The Etiological Characteristics of Hand, Foot, and Mouth Disease in Yuyao, China, 2010-2023
Abstract
Background: We aimed to analyze the etiological composition of Hand, Foot, and Mouth Disease (HFMD) in Yuyao from 2010 to 2023, and to provide scientific decision and basis for the development of preventive and control measures for HFMD.
Methods: Employing descriptive epidemiological methods, we analyzed the etiological results of mild cases of HFMD monitored from 2010 to 2023.
Results: From 2010 to 2023, 4,294 samples from HFMD patients in Yuyao, China were analyzed, with 2,362 (55.01%) testing positive for enteroviruses. The most common serotypes were EV71 (30.57%), CA16 (25.91%), and CA6 (8.26%). There was a significant variation in positivity rates over the years, with the lowest in 2023 (22.61%) and the highest in 2012 (95.45%). EV71 was the dominant serotype before 2018, but other serotypes became more prevalent afterward, with CA6 emerging as the primary strain post-2018.HFMD cases occurred year-round, with a clear seasonal pattern peaking from April to October, especially in May. This period accounted for 81.63% of all cases. The disease affected individuals of all ages, but the majority (83.74%) were children under six. Males had a higher detection rate than females, with a significant difference between the genders.
Conclusion: Between 2010 and 2023, the composition of pathogens causing HFMD in Yuyao underwent significant changes. These observations not only deepened the understanding of the epidemic trends and etiological evolution of the disease in the area but also provided scientific support for the development of more targeted prevention and control measures.
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25. Nhan LNT, Khanh TH, Hong NTT, et al (2020). Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 - 2018. PLoS Negl Trop Dis, 14 (8):e0008544.
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27. Hu L, Maimaiti H, Zhou L, et al (2022). Changing serotypes of hand, foot and mouth disease in Shanghai, 2017-2019. Gut Pathog, 14 (1):12.
28. Xu C (2017). Spatio-Temporal Pattern and Risk Factor Analysis of Hand, Foot and Mouth Disease Associated with Under-Five Morbidity in the Beijing-Tianjin-Hebei Region of China. Int J Environ Res Public Health, 14 (4):416.
29. Xu L, Shi Y, Rainey JJ, et al (2018). Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009-2015. BMC Infect Dis, 18 (1):624.
30. Chen Y, Sun W, Ling F, Sun J, et al (2022). Seasonality and Meteorological Factors Associated With Different Hand, Foot, and Mouth Disease: Serotype-Specific Analysis From 2010 to 2018 in Zhejiang Province, China. Front Microbiol, 13:901508.
31. Lee JY, Son M, Kang JH, et al (2018). Serum interleukin-6 levels as an indicator of aseptic meningitis among children with enterovirus 71-induced hand, foot and mouth disease. Postgrad Med, 130 (2):258-263.
32. Jia J, Kong F, Xin X, et al (2021). Epidemiological Characteristics of Hand, Foot, and Mouth Disease Outbreaks in Qingdao, 2009-2018. Iran J Public Health, 50 (5):999-1008.
2. Tapparel C, Siegrist F, Petty TJ, et al (2013). Picornavirus and enterovirus diversity with associated human diseases. Infect Genet Evol, 14:282-93.
3. Song Y, Zhang Y, Ji T, et al (2017). Persistent circulation of Coxsackievirus A6 of genotype D3 in mainland of China between 2008 and 2015. Sci Rep, 7 (1):5491.
4. Puenpa J, Wanlapakorn N, Vongpunsawad S, et al (2019). The History of Enterovirus A71 Outbreaks and Molecular Epidemiology in the Asia-Pacific Region. J Biomed Sci, 26 (1):75.
5. Ang LW, Koh BK, Chan KP, et al (2009). Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singap, 38 (2):106-12.
6. Pons-Salort M, Grassly NC (2018). Serotype-specific immunity explains the incidence of diseases caused by human enteroviruses. Science, 361 (6404):800-803.
7. Puenpa J, Chieochansin T, Linsuwanon P, et al (2013). Hand, foot, and mouth disease caused by coxsackievirus A6, Thailand, 2012. Emerg Infect Dis, 19 (4):641-3.
8. Kanbayashi D, Kaida A, Hirai Y, et al (2019). An Epidemic of Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 in Osaka City, Japan, in 2017. Jpn J Infect Dis, 72 (5):334-336.
9. Justino MCA, da SMD, Souza MF, et al (2020). Atypical hand-foot-mouth disease in Belém, Amazon region, northern Brazil, with detection of coxsackievirus A6. J Clin Virol, 126:104307.
10. Zhang M, Chen X, Wang W, et al (2022). Genetic characteristics of Coxsackievirus A6 from children with hand, foot and mouth disease in Beijing, China, 2017-2019. Infect Genet Evol, 106:105378.
11. Li JF, Zhang CJ, Li YW, et al (2022). Coxsackievirus A6 was the most common enterovirus serotype causing hand, foot, and mouth disease in Shiyan City, central China. World J Clin Cases, 10 (31):11358-11370.
12. Li JX, Song YF, Wang L, et al (2016). Two-year efficacy and immunogenicity of Sinovac Enterovirus 71 vaccine against hand, foot and mouth disease in children. Expert Rev Vaccines, 15 (1):129-37.
13. Takahashi S, Liao Q, Van Boeckel TP, et al (2016). Hand, Foot, and Mouth Disease in China: Modeling Epidemic Dynamics of Enterovirus Serotypes and Implications for Vaccination. PLoS Med, 13 (2):e1001958.
14. Di B, Zhang Y, Xie H, et al (2014). Circulation of Coxsackievirus A6 in hand-foot-mouth disease in Guangzhou, 2010-2012. Virol J, 11:157.
15. Chen YJ, Chang SC, Tsao KC, et al (2012). Comparative genomic analysis of coxsackievirus A6 strains of different clinical disease entities. PLoS One, 7 (12):e52432.
16. Wu Q, Xu Q, Zhou X, et al (2021). Etiological characteristics of hand, foot and mouth disease in Yangzhou from 2015 to 2019. Zhonghua Yu Fang Yi Xue Za Zhi, 55(3):394-398.
17. Wang P, Zhou X, Liu L, et al (2023). Etiologic and epidemiological characteristics of hand, foot and mouth disease in Ji’ an, from 2013 to 2020. Chinese J Exp Clin Virol, 37:67-70.
18. Xue RZ WR, Chen HL (2023). Etiological characteristics of hand, foot and mouth disease in Xi′an from 2019 to 2021. Chin J Microbiol Immunol, 43:381-388.
19. Wang XF,Zhu DW,Yuan SS. Impact of enterovirus 71 vaccine vaccination on incidence of hand, foot and mouth disease among children in China mainland:an interrupted time series analysis. Chin J Public Health. 2021;37:1418-20. (in Chinese).
20. Anh NT, Nhu LNT, Van HMT, et al (2018). Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam. Emerg Infect Dis, 24 (4):654-662.
21. Wang M, Chen T, Peng J, et al (2022). The spatial-temporal distribution and etiological characteristics of hand-foot-and-mouth disease before and after EV‑A71 vaccination in Kunming, China, 2017-2020. Sci Rep, 12 (1):17028.
22. He F, Rui J, Deng Z, et al (2022). Surveillance, Epidemiology and Impact of EV-A71 Vaccination on Hand, Foot, and Mouth Disease in Nanchang, China, 2010-2019. Front Microbiol, 12:811553.
23. Jiang L, Jiang H, Tian X, Xia X, Huang T (2021). Epidemiological characteristics of hand, foot, and mouth disease in Yunnan Province, China, 2008-2019. BMC Infect Dis, 21 (1):751.
24. Santangelo OE, Gianfredi V, Provenzano S, et al (2023). Digital epidemiology and infodemiology of hand-foot-mouth disease (HFMD) in Italy. Disease trend assessment via Google and Wikipedia. Acta Biomed, 94 (4):e2023107.
25. Nhan LNT, Khanh TH, Hong NTT, et al (2020). Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 - 2018. PLoS Negl Trop Dis, 14 (8):e0008544.
26. Wieczorek M, Ciąćka A, Krzysztoszek A, et al (2017). Genetic Characterization of Human Enteroviruses Associated with Hand, Foot and Mouth Diseases in Poland, 2013-2016. Pol J Microbiol, 66 (3):405-409.
27. Hu L, Maimaiti H, Zhou L, et al (2022). Changing serotypes of hand, foot and mouth disease in Shanghai, 2017-2019. Gut Pathog, 14 (1):12.
28. Xu C (2017). Spatio-Temporal Pattern and Risk Factor Analysis of Hand, Foot and Mouth Disease Associated with Under-Five Morbidity in the Beijing-Tianjin-Hebei Region of China. Int J Environ Res Public Health, 14 (4):416.
29. Xu L, Shi Y, Rainey JJ, et al (2018). Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009-2015. BMC Infect Dis, 18 (1):624.
30. Chen Y, Sun W, Ling F, Sun J, et al (2022). Seasonality and Meteorological Factors Associated With Different Hand, Foot, and Mouth Disease: Serotype-Specific Analysis From 2010 to 2018 in Zhejiang Province, China. Front Microbiol, 13:901508.
31. Lee JY, Son M, Kang JH, et al (2018). Serum interleukin-6 levels as an indicator of aseptic meningitis among children with enterovirus 71-induced hand, foot and mouth disease. Postgrad Med, 130 (2):258-263.
32. Jia J, Kong F, Xin X, et al (2021). Epidemiological Characteristics of Hand, Foot, and Mouth Disease Outbreaks in Qingdao, 2009-2018. Iran J Public Health, 50 (5):999-1008.
| Files | ||
| Issue | Vol 54 No 11 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Hand Foot Mouth disease Etiological characteristics Enterovirus China | ||
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How to Cite
1.
Huang S, Luo X, Yu D. The Etiological Characteristics of Hand, Foot, and Mouth Disease in Yuyao, China, 2010-2023. Iran J Public Health. 2025;54(11):2435-2443.
