Temporal trends in clinical and molecular epidemiology of pediatric hand, foot, and mouth disease, 2008-2024: Insights from 17 years of surveillance

Abstract

Objective

We aimed to investigate the temporal trends in the clinical and molecular epidemiology of pediatric hand, foot, and mouth disease (HFMD) since its designation as a notifiable disease (2008).

Methods

We retrospectively analyzed the pediatric HFMD cases from a single-center database from 2008 to 2024 and performed a binary logistic regression model to identify risk factors for severe disease among laboratory-confirmed cases.

Results

114,420 HFMD cases were reported over 17 years, including 569 severe cases (0.50%, 569/114,420) and 27 deaths (4.75%, 27/569). Following a peak in 2010, annual case numbers stabilized at approximately 10,000 from 2016, declined markedly after vaccine introduction, and dropped further during the COVID-19 pandemic, with a rebound in 2023. Before 2016, Coxsackievirus A16 (CV-A16) (30.66%) and Enterovirus 71 (EV-A71) (23.15%) were the predominant serotypes; subsequently, Coxsackievirus A6 (CV-A6) gradually emerged as the dominant circulating strain. A gradual increase in the age of affected children was observed, with a notable rise in cases among those aged ≥5 years during the post-pandemic period. Multivariable analysis revealed younger age, EV-A71 infection, and rural residence as independent risk factors for severe HFMD.

Conclusions

The evolving epidemiology of pediatric HFMD and the rising age of susceptibility highlight the need for continuous surveillance and early warning to guide prevention and strengthen public health response.