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Jia R, Yin J, Cheng W, Yuan S, Li L, Song X, Zhang Y, Bai Y. A multiplex one-step fluorescence quantitative differential diagnosis method for severe hand, foot and mouth disease caused by coxsackievirus A16. J Virol Methods 2024; 329:114983. [PMID: 38901646 DOI: 10.1016/j.jviromet.2024.114983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
Hand foot and mouth disease (HFMD) is a common childhood infectious disease which is caused by human enterovirus. The objective of this study was to develop a rapid, sensitive, and accurate method for detecting severe HFMD caused by coxsackievirus A16 (CV-A16). A closed-tube sensitive multiplex one-step reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was applied to detect CV-A16 in the early stage of severe HFMD. This assay targeted the CV-A16 structure protein VP1 to distinguish CV-A16 from other coxsackieviruses The 5'UTR region of enteric viruses was used for detecting the enterovirus and ribonuclease P (RNaseP) was adopted as the internal reference gene. The multiplex MGB probe assay system was used to detect PCR amplicons with different fluorescence reporters in the same system. The limit of detection (LOD) of the RT-qPCR assay for the CV-A16 VP1 gene was 125.893 copies/μl, for the 5' UTR was 50.1187 copies/μl and for the RNaseP gene was 158.49 copies/μl. Furthermore, specificity analysis showed that the multiplex RT-PCR had no cross-reactivity with the influenza virus, herpangina virus and SARS-COV-2. In correlation analysis, the sensitivity of the multiplex RT-qPCR assay for CV-A16 detection was 100 % (288/288) and the specificity of the multiplex RT-qPCR assay was 99.94 % (3395/3397). The overall agreement between the multiplex RT-qPCR and the results of clinical diagnosis was 99.95 % (3683/3685) and kappa value was 0.996 (p<0.001). The entire procedure, from specimen processing to result reporting, could be completed within 1.5 hours. The one-step multiplex RT-qPCR assay for detecting CV-A16 developed in this study is a good laboratory diagnostic tool for rapid and reliable distinguished detection of CV-A16, especially for severe HFMD patients at an early stage in the disease with low virus load of CV-A16.
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Affiliation(s)
- Rui Jia
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China; Zhengzhou University, China
| | | | - Weyland Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China
| | - Shuo Yuan
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China
| | - Lifeng Li
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China
| | - Xiaorui Song
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China
| | - Yaodong Zhang
- Children's Hospital Affiliated to Zhengzhou University, Henan International Joint Laboratory of Children's Infectious Diseases, China
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Cheng L, Zhong S, Xu X, Li J, Xie F, Lin Y, Zhang D. Chinese parents' intention to vaccinate their 0-5-year-old children with the EV-71 vaccine against hand, foot, and mouth disease and willingness-to-pay. Front Public Health 2024; 12:1336687. [PMID: 38525345 PMCID: PMC10958786 DOI: 10.3389/fpubh.2024.1336687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024] Open
Abstract
Background This study aimed to determine the intention and willingness-to-pay (WTP) of Chinese parents/guardians to vaccinate their children with the EV-71 vaccine. Knowledge levels about hand, foot, and mouth disease (HFMD) and the EV-71 vaccine were also investigated. Methods A cross-sectional, self-administered online survey was conducted between November 2022 and March 2023. A stratified multi-stage random sampling method was used to recruit parents/guardians of children aged 0-5 years in southeastern China. Results A total of 3,626 complete responses were received. The mean knowledge score of HFMD was 9.99 (±4.23) out of a total of 14 points. The majority of the participants reported a somewhat willing intent (58.8%), followed by an extremely willing intent (28.9%). Participants who did not consider the EV-71 vaccine expensive (OR = 2.94, 95%CI 2.45-3.53) perceived that the EV-71 vaccine is effective (OR = 2.73, 95%CI 1.52-4.90), and a high knowledge level of HFMD (OR = 1.90, 95%CI 1.57-2.29) had the highest significant odds of having an extremely willing intent to vaccinate their children with the EV-71 vaccine. The median (interquartile range [IQR]) of WTP for the EV-71 vaccine was CNY¥200/USD$28 (IQR CNY¥100-400/USD$14-56). The highest marginal WTP for the vaccine was mainly influenced by the perceived high cost of the vaccine. Those participants who did not consider the EV-71 vaccine expensive had more than 10 times higher odds of vaccinating their children (OR = 10.86, 95%CI 8.49-13.88). Perceived susceptibility, perceived benefits, and perceived barriers were also significant influencing factors in the highest marginal WTP. Conclusion The findings demonstrate the importance of improving health promotion and reducing the barriers to EV-71 vaccination. Therefore, it is important to improve health promotion and reduce the barriers to EV-71 vaccination.
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Affiliation(s)
- Lu Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Sumei Zhong
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Xiaonan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Junrong Li
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Fangqin Xie
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Dongjuan Zhang
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
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Wu G, Zhou H, Lv D, Zheng R, Wu L, Yu S, Kai J, Xu N, Gu L, Hong N, Shentu J. Phase I, Single-Dose Study to Assess the Pharmacokinetics and Safety of Suramin in Healthy Chinese Volunteers. Drug Des Devel Ther 2023; 17:2051-2061. [PMID: 37457890 PMCID: PMC10349579 DOI: 10.2147/dddt.s416325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Suramin is a multifunctional molecule with a wide range of potential applications, including parasitic and viral diseases, as well as cancer. Methods A double-blinded, randomized, placebo-controlled single ascending dose study was conducted to investigate the safety, tolerability, and pharmacokinetics of suramin in healthy Chinese volunteers. A total of 36 healthy subjects were enrolled. All doses of suramin sodium and placebo were administered as a 30-minute infusion. Blood and urine samples were collected at the designated time points for pharmacokinetic analysis. Safety was assessed by clinical examinations and adverse events. Results After a single dose, suramin maximum plasma concentration (Cmax) and area under the plasma concentration-time curve from time zero to the time of the last measurable concentration (AUClast) increased in a dose-proportional manner. The plasma half-life (t1/2) was dose-independent, average 48 days (range 28-105 days). The cumulative percentages of the dose excreted in urine over 7 days were less than 4%. Suramin can be detected in urine samples for longer periods (more than 140 days following infusion). Suramin was generally well tolerated. Treatment-emergent adverse events (TEAEs) were generally mild in severity. Conclusion The PK and safety profiles of suramin in Chinese subjects indicated that 10 mg/kg or 15 mg/kg could be an appropriate dose in a future multiple-dose study.
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Affiliation(s)
- Guolan Wu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Polytechnic Institute, Zhejiang University, Hangzhou, People’s Republic of China
| | - Huili Zhou
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Duo Lv
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Ruling Zheng
- The Fifth Affiliated Hospital, College of Medicine, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Lihua Wu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Songxia Yu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jiejing Kai
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Nana Xu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lie Gu
- Hainan Honz Pharmaceutical Co. Ltd, Haikou, Hainan, People’s Republic of China
| | - Nanfang Hong
- Hainan Honz Pharmaceutical Co. Ltd, Haikou, Hainan, People’s Republic of China
| | - Jianzhong Shentu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Fang H, Chen C, Fang Y, He X, Hou Z, Jiang M, Jiang Y, Li S, Liu Y, Sui B, Sun Q, Wu J, Xu T, Yang J, Yin Z, Ying X, Yuan B, Zheng H, Zheng Y. A guideline for economic evaluations of vaccines and immunization programs in China. Hum Vaccin Immunother 2022; 18:2132802. [PMID: 36287462 PMCID: PMC9746533 DOI: 10.1080/21645515.2022.2132802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This study aimed to develop a consensus framework for economic evaluations of vaccines as a national guideline in China. Some unique and important aspects were particularly emphasized. Nineteen Chinese experts in the field of health economics and immunization decision-making were nominated to select and discuss relevant aspects of vaccine economic evaluations in China. A workshop attended by external experts was held to summarize unique and important aspects and formulate consensus recommendations. There were ten unique and/or important aspects identified for economic evaluations of vaccines in China, including study perspectives, comparator strategies, analysis types, model choices, costing approaches, utility measures, discounting, uncertainty, equity, and evaluation purposes. Background information and expert recommendations were provided for each aspect. Economic evaluations of vaccines should play an important role in China's immunization policy-making. This guideline can help improve the quality of economic evaluations as a good practice consensus.
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Affiliation(s)
- Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,CONTACT Hai Fang China Center for Health Development Studies, Peking University, Beijing, China
| | - Chen Chen
- School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong Province, China
| | - Shunping Li
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Binyan Sui
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Qiang Sun
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Tingting Xu
- School of Public Health, Capital Medical University, Beijing, China
| | - Juan Yang
- School of Public Health, Fudan University, Shanghai, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yaming Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
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Yang Z, Rui J, Qi L, Ye W, Niu Y, Luo K, Deng B, Zhang S, Yu S, Liu C, Li P, Wang R, Wei H, Zhang H, Huang L, Zuo S, Zhang L, Zhang S, Yang S, Guo Y, Zhao Q, Wu S, Li Q, Chen Y, Chen T. Study on the interaction between different pathogens of Hand, foot and mouth disease in five regions of China. Front Public Health 2022; 10:970880. [PMID: 36238254 PMCID: PMC9552780 DOI: 10.3389/fpubh.2022.970880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives This study aims to explore the interaction of different pathogens in Hand, foot and mouth disease (HFMD) by using a mathematical epidemiological model and the reported data in five regions of China. Methods A cross-regional dataset of reported HFMD cases was built from four provinces (Fujian Province, Jiangsu province, Hunan Province, and Jilin Province) and one municipality (Chongqing Municipality) in China. The subtypes of the pathogens of HFMD, including Coxsackievirus A16 (CV-A16), enteroviruses A71 (EV-A71), and other enteroviruses (Others), were included in the data. A mathematical model was developed to fit the data. The effective reproduction number (R eff ) was calculated to quantify the transmissibility of the pathogens. Results In total, 3,336,482 HFMD cases were collected in the five regions. In Fujian Province, the R eff between CV-A16 and EV-A71&CV-A16, and between CV-A16 and CV-A16&Others showed statistically significant differences (P < 0.05). In Jiangsu Province, there was a significant difference in R eff (P < 0.05) between the CV-A16 and Total. In Hunan Province, the R eff between CV-A16 and EV-A71&CV-A16, between CV-A16 and Total were significant (P < 0.05). In Chongqing Municipality, we found significant differences of the R eff (P < 0.05) between CV-A16 and CV-A16&Others, and between Others and CV-A16&Others. In Jilin Province, significant differences of the R eff (P < 0.05) were found between EV-A71 and Total, and between Others and Total. Conclusion The major pathogens of HFMD have changed annually, and the incidence of HFMD caused by others and CV-A16 has surpassed that of EV-A71 in recent years. Cross-regional differences were observed in the interactions between the pathogens.
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Affiliation(s)
- Zimei Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Wenjing Ye
- Fujian Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Yan Niu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kaiwei Luo
- Hunan Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Bin Deng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shi Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shanshan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Chan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Peihua Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Rui Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hongjie Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hesong Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Lijin Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Simiao Zuo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Lexin Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shurui Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shiting Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yichao Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Qinglong Zhao
- Jilin Center for Disease Control and Prevention, Changchun, Jilin, China
| | - Shenggen Wu
- Fujian Center for Disease Control and Prevention, Fuzhou, Fujian, China,Shenggen Wu
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China,Qin Li
| | - Yong Chen
- Department of Stomatology, School of Medicine, Xiamen University, Xiamen, China,Yong Chen
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China,*Correspondence: Tianmu Chen
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Huang L, Wang T, Liu X, Fu Y, Zhang S, Chu Q, Nie T, Tu H, Chen J, Fan Y. Spatial-temporal-demographic and virological changes of hand, foot and mouth disease incidence after vaccination in a vulnerable region of China. BMC Public Health 2022; 22:1468. [PMID: 35915424 PMCID: PMC9342842 DOI: 10.1186/s12889-022-13860-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background The enterovirus 71 (EV-A71) vaccine has been used in Hefei for several years, and the epidemiological significance of vaccination in this area is unclear. We aims to explore the spatial–temporal-demographic and virological changes of hand, foot and mouth disease (HFMD) after vaccination in China. Methods The data for HFMD from 2012 to 2020 were downloaded with the help of HFMD reporting system of Hefei Center for Disease Control and Prevention and combined with the EV-A71 vaccination status in Hefei. The study defined the period between 2012 to 2016 as the pre-vaccination period and explored the effect of vaccination on the incidence of HFMD by comparing the changes of HFMD before and after vaccination in terms of spatial, temporal, demographic and virological aspects. Results During the study period, a higher incidence occurred in urban area and the random distribution changed to a slight cluster after vaccination. HFMD incidence had inconsistent seasonality over years, with one or two incidence peaks in varying years. The morbidity decreased from 215.22/105 in 2012–2016 to 179.81/105 in 2017–2020 (p < 0.001). Boys, 0–4 years old children and Scattered children were more susceptible to HFMD compared with the others, the proportions decreased after vaccination except in Scattered children. The main pathogenic enterovirus gradually changed from EV-A71 to Other Enteroviruses, especially coxsackieviruses A6 (CV-A6) after the implementation of EV-A71 vaccination. Conclusions The EV-A71 vaccine was effective in reducing the incidence of HFMD and changing the spatial, temporal, demographic, and virological characteristic. These changes should be considered during the vaccination implementation to further reduce the disease burden of HFMD. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13860-z.
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Affiliation(s)
- Li Huang
- Faculty of Clinical Medicine, Anhui Medical College, Hefei, 230601, Anhui, China
| | - Ting Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xuxiang Liu
- Hefei Center for Disease Control and Prevention, Hefei, 230061, Anhui, China
| | - Yuansheng Fu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Sichen Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Qinshu Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Tingyue Nie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Houmian Tu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jian Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
| | - Yinguang Fan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
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