Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009–2016

• Published in: Scientific Reports Vol. 7; no. 1; pp. 8900 - 9
• Main Authors: Wang, Jing, Hu, Tao, Sun, Dapeng, Ding, Shujun, Carr, Michael J., Xing, Weijia, Li, Shixue, Wang, Xianjun, Shi, Weifeng
• Format: Journal Article
• Language: English
• Published: London Springer Science and Business Media LLC 21.08.2017; Nature Publishing Group UK; Nature Publishing Group; Nature Portfolio
• Subjects: 45/23; 45/90; 631/326/596/2562; 692/699/255/2514; Adolescent; Adult; Age Factors; Child; Child, Preschool; Children; China; China - epidemiology; Epidemics; Female; Geography, Medical; Hand, Foot and Mouth Disease; Hand, Foot and Mouth Disease - epidemiology; Hand, Foot and Mouth Disease - history; History, 21st Century; Humanities and Social Sciences; Humans; Incidence; Infant; Infant, Newborn; Male; Medicine; Middle Aged; Mortality; multidisciplinary; Public Health Surveillance; Q; R; Rural areas; Science; Science (multidisciplinary); Sex Factors; Urban areas; Young Adult; China; Shandong China
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-017-09196-z

In the past decade, hand, foot, and mouth disease (HFMD) has posed a serious threat to childhood health in China; however, no epidemiological data from large HFMD epidemics have been described since 2013. In the present study, we described the epidemiological patterns of HFMD in Shandong province during 2009–2016 from a large number of symptomatic cases (n = 839,483), including >370,000 HFMD cases since 2013. Our results revealed that HFMD activity has remained at a high level and continued to cause annual epidemics in Shandong province from 2013 onwards. Although the incidence rate was significantly higher in urban areas than in rural areas, no significantly higher case-severity and case-fatality rates were found in urban areas. Furthermore, the seventeen cities of Shandong province could be classified into three distinct epidemiological groups according to the different peak times from southwest (inland) to northeast (coastal) regions. Notably, a replacement of the predominant HFMD circulating agent was seen and non-EVA71/Coxsackievirus A16 enteroviruses became dominant in 2013 and 2015, causing approximately 30% of the severe cases. Our study sheds light on the latest epidemiological characteristics of HFMD in Shandong province and should prove helpful for the prevention and control of the disease in Shandong and elsewhere.