Transmissibility of hand, foot, and mouth disease in 97 counties of China

doi:10.1038/s41598-022-07982-y

. 2022 Mar 8;12(1):4103.

doi: 10.1038/s41598-022-07982-y.

Transmissibility of hand, foot, and mouth disease in 97 counties of China

Wei Zhang^#¹, Jia Rui^#¹, Xiaoqing Cheng^#², Bin Deng¹, Hesong Zhang¹, Lijing Huang¹, Lexin Zhang¹, Simiao Zuo¹, Junru Li¹, XingCheng Huang¹, Yanhua Su¹, Benhua Zhao¹, Yan Niu³, Hongwei Li⁴, Jian-Li Hu⁵, Tianmu Chen⁶

Affiliations

¹ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China.
² Jiangsu Provincial Center for Disease Control and Prevention, 172, Jiangsu 21, Rd, Nanjing City, 210009, Jiangsu Province, People's Republic of China.
³ Chinese Center for Disease Control and Prevention, Beijing City, People's Republic of China. niuyan@chinacdc.cn.
⁴ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China. rocque@xmu.edu.cn.
⁵ Jiangsu Provincial Center for Disease Control and Prevention, 172, Jiangsu 21, Rd, Nanjing City, 210009, Jiangsu Province, People's Republic of China. jshjl@jscdc.cn.
⁶ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China. 13698665@qq.com.

^# Contributed equally.

PMID: 35260706
PMCID: PMC8902910
DOI: 10.1038/s41598-022-07982-y

Transmissibility of hand, foot, and mouth disease in 97 counties of China

Wei Zhang et al. Sci Rep. 2022.

. 2022 Mar 8;12(1):4103.

doi: 10.1038/s41598-022-07982-y.

Authors

Affiliations

¹ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China.
² Jiangsu Provincial Center for Disease Control and Prevention, 172, Jiangsu 21, Rd, Nanjing City, 210009, Jiangsu Province, People's Republic of China.
³ Chinese Center for Disease Control and Prevention, Beijing City, People's Republic of China. niuyan@chinacdc.cn.
⁴ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China. rocque@xmu.edu.cn.
⁵ Jiangsu Provincial Center for Disease Control and Prevention, 172, Jiangsu 21, Rd, Nanjing City, 210009, Jiangsu Province, People's Republic of China. jshjl@jscdc.cn.
⁶ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, 4221-117 South Xiang'an Road, Xiang'an District, Xiamen City, Fujian Province, People's Republic of China. 13698665@qq.com.

^# Contributed equally.

PMID: 35260706
PMCID: PMC8902910
DOI: 10.1038/s41598-022-07982-y

Abstract

Hand, foot, and mouth disease (HFMD) is a serious disease burden in the Asia-Pacific region, including China. This study calculated the transmissibility of HFMD at county levels in Jiangsu Province, China, analyzed the differences of transmissibility and explored the possible influencing factors of its transmissibility. We built a mathematical model for seasonal characteristics of HFMD, estimated the effective reproduction number (R_eff), and compared the incidence rate and transmissibility in different counties using non-parametric tests, rapid cluster analysis and rank-sum ratio in 97 counties in Jiangsu Province from 2015 to 2020. The average daily incidence rate was between 0 and 4 per 100,000 people in Jiangsu Province from 2015-2020. The Quartile of R_eff in Jiangsu Province from 2015 to 2020 was 1.54 (0.49, 2.50). Rugao District and Jianhu District had the highest transmissibility according to the rank-sum ratio. R_eff generally decreased in 2017 and increased in 2018 in most counties, and the median level of R_eff was the lowest in 2017 (P < 0.05). The transmissibility was different in 97 counties in Jiangsu Province. The reasons for the differences may be related to the climate, demographic characteristics, virus subtypes, vaccination, hygiene and other infectious diseases.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Figure 1**
Map of average daily morbidity in Jiangsu Province form 2015–2020.

**Figure 2**
The simulated incidence rates of HFMD in different regions in Southern Jiangsu. No. 1–40 refers to Southern Jiangsu, including Changzhou city No. 1–6 (Jintang district, Suyang county-level-city, Tianning district, Wujin district, Xinbei district, Zhonglou district, respectively), Nanjing city No. 7–17 (Gaochun district, Gulou district, Jianye district, Jiangning district, Liuhe district, Pukou district, Qixia district, Qinhuai district, Sushui district, Xuanwu district, Yuhuatai district, respectively), Suzhou city No.18–27 (Changshu county-level-city, Gongyeyuan district, Gusu district, Huqiu district, Kunshan county-level-city, Taichng county-level-city, Wujiang district, Wuzhong district, Xiangcheng district, Zhangjiagang county-level-city, respectively), Wuxi city No. 28–34 (Binhu district, Huishan district, Jiangyin county-level-city, Liangxi district, Xishan district, Xin district, Yixing county-level-city, respectively) and Zhenjiang city No. 35–40 (Dantu district, Danyang county-level-city, Jingkou district, Jurong county-level-city, Runzhou district, Yangzhong county-level-city, respectively).

**Figure 3**
The simulated incidence rates of HFMD in different regions in Northern Jiangsu. No. 41–77 refers to Northern Jiangsu, including Huaian city No. 41–47 (Huaian district, Huaiyin district, Jinhu county, Kafaqu district, Lianshui county, Qingjiangpu district, Xuyi county, respectively), Lianyun city No. 48–53 (Donghai county, Ganyu county, Guannan county, Guanyun district, Haizhou district, Lianyungang district, respectively), Suqian city No. 54–58 (Muyang county, Siyang county, Sihong county, Sucheng district, Suyu district, respectively), Yancheng city No. 59–67 (Binhai county, Dafeng district, Dongtai county-level-city, Funing county, Jianhu county, Sheyang county, Tinghu district, Xiangshui county, Yandu district, respectively), Xuzhou city No. 68–77 (Fengxian county, Gulou district, Jiawang district, Peixian county, Pizhou county-level-city, Quanshan district, Suining county, Tongshan district, Xinyi county-level-city, Yunlong district, respectively).

**Figure 4**
The simulated incidence rates of HFMD in different regions in Central Jiangsu. No. 78–97 refers to Central Jiangsu, including Nantong city No. 78–85 (Chongchun district, Gangzha district, Haian county-level-city, Haimen district, Qidong county-level-city, Rudong county, Rugao county-level-city, Tongzhou district, respectively), Taizhou city No. 86–91 (Gaogang district, Hailing district, Jiangyan district, Jingjiang county-level-city, Taixing county-level-city, Xinghua, county-level-city respectively), Yangzhou city No. 92–97 (Baoying county, Gaoyou county-level-city, Guangling district, Hanjiang district, Jiangdu district, Yizheng county-level-city, respectively).

**Figure 5**
The effective reported number of HFMD in different regions in Southern Jiangsu. No. 1–40 refers to Southern Jiangsu, including Changzhou city No. 1–6 (Jintang district, Suyang county-level-city, Tianning district, Wujin district, Xinbei district, Zhonglou district, respectively), Nanjing city No. 7–17 (Gaochun district, Gulou district, Jianye district, Jiangning district, Liuhe district, Pukou district, Qixia district, Qinhuai district, Sushui district, Xuanwu district, Yuhuatai district, respectively), Suzhou city No.18–27 (Changshu county-level-city, Gongyeyuan district, Gusu district, Huqiu district, Kunshan county-level-city, Taichng county-level-city, Wujiang district, Wuzhong district, Xiangcheng district, Zhangjiagang county-level-city, respectively), Wuxi city No. 28–34 (Binhu district, Huishan district, Jiangyin county-level-city, Liangxi district, Xishan district, Xin district, Yixing county-level-city, respectively) and Zhenjiang city No. 35–40 (Dantu district, Danyang county-level-city, Jingkou district, Jurong county-level-city, Runzhou district, Yangzhong county-level-city, respectively).

**Figure 6**
The effective reported number of HFMD in different regions in Northern Jiangsu. No. 41–77 refers to Northern Jiangsu, including Huaian city No. 41–47 (Huaian district, Huaiyin district, Jinhu county, Kafaqu district, Lianshui county, Qingjiangpu district, Xuyi county, respectively), Lianyun city No. 48–53 (Donghai county, Ganyu county, Guannan county, Guanyun district, Haizhou district, Lianyungang district, respectively), Suqian city No. 54–58 (Muyang county, Siyang county, Sihong county, Sucheng district, Suyu district, respectively), Yancheng city No. 59–67 (Binhai county, Dafeng district, Dongtai county-level-city, Funing county, Jianhu county, Sheyang county, Tinghu district, Xiangshui county, Yandu district, respectively), Xuzhou city No. 68–77 (Fengxian county, Gulou district, Jiawang district, Peixian county, Pizhou county-level-city, Quanshan district, Suining county, Tongshan district, Xinyi county-level-city, Yunlong district, respectively).

**Figure 7**
The effective reported number of HFMD in different regions Central Jiangsu. No. 78–97 refers to Central Jiangsu, including Nantong city No. 78–85 (Chongchun district, Gangzha district, Haian county-level-city, Haimen district, Qidong county-level-city, Rudong county, Rugao county-level-city, Tongzhou district, respectively), Taizhou city No. 86–91 (Gaogang district, Hailing district, Jiangyan district, Jingjiang county-level-city, Taixing county-level-city, Xinghua, county-level-city respectively), Yangzhou city No. 92–97 (Baoying county, Gaoyou county-level-city, Guangling district, Hanjiang district, Jiangdu district, Yizheng county-level-city, respectively).

**Figure 8**
Sensitivity analysis of k (range 0–1).

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References

1. Repass GL, Palmer WC, Stancampiano FF. Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. Clevel. Clin. J. Med. 2014;81:537–543. doi: 10.3949/ccjm.81a.13132. - DOI - PubMed
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[1] Repass GL, Palmer WC, Stancampiano FF. Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. Clevel. Clin. J. Med. 2014;81:537–543. doi: 10.3949/ccjm.81a.13132. - DOI - PubMed

[2] Repass GL, Palmer WC, Stancampiano FF. Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. Clevel. Clin. J. Med. 2014;81:537–543. doi: 10.3949/ccjm.81a.13132. - DOI - PubMed

[3] Koh WM, et al. The epidemiology of hand, foot and mouth disease in asia: a systematic review and analysis. Pediatr. Infect. Dis. J. 2016;35:e285–300. doi: 10.1097/inf.0000000000001242. - DOI - PMC - PubMed

[4] Koh WM, et al. The epidemiology of hand, foot and mouth disease in asia: a systematic review and analysis. Pediatr. Infect. Dis. J. 2016;35:e285–300. doi: 10.1097/inf.0000000000001242. - DOI - PMC - PubMed

[5] Ramdass P, Mullick S, Farber HF. Viral skin diseases. Prim. Care. 2015;42:517–567. doi: 10.1016/j.pop.2015.08.006. - DOI - PubMed

[6] Ramdass P, Mullick S, Farber HF. Viral skin diseases. Prim. Care. 2015;42:517–567. doi: 10.1016/j.pop.2015.08.006. - DOI - PubMed

[7] Bian L, et al. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Rev. Anti Infect. Ther. 2015;13:1061–1071. doi: 10.1586/14787210.2015.1058156. - DOI - PubMed

[8] Bian L, et al. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Rev. Anti Infect. Ther. 2015;13:1061–1071. doi: 10.1586/14787210.2015.1058156. - DOI - PubMed

[9] Wang XF, Lu J, Liu XX, Dai T. Epidemiological features of hand, foot and mouth disease outbreaks among Chinese preschool children: a meta-analysis. Iran. J. Public Health. 2018;47:1234–1243. - PMC - PubMed

[10] Wang XF, Lu J, Liu XX, Dai T. Epidemiological features of hand, foot and mouth disease outbreaks among Chinese preschool children: a meta-analysis. Iran. J. Public Health. 2018;47:1234–1243. - PMC - PubMed

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Transmissibility of hand, foot, and mouth disease in 97 counties of China

Affiliations

Transmissibility of hand, foot, and mouth disease in 97 counties of China

Authors

Affiliations

Abstract

Conflict of interest statement

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