Clinical Scorecard: Epidemiological Trends of Hand, Foot, and Mouth Disease Across Three Distinct Periods in Jiangxi Province, China: A Retrospective Analysis from 2009 to 2022

At a Glance

Key Highlights

• HFMD is highly contagious with mostly mild symptoms but can cause severe complications including neurological and pulmonary manifestations.
• The inactivated EV-A71 vaccine, introduced in China since 2016 for children aged 6 months to 5 years, shows high efficacy (97%) against EV-A71 associated HFMD.
• Non-pharmacological interventions (NPIs) during COVID-19 (e.g., quarantine, distancing, masking) have impacted HFMD transmission dynamics.

Guideline-Based Recommendations

Diagnosis

• Clinical diagnosis based on fever, vesicular rash on hands and feet, and oral ulcers.
• Laboratory confirmation via RT-PCR testing for EV-A71, CVA16, and other enteroviruses, especially in severe or fatal cases.

Management

• Supportive care for mild cases as most are self-limiting.
• Close monitoring and early intervention for severe complications such as aseptic meningitis, encephalitis, and pulmonary edema.

Monitoring & Follow-up

• Enhanced surveillance through national reporting systems.
• Regular collection of clinical specimens from severe, fatal, and selected mild cases for pathogen identification.
• Monitoring vaccination coverage rates and NPI stringency indices to assess impact on HFMD incidence.

Risks

• Severe complications predominantly associated with EV-A71 infection in young children.
• Limitations of EV-A71 vaccine include narrow protection spectrum and uncertain immunity duration.
• Uneven vaccine coverage and potential resurgence without sustained public health interventions.

Patient & Prescribing Data

Children under 10 years, with focus on those aged 6 months to 5 years for vaccination

Two-dose inactivated EV-A71 vaccine schedule (28-day interval) initiated since 2016; real-world data show reduction in HFMD incidence, severity, and mortality post-vaccination

Clinical Best Practices

• Implement EV-A71 vaccination programs targeting children aged 6 months to 5 years to reduce severe HFMD cases.
• Maintain enhanced surveillance integrating clinical, laboratory, and vaccination data for timely outbreak detection and response.
• Incorporate non-pharmacological interventions during outbreaks to mitigate transmission, especially in high-incidence regions.
• Use epidemiological modeling and forecasting tools to guide public health strategies and resource allocation.

References

• Chinese HFMD pathogenic surveillance protocol
• Oxford COVID-19 Government Response Tracker (OxCGRT)