Objective To understand the epidemiological characteristics of pathogens causing hand, foot and mouth disease (HFMD) and herpangina in China, and provide evidence for the development of disease prevention and control strategies.

Methods In this study, descriptive epidemiological method was used to analyze the sentinel surveillance data of HFMD and herpangina in 5 provinces (municipality) with high HFMD incidences in China in 2024, including Anhui (east China), Chongqing (southwest China), Yunnan (southwest China), Hunan (central China), and Henan (central China). The epidemiological and etiological characteristics of both HFMD cases and herpangina cases were compared by using χ².

Results In 2024, a total of 1961 cases were included from the five provinces (municipality), in which HFMD accounted for 55.53% and herpangina accounted for 44.47%. The incidence peak of the two diseases was during week 15 - week 26, and during this period HFMD cases accounted for 54.83% and herpangina cases accounted for 45.17%. The positive detection rate of enterovirus for HFMD (73.65%) was higher than that of herpangina (51.49%), the difference was significant (P<0.001). The differences in enterovirus spectrum of two diseases were significant (P<0.001). For HFMD, CVA16 was the predominant pathogen (59.48%), followed by other enteroviruses (20.32%); while for herpangina, 59.24% of the cases were infected with other enteroviruses, followed by CVA10 (18.93%). In terms of demographic characteristics, both HFMD and herpangina mainly affected children under 5 years old, with HFMD and herpangina accounting for 76.68% and 83.07% of total cases, respectively. The male to female ratio of the cases was 1.51∶1 for HFMD and 1.27∶1 for herpangina. In terms of clinical characteristics, the proportion of the cases with fever caused by CVA10 was 87.69%, higher than those of the cases caused by CVA16 (33.91%) and CVA6 (79.73%). The rash sites of children infected with CVA6 were wider than those infected with CVA16 and CVA10. Up to 78.00% of children with herpangina had fever symptoms, and 2.57%−4.29% of children had neurological symptoms, such as drowsiness, convulsions, headache and restlessness.

Conclusion HFMD and herpangina shared similar epidemic seasons and affected populations, but differed in the positive detection rates of enteroviruses and the spectrum of predominant pathogens. It is suggested to strengthen the surveillance for herpangina to provide evidence for the development of prevention and control strategies.