Impact of the coronavirus disease 2019 interventions on the incidence of hand, foot, and mouth disease in mainland China

Zheng Zhao, Canjun Zheng, Hongchao Qi, Yue Chen, Michael P. Ward, Fengfeng Liu, Jie Hong, Qing Su, Jiaqi Huang, Xi Chen, Jiaxu Le, Xiuliang Liu, Minrui Ren, Jianbo Ba, Zhijie Zhang*, Zhaorui Chang, Zhongjie Li

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: In early 2020, non-pharmaceutical interventions (NPIs) were implemented in China to reduce and contain the coronavirus disease 2019 (COVID-19) transmission. These NPIs might have also reduced the incidence of hand, foot, and mouth disease (HFMD). Methods: The weekly numbers of HFMD cases and meteorological factors in 31 provincial capital cities and municipalities in mainland China were obtained from Chinese Center for Disease Control and Prevention (CCDC) and National Meteorological Information Center of China from 2016 to 2020. The NPI data were collected from local CDCs. The incidence rate ratios (IRRs) were calculated for the entire year of 2020, and for January–July 2020 and August–December 2020. The expected case numbers were estimated using seasonal autoregressive integrated moving average models. The relationships between kindergarten closures and incidence of HFMD were quantified using a generalized additive model. The estimated associations from all cities were pooled using a multivariate meta-regression model. Findings: Stringent NPIs were widely implemented for COVID-19 control from January to July 2020, and the IRRs for HFMD were less than 1 in all 31 cities, and less than 0·1 for 23 cities. Overall, the proportion of HFMD cases reduced by 52·9% (95% CI: 49·3−55·5%) after the implementation of kindergarten closures in 2020, and this effect was generally consistent across subgroups. Interpretation: The decrease in HFMD incidence was strongly associated with the NPIs for COVID-19. HFMD epidemic peaks were either absent or delayed, and the final epidemic size was reduced. Kindergarten closure is an intervention to prevent HFMD outbreaks. Funding: This research was supported by the National Natural Science Foundation of China (81973102 & 81773487), Public Health Talents Training Program of Shanghai Municipality (GWV-10.2-XD21), the Shanghai New Three-year Action Plan for Public Health (GWV-10.1-XK16), the Major Project of Scientific and Technical Winter Olympics from National Key Research and Development Program of China (2021YFF0306000), 13th Five-Year National Science and Technology Major Project for Infectious Diseases (2018ZX10725-509) and Key projects of the PLA logistics Scientific research Program (BHJ17J013).

Original languageEnglish
Article number100362
JournalThe Lancet Regional Health - Western Pacific
Volume20
Early online date1 Jan 2022
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
We would like to thank the CCDC for assistance in research design and data collection. We also would like to thank local CDCs for assistance in support of data collection, the views expressed are those of the authors alone. This research was supported by National Natural Science Foundation of China (81973102, 81773487), Public Health Talents Training Program of Shanghai Municipality (GWV-10.2-XD21) and the Shanghai New Three-year Action Plan for Public Health (GWV-10.1-XK16). The datasets used and analyzed during the current study available from the corresponding author on reasonable request. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Publisher Copyright:
© 2021 The Author(s)

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