Epidemiology of Hand, Foot, and Mouth Disease in China

Mary E. Wilson, MD

Severe hand, foot, and mouth disease is associated primarily with enterovirus 71 in China; children aged <5 years are at highest risk for death.

Hand, foot, and mouth disease (HFMD) — especially that caused by enterovirus (EV) 71 — has become a problem, particularly in the Asia–Pacific region. To inform intervention strategies (including use of an EV71 vaccine expected to be available soon), investigators characterized the population-wide epidemiology of HFMD in China.

Initially voluntarily reportable, HFMD became statutorily notifiable in May 2008. The researchers extracted clinical, demographic, and epidemiologic data on probable and laboratory-confirmed cases reported to the Chinese CDC from 2008 through 2012. They defined severe cases as those with cardiopulmonary or neurologic complications.

Of 7.2 million probable cases reported during the study period, 3.7% were confirmed by polymerase chain reaction or viral isolation and 0.03% were fatal. Incidence from 2010 through 2012 was 1.2 per 1000 person-years. Overall, 1.1% of the patients had severe disease; of these, 3.0% died. Among patients with laboratory-confirmed HFMD, EV71 accounted for 45% of mild, 80% of severe, and 93% of fatal cases. The median age of those with EV71-associated severe disease was 2.3 years. Risk factors for death included age <5 years, EV71 infection, rural residence, and long interval between symptom onset and diagnosis. Northern China had one annual incidence peak (in June); southern China had two major peaks (in May and October). Climatic, population, and transportation factors explained a moderate-to-high proportion of seasonal variation.

Citation(s):

Xing W et al. Hand, foot, and mouth disease in China, 2008–12: An epidemiological study. Lancet Infect Dis 2014 Jan 31; [e-pub ahead of print].

Shimizu H and Nakashima K.Surveillance of hand, foot, and mouth disease for a vaccine. Lancet Infect Dis 2014 Jan 31; [e-pub ahead of print].