What is the clinical evidence from this study?

Study design: Observational. Population: Hand, foot, and mouth disease (HFMD) (n=50645). Primary outcome: Average annual incidence rate of HFMD.

July 2, 2025Open Access

Epidemiological trends of hand, foot, and mouth disease in children under age 10, Jiangning District, Jiangsu, China (2009–2023)

Key Result

Between 2009 and 2023, the average annual incidence rate of HFMD among children under 10 in Jiangning District was 3,136.01 per 100,000, with CVA6 emerging as the predominant circulating serotype.

Study Design

Type

Observational (n=50,645)

Structured PICO

Population

50,645 children under 10 years of age with hand, foot, and mouth disease (HFMD) in Jiangning District, Jiangsu, China (2009-2023)

Outcome

Epidemiological characteristics, incidence trends, and serotype distribution of HFMD

HFMD incidence remains high among children under 10 in Jiangning District, with a shift in predominant serotypes to CVA6 and a decreasing severity rate likely due to EV-A71 vaccination and improved public health interventions.

Limitations

Incompleteness of case reporting due to the asymptomatic and self-limiting nature of mild HFMD cases
Variations in diagnostic capacities and disease-reporting awareness across healthcare facilities
Limited sample size for pathogen testing and scope of serotype identification
Complex factors influencing incidence trends warrant further in-depth analysis

Abstract

PURPOSE: This study aimed to analyse the epidemiological characteristics of hand, foot, and mouth disease (HFMD) among children under age 10 in Jiangning District, Jiangsu Province, from 2009 to 2023, explore its changing trends, and provide a scientific basis for optimizing public health prevention and control strategies. METHODS: HFMD case data were obtained from the "Notifiable Infectious Disease Reporting Information Management System". Descriptive statistical analysis was used to assess HFMD incidence, joinpoint regression analysis was applied to analyse long-term trends, and wavelet analysis was used to explore seasonality and periodicity. RESULTS: A total of 50,645 HFMD cases in children under 10 years of age were reported during the study period, with an average annual incidence rate of 3,136.01 per 100,000 people. The annual incidence rate fluctuated between 544.39 per 100,000 (in 2022) and 6,260.63 per 100,000 (in 2018), showing an initial steady increase, followed by a sharp decline and a rapid rebound. HFMD showed a pronounced incidence peak during summer and autumn, with periodic fluctuations at intervals of 6 months, 12 months, and 24 months. Boys had a higher incidence rate, with an average annual rate of 3588.07 per 100,000, compared with 2646.00 per 100,000 in girls. Children aged 1 and 3 years had the highest incidence rates. The dominant serotypes shifted, with an overall decline in the proportions of EV-A71 and CVA16, whereas CVA6 emerged as the predominant circulating serotype. Moreover, the proportion of severe cases has continued to decrease. CONCLUSION: The incidence of HFMD among children under age 10 in Jiangning District remains high, and the predominant serotypes have changed in recent years. The decline in incidence during the COVID-19 pandemic and its subsequent recovery may be linked to non-pharmacological interventions and the "immune debt" phenomenon, a relationship that warrants further validation. The EV-A71 vaccine and improved public health interventions have contributed to a steady decline in the severity rate. Strengthening surveillance, developing vaccines targeting predominant serotypes, and optimizing prevention and control strategies are essential for the precise prevention and control of HFMD in children.

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