scholarly journals Severity and burden of hand, foot and mouth disease in Asia: a modelling study

2018 ◽  
Vol 3 (1) ◽  
pp. e000442 ◽  
Author(s):  
Wee Ming Koh ◽  
Hishamuddin Badaruddin ◽  
Hanh La ◽  
Mark I-Cheng Chen ◽  
Alex R Cook
Keyword(s):  
Disease Burden ◽  
Vaccine Coverage ◽  
Case Fatality ◽  
Foot And Mouth Disease ◽  
Economic Cost ◽  
Mouth Disease ◽  
Years Of Life Lost ◽  
Upper Respiratory Tract ◽  
Case Fatality Ratio ◽  
Foot And Mouth

BackgroundHand, foot and mouth disease (HFMD) affects millions of children across Asia annually, leading to an increase in implemented control policies such as surveillance, isolation and social distancing in affected jurisdictions. However, limited knowledge of disease burden and severity causes difficulty in policy optimisation as the associated economic cost cannot be easily estimated. We use a data synthesis approach to provide a comprehensive picture of HFMD disease burden, estimating infection risk, symptomatic rates, the risk of complications and death, and overall disability-adjusted life-year (DALY) losses, along with associated uncertainties.MethodsComplementary data from a variety of sources were synthesised with mathematical models to obtain estimates of severity of HFMD. This includes serological and other data extracted through a systematic review of HFMD epidemiology previously published by the authors, and laboratory investigations and sentinel reports from Singapore’s surveillance system.ResultsHFMD is estimated to cause 96 900 (95% CI 40 600 to 259 000) age-weighted DALYs per annum in eight high-burden countries in East and Southeast Asia, with the majority of DALYs attributed to years of life lost. The symptomatic case hospitalisation rate of HFMD is 6% (2.8%–14.9%), of which 18.7% (6.7%–31.5%) are expected to develop complications. 5% (2.9%–7.4%) of such cases are fatal, bringing the overall case fatality ratio to be 52.3 (24.4–92.7) per 100 000 symptomatic infections. In contrast, the EV-A71 case fatality ratio is estimated to be at least 229.7 (75.4–672.1) per 100 000 symptomatic cases. Asymptomatic rate for EV-A71 is 71.4% (68.3%–74.3%) for ages 1–4, the years of greatest incidence.ConclusionDespite the high incidence rate of HFMD, total DALY due to HFMD is limited in comparison to other endemic diseases in the region, such as dengue and upper respiratory tract infection. With the majority of DALY caused by years of life lost, it is possible to mitigate most with increased EV-A71 vaccine coverage.

scholarly journals Endemic foot and mouth disease: pastoral in-herd disease dynamics in sub-Saharan Africa

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
I. McLachlan ◽  
G. Marion ◽  
I. J. McKendrick ◽  
T. Porphyre ◽  
I. G. Handel ◽  
...  
Keyword(s):  
Disease Burden ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Sub Saharan Africa ◽  
Herd Level ◽  
Population Turnover ◽  
Foot And Mouth ◽  
Sub Saharan ◽  
Multiple Strains ◽  
Reduced Risk

AbstractFoot and mouth disease (FMD) burden disproportionally affects Africa where it is considered endemic. Smallholder livestock keepers experience significant losses due to disease, but the dynamics and mechanisms underlying persistence at the herd-level and beyond remain poorly understood. We address this knowledge gap using stochastic, compartmental modelling to explore FMD virus (FMDV) persistence, outbreak dynamics and disease burden in individual cattle herds within an endemic setting. Our analysis suggests repeated introduction of virus from outside the herd is required for long-term viral persistence, irrespective of carrier presence. Risk of new disease exposures resulting in significant secondary outbreaks is reduced by the presence of immune individuals giving rise to a period of reduced risk, the predicted duration of which suggests that multiple strains of FMDV are responsible for observed yearly herd-level outbreaks. Our analysis suggests management of population turnover could potentially reduce disease burden and deliberate infection of cattle, practiced by local livestock keepers in parts of Africa, has little effect on the duration of the reduced risk period but increases disease burden. This work suggests that FMD control should be implemented beyond individual herds but, in the interim, herd management may be used to reduced FMD impact to livestock keepers.

scholarly journals Isotype-specific antibody responses to foot-and-mouth disease virus in sera and secretions of ‘carrier’ and ‘non-carrier’ cattle

1996 ◽  
Vol 117 (2) ◽  
pp. 349-360 ◽  
Author(s):  
J. S. Salt ◽  
G. Mulcahy ◽  
R. P. Kitching
Keyword(s):  
Disease Virus ◽  
Specific Antibody ◽  
Statistical Significance ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Antibody Responses ◽  
Upper Respiratory Tract ◽  
Serum Samples ◽  
Mouth Disease Virus ◽  
Foot And Mouth

SummaryIsotype-specific antibody responses to foot-and-mouth disease virus (FMDV) were measured in the sera and upper respiratory tract secretions of vaccinated and susceptible cattle challenged with FMDV by direct contact or by intranasal inoculation. A comparison was made between cattle that eliminated FMDV and those that developed and maintained a persistent infection. Serological and mucosal antibody responses were detected in all animals after challenge. IgA and 1gM were detected before the development of IgG1and IgG2responses. 1gM was not detected in vaccinated cattle. Challenge with FMDV elicited a prolonged biphasic secretory antibody response in FMDV ‘carrier’ animals only. The response was detected as FMDVspecific IgA in both mucosal secretions and serum samples, which gained statistical significance (P< 0·05) by 5 weeks after challenge. This observation could represent the basis of a test to differentiate vaccinated and/or recovered convalescent cattle from FMDV ‘carriers’.

Case-fatality of hand, foot and mouth disease associated with EV71: a systematic review and meta-analysis

2015 ◽  
Vol 143 (14) ◽  
pp. 3094-3102 ◽  
Author(s):  
Y. Y. ZHAO ◽  
H. JIN ◽  
X. F. ZHANG ◽  
B. WANG
Keyword(s):  
Random Effects ◽  
Meta Analysis ◽  
Enterovirus 71 ◽  
Case Fatality ◽  
Foot And Mouth Disease ◽  
Model Potential ◽  
Mouth Disease ◽  
Control Measures ◽  
Health Concern ◽  
Foot And Mouth

SUMMARYHand, foot and mouth disease (HFMD) associated with enterovirus 71 (EV71) is a growing public health concern. This study aimed to estimate the case-fatality of HFMD associated with EV71 on the basis of a meta-analysis. We searched PubMed, Cochrane, Web of Science, Elsevier, CNKI, Wanfang, and VIP databases. Two authors independently selected relevant studies. The pooled estimate of case-fatality was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis and meta-regression. We identified 14 eligible studies with a total population of 112 546. The random-effects pooled case-fatality was 1·7% (95% confidence interval 1·2–2·4). The funnel plot was asymmetrical. The estimate of case-fatality was highest in mainland China (1·8%). Removal of eight local Chinese studies decreased the original estimate. The pooled case-fatality in the period of 1998–2007 (1·5%) was lower than that in the period 2008–2012 (1·8%). Control measures for HFMD associated with EV71 are essential because of the increased case-fatality over time, especially in East Asia.

scholarly journals Airborne excretion of foot-and-mouth disease virus

1969 ◽  
Vol 67 (4) ◽  
pp. 671-677 ◽  
Author(s):  
R. F. Sellers ◽  
J. Parker
Keyword(s):  
Large Volume ◽  
Technical Assistance ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Upper Respiratory Tract ◽  
Mouth Disease Virus ◽  
Foot And Mouth ◽  
Upper Respiratory ◽  
Large Animals ◽  
Cattle And Sheep

SUMMARYA large-volume sampler was used to recover virus excreted as aerosol by cattle, sheep and pigs infected with foot-and-mouth disease. Pigs were found to excrete virus to a maximum of 104.7 ID 50 per animal per hour and sheep and cattle to a maximum of 103.2 ID 50. Excretion from pigs totalled 106 ID 50 per animal over 5 days and from cattle and sheep 3 x 104 ID 50 per animal over 4 days. Maximum recovery occurred 41 hr. after infection in pigs and cattle when lesions had generalized and 17 hr. after infection in sheep before lesions had been observed. Sampling in a multistage liquid impinger showed that 65–71% of virus was excreted as an aerosol of size > 6 μ, 19–24% 3–6 μ and 10–11% less than 3 μ. The site of production of virus excreted as aerosol is suggested to be the upper respiratory tract. Under conditions of relative humidity greater than 70% and at low temperatures, survival of virus to a distance of 100 km. is likely to occur and because of the minute respiratory volume the aerosol would be sampled more efficiently by cattle than pigs or sheep and by large animals than by small. These findings are discussed in relation to spread of virus in the field.Mr Dave Allen and Massey-Ferguson Ltd. are thanked for their generous donations, with which the large-volume sampler was purchased. We are grateful to Dr C. E. Gordon Smith, Mr G. J. Harper and Dr K. P. Norris of the Microbiological Research Establishment, Porton, for advice and help and for the loan of the multistage liquid impinger. The technical assistance of N. H. Cheale and C. W. Hawkins is gratefully acknowledged.

scholarly journals Early warning of hand, foot, and mouth disease transmission: A modeling study in mainland, China

2021 ◽  
Vol 15 (3) ◽  
pp. e0009233
Author(s):  
Jia Rui ◽  
Kaiwei Luo ◽  
Qiuping Chen ◽  
Dexing Zhang ◽  
Qinglong Zhao ◽  
...  
Keyword(s):  
Early Warning ◽  
Disease Burden ◽  
Mainland China ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Warning Signals ◽  
Early Warning Signals ◽  
Foot And Mouth ◽  
Northern Regions ◽  
Warning Time

Background Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model. Methods This study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, “epidemic acceleration week (EAW)” and “recommended warning week (RWW)”, were calculated to show the early warning time. Results The mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R2 > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions. Conclusions The disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.

scholarly journals Epidemiological characteristics of hand, foot, and mouth disease in Yunnan Province, China, 2008–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Li Jiang ◽  
Hongchao Jiang ◽  
Xin Tian ◽  
Xueshan Xia ◽  
Tian Huang
Keyword(s):  
Vaccination Coverage ◽  
Yunnan Province ◽  
Enterovirus 71 ◽  
Case Fatality ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Vaccination Coverage Rate ◽  
Foot And Mouth ◽  
Before And After ◽  
Epidemiological Characteristics

Abstract Background Since 2016, enterovirus 71 (EV71) vaccines have been approved for market entry, and little is known about how the epidemiology of hand, foot, and mouth disease (HFMD) has been affected by the introduction of the vaccines in Yunnan Province. The study describes the epidemiological characteristics of HFMD before and after the introduction of EV71 vaccination in Yunnan Province. Methods Surveillance data collected between 2008 and 2019 were analyzed to produce epidemiological distribution on cases, etiologic composition, and EV71 vaccination coverage, as well as to compare these characteristics before and after EV71 vaccination. Results A total of 1,653,533 children received EV71 vaccines from 2016 through 2019 in Yunnan. The annual EV71 vaccination coverage rate ranged from 5.53 to 15.01% among children ≤5 years old. After the introduction of EV71 vaccines, the overall incidence of HFMD increased and reached over 200 cases per 100,000 population-years in 2018 and 2019. However, the case severity and case fatality rate decreased and remained lower than 1 and 0.005% after 2016, respectively. EV71-associated mild, severe and fatal cases sharply decreased. The predominant viral serotype changed to non-EV71/non-CV-A16 enteroviruses which were detected across the whole province. Conclusions Non-EV71/non-CV-A16 enteroviruses became the predominant strain and led to a higher incidence in Yunnan. Expanding EV71 vaccination and strengthening laboratory-based surveillance could further decrease the burden of severe HFMD and detect and monitor emerging enteroviruses.

scholarly journals Interaction analysis on transmissibility of main pathogens of hand, foot, and mouth disease in Xi’an: a modelling study

2019 ◽  
Author(s):  
Yao Bai ◽  
Kun Liu ◽  
Zhongjun Shao ◽  
Zhijun Chen ◽  
Tianmu Chen
Keyword(s):  
Disease Burden ◽  
Reproduction Number ◽  
Interaction Analysis ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Enterovirus A71 ◽  
Foot And Mouth ◽  
Xi’An City ◽  
High Disease Burden

Abstract Objectives: Hand, foot, and mouth disease (HFMD) has spread widely and led to high disease burden in many countries, but the interaction among the pathogens of the disease remains unclear. In this study, we aimed to analyze the interaction of the main pathogens of HFMD using a mathematical model. Method: A dataset on reported HFMD cases was collected in Xi’an City. A long-term etiological surveillance was conducted focusing on the pathogens of the disease including Enterovirus A71 (EV71), Coxsachievirus A16 (CoxA16), and other enteroviruses. A susceptible–infectious–recovered model was adopted to calculate the reproduction number during the ascending period of reported cases (defined as Rasc) and the descending period (defined as Rdes). Results: In Xi’an, Rasc and Rdes of HFMD was 1.39 (95% CI: 1.31 – 1.48) and 0.70 (95% CI: 0.65 – 0.74), respectively. CoxA16 and other enteroviruses interacted with each other and decreased the value of Rasc. However, Rdes of CoxA16 was increased by other enteroviruses directionally.However, during the reported cases decreasing period, interactions only occurred between EV71 and other enteroviruses and between CoxA16 and other enteroviruses. These interactions all decreased Rasc but increased Rdes of affected pathogens. Conclusions: The interaction of the pathogens exists in Xi’an City. The reproduction number of the affected pathogen is adjusted and verges to 1 by the interaction.

scholarly journals Ongoing Epidemiological Changes in Hand, Foot, and Mouth Disease Following the Introduction of Enterovirus 71 Vaccines in Yunnan Province, China, 2008-2019

2021 ◽  
Author(s):  
Li Jiang ◽  
Hongchao Jiang ◽  
Xin Tian ◽  
Xueshan Xia ◽  
Tian Huang
Keyword(s):  
Vaccination Coverage ◽  
Yunnan Province ◽  
Enterovirus 71 ◽  
Case Fatality ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Vaccination Coverage Rate ◽  
Foot And Mouth ◽  
Before And After ◽  
Epidemiological Changes

Abstract Background:Since 2016, enterovirus 71 (EV71) vaccines have been approved for market entry, and litter is known about how the epidemiology of hand, foot, and mouth disease (HFMD) has been affected by the introduction of the vaccines in Yunnan Province. The study describes the ongoing epidemiological changes in HFMD following the introduction of EV71 vaccination in Yunnan.Methods:Surveillance data collected between 2008 and 2019 were analyzed to produce EV71 vaccination coverage, epidemiological distribution on cases, and etiologic composition as well as to compare these characteristics before and after EV71 vaccination.Results:A total of 1,653,533 people received EV71 vaccines from 2016 through 2019 in Yunnan. The cumulative EV71 vaccination coverage rate was 68.14%. After the introduction of EV71 vaccines, the overall incidence of HFMD increased and reached over 200 cases per 100,000 population-years in 2018 and 2019. However, the case severity and case fatality rate decreased and remained lower than 1% and 0.005% after 2016, respectively. EV71-associated mild, severe and fatal cases sharply decreased. The predominant viral serotype changed to non-EV71/non-CV-A16 enteroviruses which were detected across the whole province.Conclusions: EV71 vaccination helped to reduce severe HFMD. However, other enteroviruses became the predominant strain and let to a higher incidence. Expanding EV71 vaccination and strengthening laboratory-based surveillance could further decrease the burden of severe HFMD and reveal the existence of emerging enteroviruses.

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