Trends of morbidity and mortality of hand foot and mouth disease in China, 2008–2017

  Objective   To analyze the trends of morbidity and mortality of hand foot and mouth disease (HFMD) in China from 2008 to 2017, and provide scientific evidence for the development of HFMD prevention and control strategies.

  Methods   The morbidity and mortality data of HFMD in China during this period were collected from China Public Health Science Data Center and the demographic data were collected from National Bureau of Statistics. Software Excel 2016 was used to establish the morbidity and mortality database of HFMD reports. Software JoinPoint 4.9.0.0 was used for JoinPoint regression analysis to estimate the annual average percentage change (AAPC) of reported morbidity and mortality of HFMD in different age groups and in different provinces in China from 2008 to 2017, and analyze the changing trend of HFMD morbidity and mortality.

  Results   A total of 18 183 889 cases of HFMD were reported from January 2008 to December 2017, the average annual reported morbidity was 134.75/100 000. A total of 3 632 deaths were reported, with an annual average reported mortality of 0.027/100 000. The morbidity and mortality were stable from 2008 to 2017 (P>0.05), but the mortality showed a decreasing trend from 2010 to 2017 (APC: −22.98%, 95%CI: −29.64% to −15.70%, P<0.05). The morbidity in 10 provinces (municipalities) showed an increasing trend (P<0.05), the morbidity in 4 provinces (municipalities) showed decreasing trend (P<0.05), the morbidity in 18 provinces (municipalities) remained stable, and the mortality showed decreasing trend in 5 provinces (P<0.05). The incidence of HFMD was high in children aged 0–7 years, and the highest morbidity was in children aged 1 year (3 184.19/100 000). The average annual morbidity of HFMD decreased with age (t=−2.97, P<0.05). The case fatality rate of HFMD in age group <20 years decreased with age (t=−3.18, P<0.05). The annual morbidity of HFMD in 14 age groups showed an increasing trend (P<0.05), and the annual morbidity of HFMD in 12 age groups remained stable (P>0.05). The mortality in age group 0–7 years remained stable (P>0.05).

  Conclusion   The overall HFMD morbidity and mortality in China from 2008 to 2017 were relatively stable, but the mortality showed a decreasing trend from 2010 to 2017. The morbidity of HFMD showed increasing trend in Southern China, Southwestern China, Central China and Eastern China, but the morbidity of HFMD declined in northern China and northeastern China. The morbidity of HFMD was higher in children aged 0 to 7 years. It is suggested that HFMD prevention and control should be strengthened according to the change of HFMD epidemic in different areas to reduce the morbidity and mortality of HFMD.