• Bingyi Yang, Fengfeng Liu, Qiaohong Liao, Peng Wu, Zhaorui Chang, Jiao Huang, Lu Long, Li Luo, Yu Li, Gabriel M Leung, Benjamin J Cowling, and Hongjie Yu.
• These authors contributed equally to this work.
• Eurosurveillance. 2017 Dec 1; 22 (50).

IntroductionHand, foot and mouth disease (HFMD) is usually caused by several serotypes from human enterovirus A species, including enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16). Two inactivated monovalent EV-A71 vaccines have been recently licensed in China and monovalent CV-A16 vaccine and bivalent EV-A71 and CV-A16 vaccine are under development.MethodsUsing notifications from the national surveillance system, we describe the epidemiology and dynamics of HFMD in the country, before the introduction of EV-A71 vaccination, from 2008 through 2015.ResultsLaboratory-identified serotype categories, i.e. CV-A16, EV-A71 and other enteroviruses, circulated annually. EV-A71 remained the most virulent serotype and was the major serotype for fatal cases (range: 88.5-95.4%) and severe cases (range: 50.7-82.3%) across years. Except for 2013 and 2015, when other enteroviruses were more frequently found in mild HFMD (48.8% and 52.5%), EV-A71 was more frequently detected from mild cases in the rest of the years covered by the study (range: 39.4-52.6%). The incidence rates and severity risks of HFMD associated with all serotype categories were the highest for children aged 1 year and younger, and decreased with increasing age.Discussion/ConclusionThis study provides baseline epidemiology for evaluation of vaccine impact and potential serotype replacement.

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