand, foot, and mouth disease peaked in north China, whereas southern China had semiannual outbreaks in May and September-October. Geographical differences in seasonal patterns were weakly associated with climate and demographic factors (variance explained 8-23% and 3-19%, respectively).

Interpretation

This is the largest population-based study up to now of the epidemiology of hand, foot, and mouth disease. Future mitigation policies should take into account the heterogeneities of disease burden identified. Additional epidemiological and serological studies are warranted to elucidate the dynamics and immunity patterns of local hand, foot, and mouth disease and to optimise interventions.

Funding

China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, WHO, The Li Ka Shing Oxford Global Health Programme and Wellcome Trust, Harvard Center for Communicable Disease Dynamics, and Health and Medical Research Fund, Government of Hong Kong Special Administrative Region.