背景:手,脚,口蹄疫(HFMD)是中国的主要公共卫生问题,而温度和湿度是有据可查的预测因素。然而,关于温度和湿度共同影响的证据仍然有限。还不清楚这种效果是否可以通过肠道病毒71(EV71)疫苗接种来改变。
方法:基于2012年至2019年夏季报告的320,042例手足口病病例,我们利用分布式滞后非线性模型(DLNM)和时变DLNM进行了一项研究,以研究中国的手足口病EV71疫苗策略将如何影响气象条件与手足口病风险之间的相关性。
结果:手足口病的发病率随不适指数呈臂状变化。与2012-2016年(疫苗实施前)相比,2017-2019年期间(实施EV71疫苗政策后),手足口病的14天累积风险在统计上显着增加。对于总人口来说,第75位手足口病的相对风险(RR)值范围,第90,和99%的百分位数从2012-2016年的1.082-1.303上升至2017-2019年的1.836-2.022。在分层分析中,汉族地区表现出更强的相对增长,RR值在第75位,第90,第99百分位数增加了14.3%,39.1%,和134.4%的疫苗接种后,与22.7%的增长相比,41.6%,少数民族地区为38.8%。同样,男孩的增幅更大(24.4%,47.7%,121.5%)与女孩(8.1%,28.1%,58.3%)。此外,与其他县相比,贵州中部城市群表现出更强的相对增长趋势。
结论:尽管EV71疫苗政策已经实施,未有效控制手足口病的总体风险。主要的病毒亚型发生了变化,可能改变人群易感性并影响手足口病的发生。疫苗干预的调节作用也可能受到种族、性别,和经济水平。
BACKGROUND: Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and
humidity are well-documented predictors. However, evidence on the combined effect of temperature and
humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination.
METHODS: Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China\'s HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk.
RESULTS: The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties.
CONCLUSIONS: Although the EV71 vaccine policy has been implemented, it hasn\'t effectively controlled the overall risk of HFMD. There\'s been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.