Abstract
Hand, foot, and mouth disease (HFMD) is endemic in the Pacific region, especially in mainland China. The case-fatality ratio of HFMD is increasing steadily. Knowledge of the changing epidemiology of HFMD in different regions is necessary for implementing appropriate intervention strategies. In this study, we describe the clinical and epidemiological characteristics of HFMD in Hunan Children’s Hospital between 2013 and 2017. A total of 7203 patients with HFMD were admitted, with complication and mortality rates of 35.62% and 0.78%, respectively. The total number of children with HFMD, proportion of severely ill children, and HFMD mortality rate were the highest in 2014. The number of cases caused by EV-A71 and CV-A16 decreased continuously, while the number of cases caused by ‘other enteroviruses’ increased yearly since 2014, suggesting that other enteric viruses will gradually replace EV-A71 and CV-A16 as the main pathogenic HFMD agents. Furthermore, EV-A71 and mixed infections accounted for the high case fatality rates in children with severe HFMD, among whom EV-A71 infection resulted in the highest complication and mortality rates; the mild form of the disease was dominated by ‘other enteroviruses’. In conclusion, the changing etiological pattern highlights the need to improve pathogen surveillance and vaccine strategies for HFMD control.
Highlights
Hand, foot, and mouth disease (HFMD) is a common viral disease in children aged less than 5 years old
The main infectious pathogens for children aged over 2 years were mainly ‘other enteroviruses’ and EV-A71, and mixed infections were common
Previous epidemiological data on HFMD indicated that the incidence of severe HFMD (SHFMD) in China was about 0.9% and the mortality rate was 0.20%-0.39% between 2008 and 20158
Summary
Foot, and mouth disease (HFMD) is a common viral disease in children aged less than 5 years old. It is characterised by fever and rash or herpetic lesions on the hands and feet, as well as exanthema on the oral mucosa and tongue. In China, the incidence of HFMD disease increased approximately 5-fold from 40/100,000 in 2008 to 198/100,000 population in 20147. Hunan Province had an approximately 6-fold increase in incidence from 55.31/100,000 in 2009 to 318.05/100,000 population in 2014. This indicates that the prevention and treatment of HFMD in China is suboptimal. This study aimed to illustrate the clinical and epidemiological characteristics of a population at high risk of HFMD, with a view to provide information for prevention and treatment programmes
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