Abstract
Hand Foot and Mouth Disease (HFMD) constitutes a considerable burden for health care systems across China. Yet this burden displays important geographic heterogeneity that directly affects the local persistence and the dynamics of the disease, and thus the ability to control it through vaccination campaigns. Here, we use detailed geographic surveillance data and epidemic models to estimate the critical community size (CCS) of HFMD associated enterovirus serotypes CV-A16 and EV-A71 and we explore what spatial vaccination strategies may best reduce the burden of HFMD. We found CCS ranging from 336,979 (±225,866) to 722,372 (±150,562) with the lowest estimates associated with EV-A71 in the southern region of China where multiple transmission seasons have previously been identified. Our results suggest the existence of a regional immigration-recolonization dynamic driven by urban centers. If EV-A71 vaccines doses are limited, these would be optimally deployed in highly populated urban centers and in high-prevalence areas. If HFMD vaccines are included in China’s National Immunization Program in order to achieve high coverage rates (>85%), routine vaccination of newborns largely outperforms strategies in which the equivalent number of doses is equally divided between routine vaccination of newborns and pulse vaccination of the community at large.
Highlights
ObjectivesIn this study we use detailed geographic surveillance data to quantify the critical community size (CCS) of Hand Foot and Mouth Disease (HFMD) in China’s northern and southern regions using both observed and simulated incidence from time series Susceptible-Infectious-Recovered (TSIR) epidemic models
A scaled time series Susceptible-Infectious-Recovered (TSIR) model including the extinction-recolonization dynamics could be fitted in 2,897 counties
Whilst the accuracy of the estimates obtained through simulation is contingent on the parameterization of the immigration process as well as the mathematical structure of our epidemic model, we found that our estimates of critical community size (CCS) are not dissimilar from other self-immunizing childhood illnesses such as measles, rubella and pertussis[29]
Summary
In this study we use detailed geographic surveillance data to quantify the CCS of HFMD in China’s northern and southern regions using both observed and simulated incidence from TSIR epidemic models. We explore what spatial patterns of vaccination may best reduce the burden of HFMD in a context of limited vaccine availability
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