Zhao Zheng, Zheng Canjun, Qi Hongchao, Chen Yue, Ward Michael P, Liu Fengfeng, Hong Jie, Su Qing, Huang Jiaqi, Chen Xi, Le Jiaxu, Liu Xiuliang, Ren Minrui, Ba Jianbo, Zhang Zhijie, Chang Zhaorui, Li Zhongjie
Department of Epidemiology and Health Statistics, Fudan University, Shanghai, China.
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Lancet Reg Health West Pac. 2022 Mar;20:100362. doi: 10.1016/j.lanwpc.2021.100362. Epub 2022 Jan 1.
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).
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.
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.
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.
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).
2020年初，中国实施了非药物干预措施（NPIs）以减少和控制2019冠状病毒病（COVID-19）的传播。这些非药物干预措施可能也降低了手足口病（HFMD）的发病率。
从中国疾病预防控制中心（CCDC）和国家气象信息中心获取了2016年至2020年中国大陆31个省会城市和直辖市手足口病病例的每周数据及气象因素。非药物干预措施数据从当地疾病预防控制中心收集。计算了2020年全年以及2020年1月至7月和2020年8月至12月的发病率比（IRRs）。使用季节性自回归积分滑动平均模型估计预期病例数。使用广义相加模型量化幼儿园关闭与手足口病发病率之间的关系。使用多变量meta回归模型汇总所有城市的估计关联。
2020年1月至7月广泛实施了严格的非药物干预措施以控制COVID-19，所有31个城市手足口病的发病率比均小于1，23个城市小于0.1。总体而言，2020年实施幼儿园关闭措施后，手足口病病例比例降低了52.9%（95%CI：49.3 - 55.5%），且这一效果在各亚组中总体一致。
手足口病发病率的下降与COVID-19的非药物干预措施密切相关。手足口病疫情高峰要么未出现，要么延迟出现，且最终疫情规模减小。幼儿园关闭是预防手足口病暴发的一项干预措施。
本研究得到了中国国家自然科学基金（81973102 & 81773487）、上海市公共卫生人才培养计划（GWV-10.2-XD21）、上海市公共卫生新三年行动计划（GWV-10.1-XK16）、国家重点研发计划科技冬奥重大项目（2021YFF0306000）、十三五国家传染病重大科技专项（2018ZX10725-509）以及解放军后勤科研计划重点项目（BHJ17J013）的支持。
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