Effects of different levels of non-pharmaceutical interventions on hand, foot and mouth disease in Guangzhou, China

Keyi Wu; Xiaowei Ma; Huamin Liu; Jiazhen Zheng; Rui Zhou; Zelin Yuan; Zhiwei Huang; Qi Zhong; Yining Huang; Zhoubin Zhang; Xianbo Wu

doi:10.1186/s12889-022-14850-x

Effects of different levels of non-pharmaceutical interventions on hand, foot and mouth disease in Guangzhou, China

BMC Public Health. 2022 Dec 20;22(1):2398. doi: 10.1186/s12889-022-14850-x.

Authors

Keyi Wu^#¹, Xiaowei Ma^#², Huamin Liu¹, Jiazhen Zheng¹, Rui Zhou¹, Zelin Yuan¹, Zhiwei Huang¹, Qi Zhong¹, Yining Huang¹, Zhoubin Zhang^#³, Xianbo Wu^#⁴

Affiliations

¹ Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Baiyun District, Nos.1023-1063, Shatai South Road, Guangzhou, 510515, China.
² Guangzhou Center for Disease Control and Prevention, Guangzhou City, 510440, Guangdong, China.
³ Guangzhou Center for Disease Control and Prevention, Guangzhou City, 510440, Guangdong, China. zhoubinzhanggz@21cn.com.
⁴ Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Baiyun District, Nos.1023-1063, Shatai South Road, Guangzhou, 510515, China. wuxb1010@smu.edu.cn.

^# Contributed equally.

Abstract

Background: Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 (COVID-19) may have suppressed the transmission of other infectious diseases. This study aimed to evaluate the impact of different degrees of NPIs during the COVID-19 pandemic on hand, foot and mouth disease (HFMD) in Guangzhou, China.

Methods: Weekly reported HFMD cases and pathogens information during 2015-2021 in Guangzhou were collected from the China National Notifiable Disease Reporting System. The observed number of HFMD cases in 2020 and 2021 was compared to the average level in the same period during 2015-2019. Then, an interrupted time-series segmented regression analysis was applied to estimate the impact of NPIs on HFMD, such as social distancing, suspension of schools, community management and mask wearing. The effects across different subgroups stratified by gender, children groups and enterovirus subtype of HFMD were also examined.

Results: A total of 13,224 and 36,353 HFMD cases were reported in 2020 and 2021, which decreased by 80.80% and 15.06% respectively compared with the average number of cases in the same period during 2015-2019. A significant drop in the number of HFMD cases during time when strict NPIs were applied (relative change: 69.07% [95% confidence interval (CI): 68.84%-69.30%]). The HFMD incidence rebounded to historical levels in 2021 as the lockdown eased. The slightest reduction of HFMD cases was found among children at kindergartens or childcare centres among the three children groups (children at kindergartens or childcare centres: 55.50% [95% CI: 54.96%-56.03%]; children living at home: 72.64% [95% CI: 72.38%-72.89%]; others: 74.06% [95% CI: 73.19%-74.91%]).

Conclusions: The strong NPIs during the COVID-19 epidemic may have a significant beneficial effect on mitigating HFMD. However, the incidence of HFMD rebounded as the NPIs became less stringent. Authorities should consider applying these NPIs during HFMD outbreaks and strengthening personal hygiene in routine prevention.

Keywords: COVID-19; HFMD; Infectious disease control; Natural experiment; Non-pharmaceutical interventions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
China / epidemiology
Communicable Disease Control
Foot-and-Mouth Disease* / epidemiology
Hand, Foot and Mouth Disease* / epidemiology
Hand, Foot and Mouth Disease* / prevention & control
Humans
Incidence
Pandemics / prevention & control