Population Incidence Rates Research Articles

Staphylococcus aureus bacteraemia at Alice Springs Hospital, Central Australia, 2003-2006.

Infectious diseases remain the leading cause of death at Alice Springs Hospital (ASH) and Staphylococcus aureus bacteraemia (SAB) is the second most common bloodstream infection. Non-multidrug-resistant, methicillin-resistant S. aureus (nmMRSA) is endemic to the region. To determine whether differences exist between racial groups and resistance phenotypes in the clinical manifestations and outcomes of SAB at ASH. A retrospective review of medical and pathology records for inpatients with SAB between 1 January 2003 and 31 December 2006. A total of 125 patients (indigenous, 111; non-indigenous, 14) presented with SAB during the study period. Among indigenous patients, there were 95 adults and 16 children. No non-indigenous child was admitted with SAB. The mean annual incidence rate was 160.7/100 000 indigenous population and 8.1/100 000 non-indigenous population (incidence rate ratio 19.9) (P = 0.010). Isolates were predominantly methicillin-susceptible S. aureus (indigenous, 85; non-indigenous, 13). Twenty of 27 MRSA isolates were non-multidrug-resistant. Indigenous adults were more likely to present with an infective focus (indigenous, 75; non-indigenous, 6) (P = 0.004). These were most often skin infections (skin abscesses, 31; scabies, 4). Twenty-seven indigenous adults self-discharged after receiving a median of only 5 days (inter-quartile range (IQR), 3-9) of antibiotic therapy. Ninety-day mortality rates for indigenous and non-indigenous adults were 14.7% and 14.3% respectively. The median age of death for indigenous adults was 50 years (IQR, 37-68). Indigenous Australians have the highest reported incidence rate of SAB worldwide. This reflects the socioeconomic disadvantage experienced by indigenous Australians whose living conditions predispose to pathogen transmission and limits opportunities to maintain adequate skin hygiene.

Abstract 3596: Globally, minorities are at increased risk for lung cancer

Abstract Purpose of Study: To determine whether identifiable minority populations in countries of the six regions of the world experience higher incidence rates of lung cancer than do the members of the majority population of those countries. Experimental procedures: The WHO website has codified the world's continents into six regions including Africa, Americas, South East Asia, Europe, The Eastern Mediterranean and the Western Pacific. This definition of world regions was used for this study. Data were available from five of the six regions. Countries were ordered in each region according to population density. In each region, at a minimum, the 10 most densely populated countries were included. A minority population group was defined as a numerically smaller proportion of a population differing from the majority by a specific identifiable characteristic. Minority and majority populations were defined according to the CIA world fact book and the minority rights group international. Each country was evaluated separately for incidence rates of lung cancer within both minority and majority populations. Codified study data were included for a country only if the data met the following specific criteria: (1) the data had to be presented in its original form using a case-control or cohort methodology; (2) lung cancer incidences had to be reported as an outcome. Data were only included for analysis if it were published as a case-control or cohort study with appropriate references in a peer-reviewed journal. No data from non -peer reviewed articles were considered. Results: Table 1: Lung cancer incidence rates in minority and majority populations from countries included in the top ten of the most densely populated of five world regions. Conclusions: Globally, minority populations experience much higher incidence rates for lung cancer within a country than do the majority population. We hypothesize that this is due to marginalization of these minority groups which may lead to increased smoking in the minority group members as a coping mechanism. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3596. doi:1538-7445.AM2012-3596

High School Football and Risk of Neurodegeneration: A Community-Based Study

ObjectiveTo assess whether high school football played between 1946 and 1956, when headgear was less protective than today, was associated with development of neurodegenerative diseases later in life. MethodsAll male students who played football from 1946 to 1956 in the high schools of Rochester, Minnesota, plus a non–football-playing referent group of male students in the band, glee club, or choir were identified. Using the records-linkage system of the Rochester Epidemiology Project, we reviewed (from October 31, 2010, to March 30, 2011) all available medical records to assess later development of dementia, Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS). We also compared the frequency of dementia, PD, or ALS with incidence data from the general population of Olmsted County, Minnesota. ResultsWe found no increased risk of dementia, PD, or ALS among the 438 football players compared with the 140 non–football-playing male classmates. Parkinson disease and ALS were slightly less frequent in the football group, whereas dementia was slightly more frequent, but not significantly so. When we compared these results with the expected incidence rates in the general population, only PD was significantly increased; however, this was true for both groups, with a larger risk ratio in the non–football group. ConclusionOur findings suggest that high school students who played American football from 1946 to 1956 did not have an increased risk of later developing dementia, PD, or ALS compared with non–football-playing high school males, despite poorer equipment and less regard for concussions compared with today and no rules prohibiting head-first tackling (spearing).

Descriptive Epidemiology of Primary Brain and CNS Tumors in Delhi, 2003-2007

The Delhi Population Based Cancer Registry data during the period 2003-2007 were used to describe the epidemiology of primary malignant brain and central nervous system tumors in Delhi. A total of 1989 brain and CNS tumors cases in 1291 males and 698 females were registered during the period 1st January 2003 to 31st December 2007. The age adjusted (world population) incidence rates were 3.9 per 100,000 for males and 2.4 per 100,000 for females. Gliomas were the most frequently reported histology both in males (26.6%) and females (23.2%). A male predominance in incidence was observed for all histological classifications. The rates in Delhi are low compared to the incidences reported from developed countries.

An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing incidence and prevalence rates of reasons for encounter and diagnostic titles of episodes of care across populations

This is a study of the epidemiology of family medicine (FM) in three practice populations from the Netherlands, Malta and Serbia. Incidence and prevalence rates, especially of reasons for encounter (RfEs) and episode labels, are compared. Participating family doctors (FDs) recorded details of all their patient contacts in an episode of care (EoC) structure using electronic patient records based on the International Classification of Primary Care (ICPC), collecting data on all elements of the doctor-patient encounter. RfEs presented by the patient, all FD interventions and the diagnostic labels (EoCs labels) recorded for each encounter were classified with ICPC (ICPC-2-E in Malta and Serbia and ICPC-1 in the Netherlands). The content of family practice in the three population databases, incidence and prevalence rates of the common top 20 RfEs and EoCs in the three databases are given. Data that are collected with an episode-based model define incidence and prevalence rates much more precisely. Incidence and prevalence rates reflect the content of the doctor-patient encounter in FM but only from a superficial perspective. However, we found evidence of an international FM core content and a local FM content reflected by important similarities in such distributions. FM is a complex discipline, and the reduction of the content of a consultation into one or more medical diagnoses, ignoring the patient's RfE, is a coarse reduction, which lacks power to fully characterize a population's health care needs. In fact, RfE distributions seem to be more consistent between populations than distributions of EoCs are, in many respects.

When the Diagnosis Is Dual

When the Diagnosis Is Dual

Declining rates of hepatocellular carcinoma in urban Shanghai: incidence trends in 1976–2005

In China, hepatocellular carcinoma (HCC) incidence rates in several registry catchment populations are amongst the highest worldwide. The incidence rates in urban Shanghai were analyzed between 1976 and 2005 to describe and interpret the time trends. Age-specific and age-standardized rates were calculated and graphically presented. An age-period-cohort model was fitted to assess the effects of age at diagnosis, calendar period, and birth cohort on the changing HCC incidence rates. In total, 35,241 and 13,931 men and women were diagnosed with HCC during 1976-2005 in urban Shanghai. The age-standardized incidence rates in urban Shanghai were 33.9 per 10(5) among men and 11.4 per 10(5) among women in 1976-1980, but decreased in both sexes to 25.8 per 10(5) and 8.5 per 10(5), respectively by 2001-2005. Accelerating rates in birth cohorts born in the early-1930s and decelerating rates circa 1945 were observed in both sexes, with further accelerations noted in the late-1950s (in women) and early-1960s (in men). Given the parameterization, increases in risk of HCC were seen in successive male and female generations between 1900 and 1935, followed by a further increase among successive cohorts born around 1960, with a reduction in risk in the most recent generations. The incidence rates of HCC in urban Shanghai from 1976 to 2005 have declined in both sexes, with the complex but similar patterns observed in successive generations suggestive of a shared changing prevalence in risk factors in men and women, with a role possibly for HBV interventions reducing risk of HCC in cohorts born after 1960.

A systematic review of breast cancer incidence risk prediction models with meta-analysis of their performance

A risk prediction model is a statistical tool for estimating the probability that a currently healthy individual with specific risk factors will develop a condition in the future such as breast cancer. Reliably accurate prediction models can inform future disease burdens, health policies and individual decisions. Breast cancer prediction models containing modifiable risk factors, such as alcohol consumption, BMI or weight, condom use, exogenous hormone use and physical activity, are of particular interest to women who might be considering how to reduce their risk of breast cancer and clinicians developing health policies to reduce population incidence rates. We performed a systematic review to identify and evaluate the performance of prediction models for breast cancer that contain modifiable factors. A protocol was developed and a sensitive search in databases including MEDLINE and EMBASE was conducted in June 2010. Extensive use was made of reference lists. Included were any articles proposing or validating a breast cancer prediction model in a general female population, with no language restrictions. Duplicate data extraction and quality assessment were conducted. Results were summarised qualitatively, and where possible meta-analysis of model performance statistics was undertaken. The systematic review found 17 breast cancer models, each containing a different but often overlapping set of modifiable and other risk factors, combined with an estimated baseline risk that was also often different. Quality of reporting was generally poor, with characteristics of included participants and fitted model results often missing. Only four models received independent validation in external data, most notably the 'Gail 2' model with 12 validations. None of the models demonstrated consistently outstanding ability to accurately discriminate between those who did and those who did not develop breast cancer. For example, random-effects meta-analyses of the performance of the 'Gail 2' model showed the average C statistic was 0.63 (95% CI 0.59-0.67), and the expected/observed ratio of events varied considerably across studies (95% prediction interval for E/O ratio when the model was applied in practice was 0.75-1.19). There is a need for models with better predictive performance but, given the large amount of work already conducted, further improvement of existing models based on conventional risk factors is perhaps unlikely. Research to identify new risk factors with large additionally predictive ability is therefore needed, alongside clearer reporting and continual validation of new models as they develop.

Trends in Testicular Germ Cell Tumors Among U.S. Military Servicemen, 1990–2003

To determine the incidence of testicular germ cell tumors among active duty males and compare it with the incidence in the general U.S. population. The Automated Cancer Tumor Registry and the Surveillance, Epidemiology, and End Results Program data from 1990 to 2003 were analyzed for men aged between 20 and 59 years by histology and stage at diagnosis. Rates were age adjusted using the male active duty military population as the standard. Nonseminoma incidence was significantly lower in the military than in the general population (incidence rate ratio = 0.90, 95% confidence interval = 0.82-0.98). Trends in incidence tended to be similar in both the populations. Increases were observed for both histologic types but were only significant for seminoma (Automated Cancer Tumor Registry: 21% and Surveillance, Epidemiology, and End Results program: 16%; p < 0.05). Increases in incidence were only observed for localized tumors of both histologic types. The lower incidence of nonseminoma in the military and the increased incidence of localized tumors in both populations remain unexplained.

Incidence of cutaneous malignant melanoma in Denmark, 1978-2007

Incidence rates of cutaneous malignant melanoma (CMM) have been increasing markedly worldwide. The ongoing debate about possible overdiagnosis remains unresolved. To determine the population-based incidence of CMM in Denmark between 1978 and 2007 and to analyse sex-, site- and extent of disease-specific changes in incidence rates of CMM over time. We used the virtually complete nationwide Danish Cancer Register in this population-based study, which contains data on 25,851 cases reported in Denmark between 1978 and 2007. We calculated age-standardized (world standard population) incidence rates per 100,000 person-years and age-specific rates. The age-standardized incidence rates increased from 6·5 to 14·4 among men and from 8·6 to 18·9 among women. During the last 5 years of the study period, a sudden marked increase was seen in women of all ages and in men aged 65 years or older. The most marked site-specific change was in the incidence of melanoma on the trunk in both men and women. An increase in the rates of disease with regional spread was seen during the last 10 years of observation. The incidence rate of CMM more than doubled in Denmark between 1978 and 2007. The increases in both site-specific incidence rates and CMM with regional spread suggest an association with risk behaviour, such as intermittent sun exposure, although possible overdiagnosis must be taken into account in evaluating the implications of the increase.

Épidémiologie des cancers de la cavité buccale en France

We had for objective to describe the updated epidemiology of oral cancers in France. Estimates made from data collected from various French cancer institutions. The distribution by topography, histology, regions, mean age, and specific incidence rates were calculated from the collected data. The survival data was taken from the Francim network studies. Approximately 7000 oral cavity cancers were diagnosed in France in 2005. In 2007, 1746 people died of that cancer. Standardized (world population) incidence rates are respectively, in men and women, 12.3 and 3.0 cases per 100,000 person-years. These cancers have significantly decreased in men: the standardized incidence rate decreased by 43.2% between 1980 and 2005. Among women, the trend is reversed with an increased incidence of 51.7% over the same period. In France, the incidence of oral cavity cancers has been strongly decreasing in men and strongly increasing in women. This trend should be compared to the frequency of the main risk factors: alcohol and tobacco.

Safety of treatment with biologics for psoriasis in daily practice: 5‐year data

The cumulative exposition to biologics is increasing with prolonged treatment with a certain biologic or consecutive biological treatment. However, long-term safety data are limited available. The aim of this study was to prospectively evaluate the 5-year safety of biological treatment for psoriasis in daily practice. A cohort of 173 psoriasis patients on biologics was prospectively followed for 5 years. All adverse events reported were documented and analysed. Primary endpoint was the percentage of patients reporting at least one serious adverse event. The rate of malignancies, serious infections and serious cardiovascular events was compared with the general population incidence rate. The nature and rate of dermatological adverse events was compared with a group of prospectively followed rheumatoid arthritis patients on TNF-α blocking therapy. Between February 2005 and April 2010, 173 patients were enrolled in the registry and went through a total number of 263 treatment episodes. The total number of patient-years of follow-up in the registry was 409. The number of patient-years was the highest for etanercept. Forty-nine patients (28%) reported 88 serious adverse events. Only one serious adverse event was certainly causally related to the biologic and 21 events (24% of SAEs) were considered possibly related. The incidence of malignancies, serious infections and serious cardiovascular events was comparable with the population incidence rate, except for skin malignancies. The incidence of skin malignancies was significantly higher than the general population incidence rate. The nature and rate of dermatological adverse events differed from the rheumatoid arthritis cohort. In this cohort, the safety of biological therapies for psoriasis was favourable with a low incidence of therapy-related serious adverse events.

Time and geographical variations in utilization of endocrine therapy for breast cancer in Australia

Endocrine therapies, aromatase inhibitors and tamoxifen, are commonly used as an adjuvant treatment in women with breast cancer. This study examined the trends in use of endocrine therapies in Australia between 1996 and 2008, including a comparison between Australian states. Prescription and expenditure data for tamoxifen and aromatase inhibitors (1996-2008) were obtained from the Drug Utilisation Sub-Committee. We converted prescription data to defined daily doses (DDD)/1000 population/day, the international unit of drug utilization. Utilization data in each state/territory (2003-2008) were adjusted for female population and age-standardized incidence rates of breast cancer. Total utilization of endocrine therapies increased by 30% from 1.66 to 2.14 DDD/1000/day between 1996 and 2008. Over this period, there was a shift in use from tamoxifen to aromatase inhibitors which became the highest used products in 2008. Anastrozole was the most used aromatase inhibitor and its use increased markedly after being listed on Australia's national Pharmaceutical Benefits Scheme (PBS) for early breast cancer in 2005 (average increase of 0.14 DDD/1000/day per annum between 2005 and 2008). PBS expenditure for endocrine therapies increased by 265% from $16 million to $58 million between 1996 and 2008. Utilization of endocrine therapies was overall comparable between regions except that it was substantially lower in the Northern Territory. Use of aromatase inhibitors has overtaken use of tamoxifen in 2008. Further real-world effectiveness data are required to evaluate whether large associated increases in expenditures partly because of the higher costs of aromatase inhibitors are actually justified.

Secondary solid cancers after allogeneic hematopoietic cell transplantation using busulfan-cyclophosphamide conditioning

AbstractRisks of secondary solid cancers among allogeneic hematopoietic cell transplant (HCT) recipients who receive conditioning without total body irradiation are not well known. We evaluated the incidence and risk factors for solid cancers after HCT using high-dose busulfan-cyclophosphamide conditioning in 4318 recipients of first allogeneic HCT for acute myeloid leukemia in first complete remission (N = 1742) and chronic myeloid leukemia in first chronic phase (N = 2576). Our cohort represented 22 041 person-years at risk. Sixty-six solid cancers were reported at a median of 6 years after HCT. The cumulative-incidence of solid cancers at 5 and 10 years after HCT was 0.6% and 1.2% among acute myeloid leukemia and 0.9% and 2.4% among chronic myeloid leukemia patients. In comparison to general population incidence rates, HCT recipients had 1.4× higher than expected rate of invasive solid cancers (95% confidence interval, 1.08-1.79, P = .01). Significantly elevated risks were observed for tumors of the oral cavity, esophagus, lung, soft tissue, and brain. Chronic graft-versus-host disease was an independent risk factor for all solid cancers, and especially cancers of the oral cavity. Recipients of allogeneic HCT using busulfan-cyclophosphamide conditioning are at risk for developing solid cancers. Their incidence continues to increase with time, and lifelong cancer surveillance is warranted in this population.

HIV and Hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis

BackgroundHigh Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.MethodsThe authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.ResultsThirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.ConclusionsAlthough important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.

The thickness of melanomas has decreased in central Italy, but only for thin melanomas, while thick melanomas are as thick as in the past

The objective of this study was to evaluate the time trend of melanoma thickness in a population-based case series. All invasive (n=2862) and in-situ (n=605) cutaneous melanoma incident cases diagnosed in 1985-2004 were retrieved from the Tuscany Cancer Registry, central Italy. Standardized (European population) incidence rates were computed for four periods: 1985-1989, 1990-1994, 1995-1999, 2000-2004, and for Breslow thickness classes (< or =1, 1.01-2.00, >2 mm). The annual percent change (APC) of the standardized rates was computed. Thickness was evaluated on the basis of sex, age, morphology type, site and period of time. Median thickness was evaluated by means of a nonparametric K-sample test. The incidence rate of melanoma rose significantly for both invasive (APC=+5.1%) and in-situ lesions (APC=+11.1). The sex distribution of patients with invasive melanoma did not change over time (mean male/female ratio 0.95). The mean age at diagnosis did not change (57.2 years; SD=17.2 years). From 1985-1989 to 2000-2004 the median value of thickness decreased from 1.68 to 0.8 mm (P<0.001). Within the Breslow categories the median value of thickness decreased significantly for thin melanomas (< or =1 mm) but not for intermediate (1.01-2.00) or for thick melanomas (>2 mm). Among the most common melanoma types, the median thickness decreased for superficial spreading melanomas but not for nodular melanomas. Over time, the incidence of melanoma has increased notably and the median thickness has decreased. However, median thickness has decreased only among thin melanomas, whereas it has not changed for thick melanomas, most of which are of the nodular type.

Injury to recreational and professional cricket players: Circumstances, type and potential for intervention

This paper describes injury (circumstances and type) experienced by sub-populations at all levels of cricket and, where possible, the type of protective equipment used. The sample differs to that generally examined in the literature in that it is not restricted to evaluation of elite and professional players only. Over a 6-year period (2000–2005), 498 cases were identified. The average age of injury was 27 years and 86% of those injured were male. The population incidence rate was 2.3 per 100,000 per year, and participation incidence rate 39 per 100,000 per year. Over all age groups upper limb (36%) and lower limb (31%) were most commonly injured. Fracture was the main type of injury. Differences among age groups were identified. Children (<10 years) most commonly suffered head injury (contact with the bat); 10–19 year olds, head, upper and lower limb injury (in similar proportions) generally from contact with bat/ball; those over 20 years mainly had upper and lower limb injuries. Contact with the bat/ball was the dominant mechanism of injury for those under 50 years of age while overexertion, strenuous or repetitive movements, slips and falls were the mechanisms for those over 50. The large number of head injuries to children is of concern and both these, and the substantial number of injuries to the hand/phalanges (63% of all upper limb injuries), are important targets for injury prevention. The difference in injury patterns between children and adults is indicative of a need to develop, and use, different types of PPE at different skill/age levels.

Nighttime light level co-distributes with breast cancer incidence worldwide

Breast cancer incidence varies widely among countries of the world for largely unknown reasons. We investigated whether country-level light at night (LAN) is associated with incidence. We compared incidence rates of five common cancers in women (breast, lung, colorectal, larynx, and liver), observed in 164 countries of the world from the GLOBOCAN database, with population-weighted country-level LAN, and with several developmental and environmental indicators, including fertility rate, per capita income, percent of urban population, and electricity consumption. Two types of regression models were used in the analysis: Ordinary Least Squares and Spatial Errors. We found a significant positive association between population LAN level and incidence rates of breast cancer. There was no such an association between LAN level and colorectal, larynx, liver, and lung cancers. A sensitivity test, holding other variables at their average values, yielded a 30-50% higher risk of breast cancer in the highest LAN exposed countries compared to the lowest LAN exposed countries. The possibility that under-reporting from the registries in the low-resource, and also low-LAN, countries created a spurious association was evaluated in several ways and shown not to account for the results. These findings provide coherence of the previously reported case-control and cohort studies with the co-distribution of LAN and breast cancer in entire populations.

Brain cancer incidence trends in relation to cellular telephone use in the United States

The use of cellular telephones has grown explosively during the past two decades, and there are now more than 279 million wireless subscribers in the United States. If cellular phone use causes brain cancer, as some suggest, the potential public health implications could be considerable. One might expect the effects of such a prevalent exposure to be reflected in general population incidence rates, unless the induction period is very long or confined to very long-term users. To address this issue, we examined temporal trends in brain cancer incidence rates in the United States, using data collected by the Surveillance, Epidemiology, and End Results (SEER) Program. Log-linear models were used to estimate the annual percent change in rates among whites. With the exception of the 20-29-year age group, the trends for 1992-2006 were downward or flat. Among those aged 20-29 years, there was a statistically significant increasing trend between 1992 and 2006 among females but not among males. The recent trend in 20-29-year-old women was driven by a rising incidence of frontal lobe cancers. No increases were apparent for temporal or parietal lobe cancers, or cancers of the cerebellum, which involve the parts of the brain that would be more highly exposed to radiofrequency radiation from cellular phones. Frontal lobe cancer rates also rose among 20-29-year-old males, but the increase began earlier than among females and before cell phone use was highly prevalent. Overall, these incidence data do not provide support to the view that cellular phone use causes brain cancer.

The enterovirus 71 epidemic in 2008—public health implications for Hong Kong

We compared the epidemiological, clinical and laboratory characteristics of enterovirus 71 (EV71) cases recorded in the epidemic year of 2008 with those of the past decade. We estimated the annual incidence rates in the general population and in different age groups. We reviewed the clinical and epidemiological information of the cases. The complication and case fatality rates (CFR) were compared with the corresponding average rates for the period 1998-2007. The molecular strains of EV71 isolates were determined. The estimated annual incidence was 1.4/100,000 in the general population, with the highest incidence (27.9/100,000) reported among children aged under 5 years. The seasonal peak occurred from May to July. The majority (92.9%) presented with hand-foot-mouth disease (HFMD; 90.8%) or herpangina, and 11.2% had complications including meningitis or encephalitis (6.1%), pneumonia (3.1%), acute flaccid paralysis (1.0%), and shock (1.0%). The CFR was 1.0%. Nearly half (45.9%) of school-aged cases had concurrent HFMD outbreaks at their schools/institutions. There was no statistically significant difference in the complications rate and CFR when compared to those of the past decade. Molecular analysis showed that the majority were genogroup C4 strains, similar to the past circulating strains. The cyclical high activity has had significant public health and social implications. To strengthen public health surveillance and control, EV71 infection was made a statutory notifiable disease in 2009.