Effect of EV71 Vaccination on Transmission Dynamics of Hand, Foot, and Mouth Disease and Its Epidemic Prevention Threshold
Dashan Zheng,
Lingzhi Shen,
Wanqi Wen,
Zitong Zhuang,
Samantha E. Qian,
Feng Ling,
Ziping Miao,
Rui Li,
Stephen Edward McMillin,
Sabel Bass,
Jimin Sun,
Hualiang Lin,
Kun Liu
Affiliations
Dashan Zheng
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Lingzhi Shen
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Wanqi Wen
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Zitong Zhuang
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Samantha E. Qian
College of Arts and Sciences, Saint Louis University, Saint Louis, MO 63108, USA
Feng Ling
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Ziping Miao
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Rui Li
Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, 169 Changle West Road, Xi’an 710032, China
Stephen Edward McMillin
School of Social Work, Saint Louis University, Saint Louis, MO 63103, USA
Sabel Bass
Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
Jimin Sun
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Hualiang Lin
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
Kun Liu
Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, 169 Changle West Road, Xi’an 710032, China
Objective: To investigate the effect of Enterovirus A71 (EV71) vaccination on the transmissibility of different enterovirus serotypes of hand, foot, and mouth disease (HFMD) in Zhejiang, China. Methods: Daily surveillance data of HFMD and EV71 vaccination from August 2016 to December 2019 were collected. Epidemic periods for each HFMD type were defined, and the time-varying effective reproduction number (Rt) was estimated, which could provide more direct evidence of disease epidemics than case number. General additive models (GAMs) were employed to analyze associations between EV71 vaccination quantity and rate and HFMD transmissibility. The epidemic prevention threshold, represented by required vaccination numbers and rates, was also estimated. Results: Vaccinating every 100,000 children ≤ 5 years could lead to a decrease in the Rt of EV71-associated HFMD by 14.44% (95%CI: 6.76%, 21.42%). Additionally, a positive correlation was observed between vaccinations among children ≤ 5 years old (per 100,000) and the increased transmissibility of other HFMD types (caused by enteroviruses other than EV71 and CA16) at 1.82% (95%CI: 0.80%, 2.84%). It was estimated that an additional 362,381 vaccinations, corresponding to increased vaccine coverage to 54.51% among children ≤ 5 years could effectively prevent EV71 epidemics in Zhejiang. Conclusions: Our findings highlight the importance of enhancing EV71 vaccine coverage for controlling the epidemic of EV71-HFMD and assisting government officials in developing strategies to prevent HFMD.
