Why the study?
After EV-A71 vaccination and the COVID-19 outbreak, HFMD prevalence remained high and enterovirus spatial-temporal distribution changed, warranting characterization of its epidemiological and aetiological features in Kunming.
The spatial and temporal distribution of HFMD pathogens changed significantly after EV-A71 vaccination and the COVID-19 pandemic, highlighting the need for multivalent vaccines.
Serotype shifts in HFMD after EV-A71 vaccination and COVID-19 support continued surveillance; leaves open multivalent vaccine requirements.
Background After the vaccination enterovirus 71 (EV-A71) vaccine and Corona Virus Disease 2019 (COVID-19) outbreak, the prevalence of Hand, foot, and mouth disease (HFMD) remained high and the spatial-temporal distribution of enteroviruses changed. Therefore, it is essential to define the temporal features, spatial distributions, epidemiological and aetiological characteristics of HFMD of Kunming. Methods Between 2017 and 2020, a total of 36540 HFMD children cases diagnosed with HFMD in Kunming, including 32754 enteroviruses positive clinical samples. Demographic, geographical, epidemiological and aetiological data of the cases were acquired and analyzed. Results Other enteroviruses replaced EV-A71 and the incidence of EV-A71 has decreased dramatically, while, coxsackievirus A6 (Cox A6) and coxsackievirus A16 (Cox A16) with significant outbreaks in 2018 and 2019, respectively. The major and junior peaks all extended for 2-4 months than before that vaccination EV-A71 vaccine. After the COVID-19 outbreak, Cox A6 as the predominant serotype pathogens, and only single peaks appeared in 2019 and 2020. Although the high incidence of HFMD areas were Guandu, Chenggong and Xishan, the annual incidence of different enterovirus serotype appeard in different regions. In 2017, other enteroviruses prevailed in Shilin; In 2018, Cox A16 and Cox A6 prevailed in Luquan and Shilin, respectively; In 2019, Cox A16 prevailed in Jinning; In 2020, Cox A6 and coxsackievirus A10 (Cox A10) prevailed in Luquan and Shilin, respectively. Meanwhile, the epidemic cycle of Cox A6 and Cox A16 was only 1 year, and Cox A10 and other enteroviruses were potential risk pathogens. Conclusions The spatial and temporal distribution of HFMD varies at different scales, and the incidence of different pathogens associated HFMD has obvious regional differences and seasonal trends. Therefore, the research of multivalent combined vaccines are urgently needed, while, proper preventive and protective measures could effectively control the incidence of HFMD-like diseases.
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Wang et al. (2022) studied this question.
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