Epidemiological and etiological characteristics of hand foot and mouth disease in Wuzhou, Guangxi, 2010−2020

  Objective  To analyze the epidemiological and etiological characteristics of hand foot and mouth disease (HFMD) in Wuzhou, Guangx Zhuang autonomous region, from 2010 to 2020i, and provide evidence for the formulation of preventive measures and strategy.

  Methods  The incidence data of HFMD in Wuzhou were collected from the national infectious diseases reporting system. Descriptive epidemiological method was used to analyze the case distributions, pathogen constituent and change of HFMD. JoinPoint regression model was used to analyze the trends of the incidence rate, severity rate and case fatality rate of HFMD.

  Results  From 2010 to 2020, the annual reported average incidence rate of HFMD was 314.91/100,000 in Wuzhou, the annual average rate of severe cases was 14.18/100,000, and the annual average case fatality rate was 0.02%. Both the incidence rate and severe case rate showed downward trends after 2017 annual rate of change (APC)=−29.56%, APC=−80.99%, all P＜0.05, and the case fatality rate decreased significantly after 2016 (APC=−91.26%, P＜0.05). The incidence of HFMD in Wuzhou showed obvious seasonality and spatial correlation. The annual incidence peaks mainly occurred during April-July and September-November. Wanxiu and Changzhou were the hot spot areas, while Cenxi had the highest severe case and case fatality rates, Cangwu and Longxu had increasing proportions of severe cases. The incidence in men was higher than that in women (1.54∶1). The cases was mainly children under 5 years old in or outside child cares settings (89.91%), and the severe cases were mainly children under 3 years old outside child care settings (81.30%). Both the proportion of severe case and the case fatality rate were higher in rural area than in urban area (χ²=455.532, χ²=11.093, all P＜0.001), and the proportions of severe cases in both rural area and urban area showed decreasing trends after 2017 (urban area APC=−63.25%, P=0217; rural area APC=−75.32%, P=0.178). In Wuzhou, a variety of pathogens of HFMD coexisted and the predominant pathogens constantly changed. After 2018, the positive detection rate of enterovirus 71 (EV71) gradually decreased, and coxsackievirus A6 (CA6) and CA10 became the predominant pathogens causing severe cases instead of EV71.

  Conclusion  The incidence, severe case rate and case fatality rate of HFMD showed downward trends in Wuzhou during 2010−2020, but the severe cases rate remained high. There were obvious clustering of severe cases, and the predominant pathogens has changed from EV71 to CA6 and CA10. The prevention and control of HFMD is still challenging. It is necessary to strengthen the health education about HFMD in key populations and HFMD prevention and control in key areas, and improve the pathogen surveillance and analysis.