Abstract
BackgroundOver recent decades, hand, foot and mouth disease (HFMD) has emerged as a serious public health threat in the Asia-Pacific region because of its high rates of severe complications. Understanding the differences and similarities between mild and severe cases can be helpful in the control of HFMD. In this study, we compared the two types of HFMD cases in their temporal trends.MethodsWe retrieved the daily series of disease counts of mild and severe HFMD cases reported in mainland China in the period of 2009–2014. We applied a quasi-Poisson regression model to decompose each series into the long-term linear trend, periodic variations, and short-term fluctuations, and then we compared each component between two series separately.ResultsA total of 11,101,860 clinical HFMD cases together with 115,596 severe cases were included into this analysis. We found a biennial increase of 24.46 % (95 % CI: 22.80–26.14 %) for the baseline of disease incidence of mild cases, whereas a biennial decrease of 8.80 % (95 % CI: 7.26–10.31 %) was seen for that of severe cases. The periodic variations of both two series could be characterized by a mixture of biennial, annual, semi-annual and eight-monthly cycles. However, compared to the mild cases, we found the severe cases vary more widely for the biennial and annual cycle, and started its annual epidemic earlier. We also found the short-term fluctuations between two series were still significantly correlated at the current day with a correlation coefficient of 0.46 (95 % CI: 0.43–0.49).ConclusionsWe found some noticeable differences and also similarities between the daily series of mild and severe HFMD cases at different time scales. Our findings can help us to deepen the understanding of the transmission of different types of HFMD cases, and also provide evidences for the planning of the associated disease control strategies.
Highlights
Over recent decades, hand, foot and mouth disease (HFMD) has emerged as a serious public health threat in the Asia-Pacific region because of its high rates of severe complications
Hand, foot and mouth disease (HFMD) is a common childhood infectious disease caused by viruses that belong to the Enterovirus group, mainly by Coxsackievirus A16 (CVA 16), Enterovirus 71 (EVA 71) and, more recently, Coxsackievirus A6 (CVA 6) [1]
The outbreaks of HFMD reported before the mid-1990s are normally considered as “benign” with rare severe and fatal cases, or many severe cases have been initially misdiagnosed as some other diseases [2]
Summary
Hand, foot and mouth disease (HFMD) has emerged as a serious public health threat in the Asia-Pacific region because of its high rates of severe complications. Foot and mouth disease (HFMD) is a common childhood infectious disease caused by viruses that belong to the Enterovirus group, mainly by Coxsackievirus A16 (CVA 16), Enterovirus 71 (EVA 71) and, more recently, Coxsackievirus A6 (CVA 6) [1]. It is typically characterized by a febrile illness followed by rash on hands and feet, sometimes with vesicular/ulcer in the mouth [2]. Since HFMD has started to prompt huge public health concerns in the Asia-Pacific region given its threat to young lives and the potential for its emergence as a leading cause of enterovirus-related CNS disease after poliomyelitis [21]
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