Spatiotemporal cluster patterns of hand, foot, and mouth disease at the province level in mainland China, 2011-2018

Although three monovalent EV-A71 vaccines have been launched in mainland China since 2016, hand, foot, and mouth disease (HFMD) still causes a considerable disease burden in China. Vaccines’ use may change the epidemiological characters of HFMD. All HFMD cases’ data from January 2011 to December 2018 were obtained from the public health science data center given by the Chinese Center for Diseases Control and Prevention. Spatial autocorrelation analysis and space-time scan statistics analysis were used to explore the spatiotemporal distribution pattern of this disease at the provincial level in mainland China. Interrupted time series (ITS) was used to analyze the impact of the EV-A71 vaccine on the incidence of HFMD. This study found that the median annual incidence of HFMD was 153.78 per 100,000 (ranging from 120.79 to 205.06) in mainland China from 2011 to 2018. Two peaks of infections were observed per year. Children 5 years and under were the main morbid population. The global autocorrelation analysis showed that the spatial distribution of HFMD was presented a significant clustering pattern in each year (P < 0.001), and the local autocorrelation analysis indicated that the high incidence areas were clustered in the southern and southeastern coastal provinces. The distribution of HFMD cases was clustered in time and space. The range of cluster time was between April and October. The most likely cluster appeared in the southern coastal provinces (Guangxi, Guangdong, Hainan) from 2011 to 2017 and in the southeastern coastal provinces (Shanghai, Jiangsu, Zhejiang) in 2018. It is necessary to advance the EV-A71 vaccination plan, analyze the spatial-temporal distribution characteristics of different enterovirus pathogens of HFMD, and promote HFMD multivalent vaccines. The results can provide the basis for implementing effective disease prevention and control policies.