Key result
Introduction of EV71 vaccines was associated with a decrease in overall HFMD case-severity risk from 1.4% to 0.3%, despite an increase in overall incidence driven by other enteroviruses.
Why the study?
Hand, foot, and mouth disease poses a serious threat to children's health, and three inactivated monovalent EV71 vaccines proved highly efficacious in phase III trials became available in China.
Does the introduction of EV71 vaccines reduce the incidence and severity of HFMD in children?
Observational
Does the introduction of EV71 vaccines reduce the incidence and severity of HFMD in children?
Absolute Event Rate: 0.3% vs 1.4%
The introduction of EV71 vaccines decreased the incidence of EV71-related HFMD and overall disease severity, though overall HFMD incidence increased due to other serotypes.
EV71 vaccination programs should be expanded in endemic regions; extends real-world effectiveness data and supports multivalent enterovirus vaccine development.
BACKGROUND: Hand, foot, and mouth disease (HFMD) has posed a serious threat to children's health. Three inactivated monovalent enterovirus 71 (EV71) vaccines are proved to be highly efficacious in phase III clinical trials and are now available in China. METHODS: We analyzed the citywide surveillance data on HFMD cases in Chengdu during 2009-2018, and estimated cumulative first-dose EV71 vaccination coverage among children eligible to EV71 vaccination after August 2016 in Chengdu. Time series susceptible-infected-recovered model was developed to analyze basic reproduction number and herd immunity threshold of HFMD. Overall and serotype-specific HFMD incidences and severity risks were compared before and after the EV71 vaccination. RESULTS: Among 3 laboratory-identified serotype categories, i.e. EV71, coxsackievirus A16 (CV-A16), and other enteroviruses, the major serotype attributed to HFMD has been changing across years. The cumulative first-dose EV71 vaccination coverage rate was estimated as 60.8% during the study period in Chengdu. By contrast, herd immunity threshold for EV71-related HFMD was 94.0%. After introduction of EV71 vaccines, the overall incidence of HFMD increased 60.8%, mainly driven by 173.7% and 11.8% increased in HFMD caused by other enteroviruses and CV-A16, respectively, which offset a significant reduction in the incidence of HFMD caused by EV71. The overall case-severity risk decreased from 1.4% to 0.3%, with significantly declined presented in all serotype categories. CONCLUSIONS: The incidence and severity of EV71-related HFMD decreased following implementation of EV71 vaccination. Developing multivalent vaccines and strengthening laboratory-based surveillance could further decline burden of HFMD.
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Han et al. (2020) conducted an observational in Hand, foot, and mouth disease (HFMD). EV71 vaccination vs. Before EV71 vaccination was evaluated on Overall case-severity risk. Introduction of EV71 vaccines was associated with a decrease in overall HFMD case-severity risk from 1.4% to 0.3%, despite an increase in overall incidence driven by other enteroviruses.
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