Epidemic disease characteristics and control system of HFMD in Wanzai County, Yichun City, Jiangxi Province (2010-2024)

Epidemic disease characteristics and control system of HFMD in Wanzai County, Yichun City, Jiangxi Province (2010-2024) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemic disease characteristics and control system of HFMD in Wanzai County, Yichun City, Jiangxi Province (2010-2024) Quanguo Guo, Jingjing Pei, Zhaoli Wang, Shanshan Yan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8279931/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Objective This study aimed to analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in Wanzai County from 2010 to 2024, identify key influencing factors, and provide evidence for local prevention and control strategies. Methods We collected reported HFMD case data and demographic information in Wanzai County from January 2010 to December 2024. Descriptive epidemiological methods were used to analyze temporal, spatial, and population distributions. Trend regression analysis was applied to incidence data, and pathogen composition changes were examined. Results A total of 8,101 HFMD cases were reported during the study period, with an average annual incidence rate of 101.71 per 100,000. Case numbers peaked in 2015 and 2018, followed by a continuous decline after 2019. Seasonal distribution showed a bimodal pattern in most years, with the main peak from May to July and a secondary peak in October. From 2021 to 2023, an increasing trend was observed from November to December. Spatial analysis revealed significant clustering, with Kangle Town and Zhutan Town as high-incidence areas. Children aged 1–3 years constituted the high-risk group, and scattered children were the main affected population, though the proportion of cases among childcare facility children increased after 2020. Male incidence was significantly higher than female incidence ( P < 0.05), with a sex ratio declining in recent years. Pathogen analysis indicated significant gender differences in infection with different enterovirus strains ( P < 0.05). Conclusion HFMD in Wanzai County demonstrates distinct temporal, spatial, and population clustering. Prevention and control efforts should be intensified in high-incidence areas, targeted towards key demographic groups, and reinforced during peak seasons through enhanced surveillance and health education. Hand foot and mouth disease Wanzai County Epidemiological characteristics Precision prevention and control Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction HFMD is a common infectious disease caused by various enteroviruses, including Coxsackievirus A16 (CoxA16) and Enterovirus 71 (EV71). It poses a significant public health challenge due to its high prevalence, particularly among infants and children under five years of age [1–3] . While most cases are self-limiting with mild symptoms, a subset of patients can develop severe neurological and systemic complications, such as encephalitis and pulmonary edema, leading to fatal outcomes and imposing a substantial disease burden globally [4–8] . The Asia-Pacific region bears the highest HFMD burden, with frequent outbreaks reported in countries like China, Malaysia, and Vietnam [9–11] . In China, HFMD has been a notifiable disease since 2008, with its incidence rate consistently ranking top among Class C infectious diseases [12–14] . Moreover, since the implementation of "Class B management for COVID-19" on January 8, 2023, population mobility has resumed and gatherings have increased, leading to a resurgence in HFMD cases, posing a severe challenge to the health of infants and young children and public health work [15] . Furthermore, significant regional heterogeneity exists in HFMD distribution across China, with higher incidence rates observed in southern, eastern, and central regions [16] . Although the promotion of EV71 vaccination and national guidelines have contributed to a recent downward trend in HFMD incidence nationally, heterogeneity persists at the local level. Current research predominantly focuses on national or provincial scales, creating a knowledge gap at the county level, which is the fundamental unit for public health implementation. A precise understanding of local epidemiology is crucial for effective grassroots control. Wanzai County, located in northwestern Jiangxi Province, features a subtropical monsoon climate conducive to enterovirus survival and transmission. With a registered population of approximately 600,000, 72% of whom are rural residents, and a high density of kindergartens, the county presents a complex scenario for HFMD transmission. However, a systematic epidemiological analysis of HFMD in Wanzai County is lacking, hindering the development of targeted intervention strategies. To address this gap, this study analyzes 15 years (2010–2024) of HFMD surveillance data from Wanzai County. We aim to delineate the spatiotemporal patterns and demographic characteristics of HFMD, assess the impact of a key provincial control policy enacted in 2018, and provide evidence for developing precise, localized prevention and control measures. Materials and methods Data sources Data were sourced from reported HFMD cases at the Wanzai County Center for Disease Control and Prevention from 2010 to 2024, including information on time of onset, age, gender, region, and etiology (EV71, CoxA16, other enteroviruses). Inclusion criteria: Children with household registration in Wanzai County or non-registered children continuously residing there for ≥6 months. Statistical analysis This retrospective study employed descriptive statistics to summarize the epidemiological characteristics of HFMD cases. A segmented regression model was used to evaluate the impact of the "Jiangxi Province Hand, Foot and Mouth Disease Prevention and Control Work Plan" implemented in 2018, treating it as a policy breakpoint. Differences in categorical variables were assessed using chi-square tests. For significant findings, pairwise comparisons were conducted with a Bonferroni adjustment to control for multiple testing (α=0.05). Ethical statement This study was based on public health surveillance data and aimed to assess and improve disease prevention and control strategies. The data used in this study were aggregated surveillance data and did not include detailed personal information; therefore, individual informed consent was not needed. All data were deidentified and anonymized to ensure the protection of personal privacy. Throughout the data collection and analysis process, we strictly adhered to relevant data protection regulations and ethical guidelines. Results Segmented Regression Analysis of HFMD Case Numbers As 2018 was a peak year for HFMD, the promulgation of the "Jiangxi Province Hand, Foot and Mouth Disease Prevention and Control Work Plan" was used as the policy breakpoint (indicated by the black vertical dashed line in the figure). As shown in Fig 1 ， a slow upward trend in case numbers before 2018 ( β =0.24, p >0.05). After 2018,case numbers increased slightly in the short term due to enhanced surveillance and local outbreaks ( D =12.6, p <0.1), but the long-term trend showed a significant decrease ( T-D =-1.35, p <0.05), clearly revealing the dual effect of the prevention and control policy: "short-term interference - long-term suppression". Classification of HFMD Etiological Detection As shown in Fig 2 ，the annual changes in the proportional composition of three pathogens (EV71, CoxA16, other enteroviruses) among HFMD cases. Between 2010 and 2015, CoxA16 was the dominant strain (accounting for over 50%). From 2016 onwards, other enteroviruses (such as CoxA6, CoxA10) became dominant (exceeding 70% by 2024). The proportion of EV71 always remained below 30%. Population Distribution As can be seen from Table 1 ，over the 15 years, the proportion of male cases was consistently higher than that of females (55.59%--67.51%), with a sex ratio between 1.25 and 2.00. The highest sex ratio was in 2018 (2.00), and the lowest was in 2020 (1.25), showing a decreasing trend in recent years. Table 1 Comparison of the incidence of hand, foot and mouth disease between men and women in Wanzai County Year Male Female Total number of cases Male percentage（100%） Female percentage（100%） Sex ratio 2010 368 192 560 65.71 34.29 1.92 2011 449 239 688 65.26 34.74 1.88 2012 134 74 208 64.42 35.58 1.81 2013 146 89 235 62.13 37.87 1.64 2014 211 149 360 58.61 41.39 1.42 2015 656 356 1012 64.82 35.18 1.84 2016 161 93 254 63.39 36.61 1.73 2017 585 327 912 64.14 35.86 1.79 2018 901 451 1352 66.64 33.36 2.00 2019 146 91 237 61.60 38.40 1.60 2020 338 270 608 55.59 44.41 1.25 2021 352 222 574 61.32 38.68 1.59 2022 237 149 386 61.40 38.60 1.59 2023 349 235 584 59.76 40.24 1.49 2024 77 54 131 58.78 41.22 1.43 A box plot， Fig 3 ，t visually presents the distribution characteristics of HFMD case numbers for males and females. The distribution range of male case numbers is wider, with relatively greater data dispersion (larger interquartile range), and the median position is higher than that for females. The distribution of female case numbers is relatively concentrated, with less dispersion (smaller interquartile range). Combined with the data in Table 1 , this further verifies the characteristics of higher case numbers and greater distribution variation among males, reflecting the imbalance in HFMD incidence across gender dimensions. A heatmap， Fig 4 ，intuitively shows the interannual changes in the proportion of cases by age group from 2010 to 2024 through color intensity. The darkest areas are concentrated in the 1-3 years age group, whose average annual incidence proportion exceeded 40%, followed by the 0-year and 4-year groups. The color for the 5 years and above group significantly lightens The following Fig 5 dynamically shows the flow changes in the proportion of cases among different occupational groups from 2010 to 2024. Scattered children always constituted the main body (proportion > 60% throughout the period). Before 2015, childcare facility children accounted for about 20%~30%; after 2020, their proportion increased significantly (approximate 35% in 2024). The proportion among students and adults always remained very low (<5%). The changes in flow width clearly show that the composition ratio of childcare facility children gradually increased over time. Temporal Distribution As shown in Fig 6 ，the trends in the number of cases and the incidence rate from 2010 to 2024 were consistent. The total number of reported HFMD cases was 8,101, with an average annual incidence rate of 101.71 per 100,000 population. Fluctuations in incidence were significant between 2010 and 2024. The trends in case numbers and incidence rates were consistent. Two peaks occurred in 2015 (1,012 cases) and 2018 (1,352 cases). After 2019, there was a continuous decline, reaching a relatively low level in 2024 (131 cases). As seen in the following Fig 7 ,HFMD incidence exhibits seasonal fluctuation patterns and interannual variation. In most years, May-July is the dark concentrated area (main peak), and October is the secondary peak (second darkest color). However, from 2021 to 2023, there was also an increasing trend in incidence during winter (November-December). Regional Distribution As can be seen from Table 2 Distribution of hand, foot and mouth disease in towns and villages of Wanzai County,over the 15 years, HFMD incidence among the 17 townships in Wanzai County was unevenly distributed, showing spatial clustering . In different years, the number of cases in Kangle Town (county seat center) and Zhutan Town was significantly higher than in other townships. Remote townships such as Chuxing Township and Bailiang Township consistently had low case numbers (annual average <20 cases). The number of cases in some townships varied significantly across years. Table 2 Distribution of hand, foot and mouth disease in towns and villages of Wanzai County Township Year 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Zhutan 137 127 37 20 19 94 17 68 78 9 14 2 5 6 0 Kangle 102 112 31 53 80 266 44 334 616 112 273 334 215 323 83 Huangmao 85 67 27 22 18 103 21 59 53 15 9 10 23 10 1 Tanbu 69 60 17 17 20 62 26 45 40 8 13 4 11 18 2 Luocheng 30 39 16 11 34 51 20 28 70 2 24 12 9 12 3 Sanxing 29 29 14 19 32 53 12 57 83 9 73 44 24 29 10 Shuangqiao 16 25 10 9 13 34 25 17 74 12 33 22 18 18 6 Gaocheng 15 26 8 6 17 51 11 50 55 11 31 21 14 35 2 Xianyuan 15 18 5 24 28 44 5 14 25 8 7 1 2 14 1 Chuxing 13 13 3 2 2 18 17 24 13 2 10 9 5 3 0 Bailiang 11 52 6 8 7 29 5 21 23 7 16 7 5 8 0 Efeng 10 24 8 16 26 38 16 70 67 17 30 46 25 35 4 Mabu 10 41 6 3 29 67 15 71 83 14 51 38 21 50 17 Baishui 6 14 3 2 7 22 1 7 8 1 3 1 3 2 0 Jiaohu 5 9 5 7 10 24 4 13 26 3 7 4 1 9 1 Lingdong 3 6 2 0 2 26 4 13 9 6 7 10 4 4 0 Gaocun 3 10 5 5 8 24 3 2 12 1 7 8 1 8 1 Unknown 1 16 5 11 8 6 8 19 17 0 0 1 0 0 0 The gender distribution of different dominant strains As can be seen from Table 3 Gender distribution of different dominant strains，the gender composition of patients infected with different dominant strains was compared. There were significant differences in the gender distribution among different dominant strains ( P <0.05), with overall male cases outnumbering female cases. The proportion of males was relatively high and similar in EV71, CoxA16 and mixed infections (64.4% - 65.1%), while it was significantly lower in other enterovirus infections (60.6%), with a corresponding increase in females (39.4%). Bonferroni test showed that the gender distribution differences among the first three and "other" strains were statistically significant ( p <0.05). Table 3 Gender distribution of different dominant strains A stock with an advantage Male Female` sex ratio χ 2 P Ev71 978( 65.1%) a 524( 34.9%) a 1.87 15.351 0.002 Cox A16 1986( 64.7%) a 1083( 35.3%) a 1.83 Ev71 ＋ Cox A16 134( 64.4%) a,b 74( 35.6%) a,b 1.81 Other 2012( 60.6%) b 1310( 39.4%) b 1.54 Total 5110( 63.1%) 2991( 36.9%) 1.71 Discussion This study is based on the surveillance data of hand-foot-mouth disease in Wanzai County from 2010 to 2024. It conducts a multi-dimensional analysis of the epidemic pattern of the disease at the county level and proposes for the first time the "double peak and double zone" epidemiological characteristics, providing data and theoretical support for precise prevention and control at the grassroots level. The results of this study show that 2015 and 2018 were the peak years of the epidemic, and the incidence rate significantly decreased after 2018. This trend is highly consistent with the promotion of EV71 vaccines and the implementation of the "Hand-Foot-Mouth Disease Prevention and Control Work Plan of Jiangxi Province", confirming the effect of the prevention and control policy of "short-term interference - long-term suppression". This trend is similar to the research results in other regions of China, such as the decline in the incidence rate of hand-foot-mouth disease in Shenzhen from 2008 to 2020 after the implementation of vaccination [17] . The decline trend after 2018 may be related to the promotion of EV71 vaccines and the strengthening of hygiene management in kindergartens and nurseries [18] . Relevant studies have shown [19] that the periodic fluctuations of hand-foot-mouth disease may also be related to the formation and fading of the immune barrier in the population. When the proportion of susceptible individuals in the population accumulates to a certain extent, it is easy to cause a rebound in the epidemic. The break-point regression analysis shows that the number of cases increased slowly before 2018 ( β =0.24, p >0.05), and there was a local data fluctuation due to the improvement of monitoring sensitivity in the short term after the implementation of the policy ( D =12.6, p <0.1), while it showed a significant downward trend in the long term ( T-D =-1.35, p <0.05), indicating that the grassroots prevention and control measures need to go through a cycle of "policy implementation - monitoring optimization - effect manifestation". In the short term, data fluctuations should be tolerated, and in the long term, measures should be maintained regularly. From 2010 to 2024, hand-foot-mouth disease showed obvious seasonality, with two peaks of incidence each year. In most years, there was a main peak from May to July and a secondary peak in October. The main peak was consistent with the characteristic of "warm and humid climate conducive to the survival of enteroviruses" in the subtropical monsoon climate, while the secondary peak was related to the increase in children's gathering activities after the start of the school year in autumn, which is consistent with the epidemic characteristics in southern China, providing a basis for seasonal prevention and control [20] . A study in Vietnam in 2020 also indicated that meteorological factors were related to the incidence of hand-foot-mouth disease, further explaining the seasonal epidemic of the disease [21] . Kangle Town and Zhutang Town were the persistent high-incidence areas, while remote towns such as Chuxing Township and Bailiang Township had consistently low incidence rates. The formation of high-incidence areas was directly related to factors such as population density, density of kindergartens and nurseries, and intensity of population mobility. The reason might be that Kangle Town and Zhutang Town had large populations and a high number of mobile populations. Therefore, it is necessary to strengthen the publicity of hand-foot-mouth disease prevention knowledge for mobile children in these areas. This regional aggregation was also found in studies on hand-foot-mouth disease in Shanghai and Guangdong Province indicating that population density and socioeconomic factors have significant impacts on the spread of the disease [21 - 23 ] . In terms of population structure [24] , scattered children accounted for over 70%, followed by children in kindergartens and nurseries, suggesting that families and kindergartens and nurseries are key scenarios for virus transmission. The incidence rate among farmers and other groups was extremely low, confirming the aggregation of the disease among children. This is similar to the analysis results of the epidemic characteristics of hand-foot-mouth disease in South Korea from 2011 to 2017 [25] indicating that children are the main susceptible population for hand-foot-mouth disease. There was a significant gender difference, with the incidence rate among males consistently higher than that among females, with a gender ratio ranging from 1.25 to 2.00, reaching a peak of 2.00 in 2018. This might be related to the fact that male children have a wider range of outdoor activities and more opportunities to be exposed to virus-contaminated sources. Therefore, prevention and control education should focus on parents of male children to enhance their risk awareness. The etiological changes showed significant phases: CoxA16 was the dominant strain from 2010 to 2015, while other enteroviruses dominated after 2016, with EV71 accounting for less than 30% throughout. This change is consistent with the domestic trend of "EV71 vaccination reducing the prevalence of EV71 and other enteroviruses filling the ecological niche", suggesting that Wanzai County should pay attention to the monitoring and research of non-EV71 viruses to avoid new epidemic risks caused by the replacement of dominant strains due to vaccination. This study first found that there were significant differences in the gender distribution of different enterovirus dominant strains ( P <0.05), with more male cases overall than female cases, consistent with the conclusion of previous studies that males are more susceptible to enterovirus infection, which may be related to differences in physiological structure and behavioral patterns between males and females. Males have more opportunities to come into contact with virus-contaminated sources in outdoor activities and collective life. Therefore, Wanzai County should strengthen intervention for male children during the high-incidence months to prevent hand-foot-mouth disease. In addition, a 2015 study on the epidemiological characteristics of hand-foot-mouth disease in Argentina also found similar gender differences [26] . Conclusions In summary, hand-foot-mouth disease in Wanzai County from 2010 to 2024 has certain epidemiological characteristics and shows certain trend changes. This study focuses on the county-level field of the disease and has unique research value. By detailing the differences in incidence at the township level, it was found that Kangle Town had 616 cases in 2018, while Chixing Township had only 13 cases in the same year. Such extreme differences are easily averaged in provincial data, highlighting the importance of county-level research for accurately identifying high-risk areas and revealing a new trend of an increasing proportion of cases among children in kindergartens and nurseries. After 2020, the proportion of cases among children in kindergartens and nurseries in Wanzai County rose from 20% to 35%, which is related to social changes after the COVID-19 pandemic. However, provincial studies have not yet focused on the impact of these grassroots social changes on the epidemic, suggesting that county-level research needs to be more closely integrated with local social and economic dynamics. The data span is longer (15 years), which can more clearly present the long-term effects of virus strain replacement and control policies. The inclusion of gender differences in pathogen analysis provides a new perspective for population-specific and strain-specific control. This study also has certain limitations. Based on the reported cases from the disease control center, the actual incidence rate may be underestimated due to unreported mild cases. Moreover, after excluding imported cases, the impact of population mobility on the epidemic cannot be analyzed, and there is a bias in case data. Additionally, factors such as meteorological factors and social behavior factors were not included in the quantitative analysis, making it impossible to distinguish the independent contribution of each factor to the incidence rate. In conclusion, this study, through 15 years of county-level data, revealed the "double peak and double zone" characteristics of hand-foot-mouth disease and the "virus strain - gender - behavior" interaction, filling the gap in grassroots research. The research results not only provide a basis for formulating precise control strategies in Wanzai County but also offer a reference analysis model for similar county-level hand-foot-mouth disease research across the country, and have important academic and practical significance for improving the grassroots infectious disease control system in China. Abbreviations HFMD: Hand, Foot, and Mouth Disease CVA16 : Coxsackievirus A16 EV-A71 : Enterovirus A71 Declarations Data availability The datasets used and analyzed in this study are available from the corresponding author upon reasonable request. However, due to privacy concerns, we are unable to provide individual case data. Instead, we can provide aggregate data that summarize the overall findings. Acknowledgements We would like to thank the Wanzai County Center for Disease Control and Prevention for providing us with the epidemic disease data, all the medical staff involved in HFMD surveillance and control, especially Professor Yan Shimmer for his guidance, as well as other organizations and individuals who supported the study. Authors’ contributions Conceptualization and methodology were undertaken by Shanshan Yan, QuanguoGuo, Jingjing Pei,and Zhaoli Wang.Quanguo Guo and Jingjing Pei were responsible for data curation,formal analysis,and investigation.The original draft was written by Quanguo Guo, Jingjing Pei and Zhaoli Wang.All authors participated in reviewing and editing the manuscript and have approved the final version. Data availability Data are available upon request from the corresponding authors. Author information Authors and Affiliations Shanshan Yan(Supervisor):Gannan Medical Universityt, Ganzhou, Jiangxi Province, China Quanguo Guo,Jingjing Pei,Zhaoli Wang:School of Public Health, Anhui University of Science and Technology, Hefei, Anhui Province, China Corresponding author Correspondence to Shanshan Yan Ethics approval and consent to participate This study was conducted in accordance with the ethical principles outlined in the World Medical Association’s Declaration of Helsinki. The research protocol was reviewed and approved by the Ethics Committee of Wanzai County Center for Disease Control and Prevention (Reference Number: Not applicable). Since this study was based on retrospective, anonymized public health surveillance data—collected as part of routine disease control activities—the Ethics Committee waived the requirement for individual informed consent. All data were de-identified prior to analysis to ensure participant confidentiality and privacy. No personal identifiable information was accessed or used in this study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Cox B, Levent F. Hand, foot, and mouth disease. JAMA. 2018;320:2492. https://doi.org/10.1001/jama.2018.17288. Zeng X-W, Bloom MS, Dharmage SC, Lodge CJ, Chen D, Li S, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8279931","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590544658,"identity":"37c99c19-dabe-4e96-8e64-90612e88bed0","order_by":0,"name":"Quanguo Guo","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Quanguo","middleName":"","lastName":"Guo","suffix":""},{"id":590544659,"identity":"72b6c629-111d-495d-bae5-803e2ec8bde2","order_by":1,"name":"Jingjing Pei","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Jingjing","middleName":"","lastName":"Pei","suffix":""},{"id":590544660,"identity":"733315de-e679-476c-b687-889710bc589d","order_by":2,"name":"Zhaoli Wang","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Zhaoli","middleName":"","lastName":"Wang","suffix":""},{"id":590544661,"identity":"334562ee-18f7-4c05-ac44-5e6f33a57d36","order_by":3,"name":"Shanshan Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYJACZhBhwMDA/vNDhYQcG3vzAaK1MEhLnLEx5uM5lkC8FgnetrTEeRI5CniVGxw/e/hzQc0de3P2swcMJM4cTm9jyGFg+FGxDbeWM3lp0jOOPUvc2ZOXkFBQcTi3jeHsAcaeM7dxazmQY8bMw3Y4AcgwOAC0JbeNsS+BmbENj5bzb4w/8/w7bA9kGDbwth1OZ2PmMcCv5UaOgTRQJeOGGznGDEDvJ7CxEdAieeONmTRv3+HEDUAGMzCQDdt42BIO4vML3/kcoMO+gRyWY8YIjEp5+fmPDz74UYFbi8IBbKJYBWFAvgGf7CgYBaNgFIwCEAAA8l5crI1HAJcAAAAASUVORK5CYII=","orcid":"","institution":"Gannan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2025-12-04 13:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8279931/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8279931/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102758155,"identity":"96e43578-5d8b-4968-9bef-55b15da57837","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":228807,"visible":true,"origin":"","legend":"\u003cp\u003eTrend in Monthly HFMD Cases\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/bcaa792686f29bbde546015d.jpeg"},{"id":102758152,"identity":"28cd6e8b-79f4-4ac4-a5d2-031dcb34222d","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":186444,"visible":true,"origin":"","legend":"\u003cp\u003eStacking area of HFMD pathogen detection in Wanzai County\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/9812196acff4a6e6e30cc4ba.jpeg"},{"id":102758158,"identity":"325913e3-0bf6-438c-b4fd-cafc3bc90114","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29073,"visible":true,"origin":"","legend":"\u003cp\u003eBox diagram of the distribution of hand, foot and mouth disease incidence in males and females in Wanzai County\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/4dd64edc4b7fdb75587b03c3.jpeg"},{"id":102758154,"identity":"5956346f-add4-496a-b360-4a9252b1c529","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":231166,"visible":true,"origin":"","legend":"\u003cp\u003eAge composition ratio of hand, foot and mouth disease incidence in Wanzai County\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/5585a4c7f7858ea69fdb7e3f.jpeg"},{"id":102758156,"identity":"08ecdf15-62c9-4255-97b6-9da9dd997b9a","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":312611,"visible":true,"origin":"","legend":"\u003cp\u003eOccupational distribution of hand, foot and mouth disease in Wan Zai County\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/6c18977d123e71388c631d24.jpeg"},{"id":102758159,"identity":"53419df4-89d7-4c75-b776-f2ad691ebb8c","added_by":"auto","created_at":"2026-02-16 10:07:28","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":247912,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly incidence of hand, foot and mouth disease in Wanzai County\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/60ab638614e620e26a11ee1d.jpeg"},{"id":102758153,"identity":"cf5cb1f2-bca9-4c4f-9f92-4313bd097cd6","added_by":"auto","created_at":"2026-02-16 10:07:27","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":294619,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly incidence of hand, foot and mouth disease in Wanzai County\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/db70f3bc464f33b1e6fb932e.jpeg"},{"id":105562022,"identity":"51b34dca-ca01-44dd-9687-38f730d947af","added_by":"auto","created_at":"2026-03-27 12:24:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2848435,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8279931/v1/9a726d90-0282-46cc-8988-d5fa0fda1893.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemic disease characteristics and control system of HFMD in Wanzai County, Yichun City, Jiangxi Province (2010-2024)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHFMD is a common infectious disease caused by various enteroviruses, including Coxsackievirus A16 (CoxA16) and Enterovirus 71 (EV71). It poses a significant public health challenge due to its high prevalence, particularly among infants and children under five years of age\u003csup\u003e[1\u0026ndash;3]\u003c/sup\u003e. While most cases are self-limiting with mild symptoms, a subset of patients can develop severe neurological and systemic complications, such as encephalitis and pulmonary edema, leading to fatal outcomes and imposing a substantial disease burden globally\u003csup\u003e[4\u0026ndash;8]\u003c/sup\u003e. The Asia-Pacific region bears the highest HFMD burden, with frequent outbreaks reported in countries like China, Malaysia, and Vietnam\u003csup\u003e[9\u0026ndash;11]\u003c/sup\u003e. In China, HFMD has been a notifiable disease since 2008, with its incidence rate consistently ranking top among Class C infectious diseases\u003csup\u003e[12\u0026ndash;14]\u003c/sup\u003e. Moreover, since the implementation of \"Class B management for COVID-19\" on January 8, 2023, population mobility has resumed and gatherings have increased, leading to a resurgence in HFMD cases, posing a severe challenge to the health of infants and young children and public health work\u003csup\u003e[15]\u003c/sup\u003e. Furthermore, significant regional heterogeneity exists in HFMD distribution across China, with higher incidence rates observed in southern, eastern, and central regions\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough the promotion of EV71 vaccination and national guidelines have contributed to a recent downward trend in HFMD incidence nationally, heterogeneity persists at the local level. Current research predominantly focuses on national or provincial scales, creating a knowledge gap at the county level, which is the fundamental unit for public health implementation. A precise understanding of local epidemiology is crucial for effective grassroots control.\u003c/p\u003e \u003cp\u003eWanzai County, located in northwestern Jiangxi Province, features a subtropical monsoon climate conducive to enterovirus survival and transmission. With a registered population of approximately 600,000, 72% of whom are rural residents, and a high density of kindergartens, the county presents a complex scenario for HFMD transmission. However, a systematic epidemiological analysis of HFMD in Wanzai County is lacking, hindering the development of targeted intervention strategies.\u003c/p\u003e \u003cp\u003eTo address this gap, this study analyzes 15 years (2010\u0026ndash;2024) of HFMD surveillance data from Wanzai County. We aim to delineate the spatiotemporal patterns and demographic characteristics of HFMD, assess the impact of a key provincial control policy enacted in 2018, and provide evidence for developing precise, localized prevention and control measures.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eData sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were sourced from reported HFMD cases at the Wanzai County Center for Disease Control and Prevention from 2010 to 2024, including information on time of onset, age, gender, region, and etiology (EV71, CoxA16, other enteroviruses). Inclusion criteria: Children with household registration in Wanzai County or non-registered children continuously residing there for \u0026ge;6 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study employed descriptive statistics to summarize the epidemiological characteristics of HFMD cases. A segmented regression model was used to evaluate the impact of the \u0026quot;Jiangxi Province Hand, Foot and Mouth Disease Prevention and Control Work Plan\u0026quot; implemented in 2018, treating it as a policy breakpoint. Differences in categorical variables were assessed using chi-square tests. For significant findings, pairwise comparisons were conducted with a Bonferroni adjustment to control for multiple testing (\u0026alpha;=0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was based on public health surveillance data and aimed to assess and improve disease prevention and control strategies. The data used in this study were aggregated surveillance data and did not include detailed personal information; therefore, individual informed consent was not needed. All data were deidentified and anonymized to ensure the protection of personal privacy. Throughout the data collection and analysis process, we strictly adhered to relevant data protection regulations and ethical guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSegmented Regression Analysis of HFMD Case Numbers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs 2018 was a peak year for HFMD, the promulgation of the \u0026quot;Jiangxi Province Hand, Foot and Mouth Disease Prevention and Control Work Plan\u0026quot; was used as the policy breakpoint (indicated by the black vertical dashed line in the figure). As shown in\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFig 1\u003c/strong\u003e\u003cstrong\u003e，\u003c/strong\u003ea slow upward trend in case numbers before 2018 (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.24, \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05). After 2018,case numbers increased slightly in the short term due to enhanced surveillance and local outbreaks (\u003cem\u003eD\u003c/em\u003e=12.6, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.1), but the long-term trend showed a significant decrease (\u003cem\u003eT-D\u003c/em\u003e=-1.35, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05), clearly revealing the dual effect of the prevention and control policy: \u0026quot;short-term interference - long-term suppression\u0026quot;.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eClassification of HFMD Etiological Detection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFig 2\u003c/strong\u003e，the annual changes in the proportional composition of three pathogens (EV71, CoxA16, other enteroviruses) among HFMD cases. Between 2010 and 2015, CoxA16 was the dominant strain (accounting for over 50%). From 2016 onwards, other enteroviruses (such as CoxA6, CoxA10) became dominant (exceeding 70% by 2024). The proportion of EV71 always remained below 30%.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs can be seen from\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e，over the 15 years, the proportion of male cases was consistently higher than that of females (55.59%--67.51%), with a sex ratio between 1.25 and 2.00. The highest sex ratio was in 2018 (2.00), and the lowest was in 2020 (1.25), showing a decreasing trend in recent years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eComparison of the incidence of hand, foot and mouth disease between men and women in Wanzai County\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal number of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale percentage（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale percentage（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSex ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA box plot，\u003cstrong\u003eFig 3\u003c/strong\u003e，t visually presents the distribution characteristics of HFMD case numbers for males and females. The distribution range of male case numbers is wider, with relatively greater data dispersion (larger interquartile range), and the median position is higher than that for females. The distribution of female case numbers is relatively concentrated, with less dispersion (smaller interquartile range). Combined with the data in Table 1\u003cstrong\u003e,\u003c/strong\u003e this further verifies the characteristics of higher case numbers and greater distribution variation among males, reflecting the imbalance in HFMD incidence across gender dimensions.\u003c/p\u003e\n\u003cp\u003eA heatmap，\u003cstrong\u003eFig 4\u003c/strong\u003e，intuitively shows the interannual changes in the proportion of cases by age group from 2010 to 2024 through color intensity. The darkest areas are concentrated in the 1-3 years age group, whose average annual incidence proportion exceeded 40%, followed by the 0-year and 4-year groups. The color for the 5 years and above group significantly lightens\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe following \u003cstrong\u003eFig 5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edynamically shows the flow changes in the proportion of cases among different occupational groups from 2010 to 2024. Scattered children always constituted the main body (proportion \u0026gt; 60% throughout the period). Before 2015, childcare facility children accounted for about 20%~30%; after 2020, their proportion increased significantly (approximate 35% in 2024). The proportion among students and adults always remained very low (\u0026lt;5%). The changes in flow width clearly show that the composition ratio of childcare facility children gradually increased over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTemporal Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in \u003cstrong\u003eFig 6\u003c/strong\u003e，the trends in the number of cases and the incidence rate from 2010 to 2024 were consistent. The total number of reported HFMD cases was 8,101, with an average annual incidence rate of 101.71 per 100,000 population. Fluctuations in incidence were significant between 2010 and 2024. The trends in case numbers and incidence rates were consistent. Two peaks occurred in 2015 (1,012 cases) and 2018 (1,352 cases). After 2019, there was a continuous decline, reaching a relatively low level in 2024 (131 cases).\u003c/p\u003e\n\u003cp\u003eAs seen in the following \u003cstrong\u003eFig 7\u003c/strong\u003e,HFMD incidence exhibits seasonal fluctuation patterns and interannual variation. In most years, May-July is the dark concentrated area (main peak), and October is the secondary peak (second darkest color). However, from 2021 to 2023, there was also an increasing trend in incidence during winter (November-December).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegional Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs can be seen from \u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDistribution of hand, foot and mouth disease in towns and villages of Wanzai County,over the 15 years, HFMD incidence among the 17 townships in Wanzai County was unevenly distributed, showing spatial clustering\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e. In different years, the number of cases in Kangle Town (county seat center) and Zhutan Town was significantly higher than in other townships. Remote townships such as Chuxing Township and Bailiang Township consistently had low case numbers (annual average \u0026lt;20 cases). The number of cases in some townships varied significantly across years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDistribution of hand, foot and mouth disease in towns and villages of Wanzai County\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTownship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"15\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZhutan\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e137\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e127\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e68\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e78\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKangle\u003c/strong\u003e\u003c/p\u003e\n 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\u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaishui\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJiaohu\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLingdong\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGaocun\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnknown\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eThe gender distribution of different dominant strains\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs can be seen from \u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eGender distribution of different dominant strains，the gender composition of patients infected with different dominant strains was compared. There were significant differences in the gender distribution among different dominant strains (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), with overall male cases outnumbering female cases. The proportion of males was relatively high and similar in EV71, CoxA16 and mixed infections (64.4% - 65.1%), while it was significantly lower in other enterovirus infections (60.6%), with a corresponding increase in females (39.4%). Bonferroni test showed that the gender distribution differences among the first three and \u0026quot;other\u0026quot; strains were statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eGender distribution of different dominant strains\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA stock with an advantage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale`\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esex ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEv71\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e978(\u003c/strong\u003e\u003cstrong\u003e65.1%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e524(\u003c/strong\u003e\u003cstrong\u003e34.9%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.87\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.351\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCox A16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1986(\u003c/strong\u003e\u003cstrong\u003e64.7%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1083(\u003c/strong\u003e\u003cstrong\u003e35.3%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.83\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEv71\u003c/strong\u003e\u003cstrong\u003e＋\u003c/strong\u003e\u003cstrong\u003eCox A16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e134(\u003c/strong\u003e\u003cstrong\u003e64.4%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea,b\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e74(\u003c/strong\u003e\u003cstrong\u003e35.6%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ea,b\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2012(\u003c/strong\u003e\u003cstrong\u003e60.6%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003eb\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1310(\u003c/strong\u003e\u003cstrong\u003e39.4%)\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003eb\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5110(\u003c/strong\u003e\u003cstrong\u003e63.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2991(\u003c/strong\u003e\u003cstrong\u003e36.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.71\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is based on the surveillance data of hand-foot-mouth disease in Wanzai County from 2010 to 2024. It conducts a multi-dimensional analysis of the epidemic pattern of the disease at the county level and proposes for the first time the \u0026quot;double peak and double zone\u0026quot; epidemiological characteristics, providing data and theoretical support for precise prevention and control at the grassroots level.\u003c/p\u003e\n\u003cp\u003eThe results of this study show that 2015 and 2018 were the peak years of the epidemic, and the incidence rate significantly decreased after 2018. This trend is highly consistent with the promotion of EV71 vaccines and the implementation of the \u0026quot;Hand-Foot-Mouth Disease Prevention and Control Work Plan of Jiangxi Province\u0026quot;, confirming the effect of the prevention and control policy of \u0026quot;short-term interference - long-term suppression\u0026quot;. This trend is similar to the research results in other regions of China, such as the decline in the incidence rate of hand-foot-mouth disease in Shenzhen from 2008 to 2020 after the implementation of vaccination\u003csup\u003e[17]\u003c/sup\u003e. The decline trend after 2018 may be related to the promotion of EV71 vaccines and the strengthening of hygiene management in kindergartens and nurseries\u003csup\u003e[18]\u003c/sup\u003e. Relevant studies have shown\u003csup\u003e[19]\u003c/sup\u003e that the periodic fluctuations of hand-foot-mouth disease may also be related to the formation and fading of the immune barrier in the population. When the proportion of susceptible individuals in the population accumulates to a certain extent, it is easy to cause a rebound in the epidemic. The break-point regression analysis shows that the number of cases increased slowly before 2018 (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.24, \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05), and there was a local data fluctuation due to the improvement of monitoring sensitivity in the short term after the implementation of the policy (\u003cem\u003eD\u003c/em\u003e=12.6, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.1), while it showed a significant downward trend in the long term (\u003cem\u003eT-D\u003c/em\u003e=-1.35, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05), indicating that the grassroots prevention and control measures need to go through a cycle of \u0026quot;policy implementation - monitoring optimization - effect manifestation\u0026quot;. In the short term, data fluctuations should be tolerated, and in the long term, measures should be maintained regularly.\u003c/p\u003e\n\u003cp\u003eFrom 2010 to 2024, hand-foot-mouth disease showed obvious seasonality, with two peaks of incidence each year. In most years, there was a main peak from May to July and a secondary peak in October. The main peak was consistent with the characteristic of \u0026quot;warm and humid climate conducive to the survival of enteroviruses\u0026quot; in the subtropical monsoon climate, while the secondary peak was related to the increase in children\u0026apos;s gathering activities after the start of the school year in autumn, which is consistent with the epidemic characteristics in southern China, providing a basis for seasonal prevention and control\u003csup\u003e[20]\u003c/sup\u003e. A study in Vietnam in 2020 also indicated that meteorological factors were related to the incidence of hand-foot-mouth disease, further explaining the seasonal epidemic of the disease\u003csup\u003e[21]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eKangle Town and Zhutang Town were the persistent high-incidence areas, while remote towns such as Chuxing Township and Bailiang Township had consistently low incidence rates. The formation of high-incidence areas was directly related to factors such as population density, density of kindergartens and nurseries, and intensity of population mobility. The reason might be that Kangle Town and Zhutang Town had large populations and a high number of mobile populations. Therefore, it is necessary to strengthen the publicity of hand-foot-mouth disease prevention knowledge for mobile children in these areas. This regional aggregation was also found in studies on hand-foot-mouth disease in Shanghai and Guangdong Province indicating that population density and socioeconomic factors have significant impacts on the spread of the disease\u003csup\u003e[21\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e23\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn terms of population structure\u003csup\u003e[24]\u003c/sup\u003e, scattered children accounted for over 70%, followed by children in kindergartens and nurseries, suggesting that families and kindergartens and nurseries are key scenarios for virus transmission. The incidence rate among farmers and other groups was extremely low, confirming the aggregation of the disease among children. This is similar to the analysis results of the epidemic characteristics of hand-foot-mouth disease in South Korea from 2011 to 2017\u003csup\u003e[25]\u003c/sup\u003e indicating that children are the main susceptible population for hand-foot-mouth disease. There was a significant gender difference, with the incidence rate among males consistently higher than that among females, with a gender ratio ranging from 1.25 to 2.00, reaching a peak of 2.00 in 2018. This might be related to the fact that male children have a wider range of outdoor activities and more opportunities to be exposed to virus-contaminated sources. Therefore, prevention and control education should focus on parents of male children to enhance their risk awareness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe etiological changes showed significant phases: CoxA16 was the dominant strain from 2010 to 2015, while other enteroviruses dominated after 2016, with EV71 accounting for less than 30% throughout. This change is consistent with the domestic trend of \u0026quot;EV71 vaccination reducing the prevalence of EV71 and other enteroviruses filling the ecological niche\u0026quot;, suggesting that Wanzai County should pay attention to the monitoring and research of non-EV71 viruses to avoid new epidemic risks caused by the replacement of dominant strains due to vaccination. This study first found that there were significant differences in the gender distribution of different enterovirus dominant strains (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), with more male cases overall than female cases, consistent with the conclusion of previous studies that males are more susceptible to enterovirus infection, which may be related to differences in physiological structure and behavioral patterns between males and females. Males have more opportunities to come into contact with virus-contaminated sources in outdoor activities and collective life. Therefore, Wanzai County should strengthen intervention for male children during the high-incidence months to prevent hand-foot-mouth disease. In addition, a 2015 study on the epidemiological characteristics of hand-foot-mouth disease in Argentina also found similar gender differences\u003csup\u003e[26]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, hand-foot-mouth disease in Wanzai County from 2010 to 2024 has certain epidemiological characteristics and shows certain trend changes. This study focuses on the county-level field of the disease and has unique research value. By detailing the differences in incidence at the township level, it was found that Kangle Town had 616 cases in 2018, while Chixing Township had only 13 cases in the same year. Such extreme differences are easily averaged in provincial data, highlighting the importance of county-level research for accurately identifying high-risk areas and revealing a new trend of an increasing proportion of cases among children in kindergartens and nurseries. After 2020, the proportion of cases among children in kindergartens and nurseries in Wanzai County rose from 20% to 35%, which is related to social changes after the COVID-19 pandemic. However, provincial studies have not yet focused on the impact of these grassroots social changes on the epidemic, suggesting that county-level research needs to be more closely integrated with local social and economic dynamics. The data span is longer (15 years), which can more clearly present the long-term effects of virus strain replacement and control policies. The inclusion of gender differences in pathogen analysis provides a new perspective for population-specific and strain-specific control. This study also has certain limitations. Based on the reported cases from the disease control center, the actual incidence rate may be underestimated due to unreported mild cases. Moreover, after excluding imported cases, the impact of population mobility on the epidemic cannot be analyzed, and there is a bias in case data. Additionally, factors such as meteorological factors and social behavior factors were not included in the quantitative analysis, making it impossible to distinguish the independent contribution of each factor to the incidence rate.\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study, through 15 years of county-level data, revealed the \u0026quot;double peak and double zone\u0026quot; characteristics of hand-foot-mouth disease and the \u0026quot;virus strain - gender - behavior\u0026quot; interaction, filling the gap in grassroots research. The research results not only provide a basis for formulating precise control strategies in Wanzai County but also offer a reference analysis model for similar county-level hand-foot-mouth disease research across the country, and have important academic and practical significance for improving the grassroots infectious disease control system in China.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eHFMD:\u003c/strong\u003eHand, Foot, and Mouth Disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCVA16\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eCoxsackievirus A16\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEV-A71\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eEnterovirus A71\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed in this study are available from the corresponding author upon reasonable request. However, due to privacy concerns, we are unable to provide individual case data. Instead, we can provide aggregate data that summarize the overall findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Wanzai County Center for Disease Control and Prevention for providing us with the epidemic disease data, all the medical staff involved in HFMD surveillance and control, especially Professor Yan Shimmer for his guidance, as well as other organizations and individuals who supported the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization and methodology were undertaken by Shanshan Yan, QuanguoGuo, Jingjing Pei,and Zhaoli Wang.Quanguo Guo and Jingjing Pei were responsible for data curation,formal analysis,and investigation.The original draft was written by Quanguo Guo, Jingjing Pei and Zhaoli Wang.All authors participated in reviewing and editing the manuscript and have approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available upon request from the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eShanshan Yan(Supervisor):Gannan Medical Universityt, Ganzhou, Jiangxi Province, China\u003c/p\u003e\n\u003cp\u003eQuanguo Guo,Jingjing Pei,Zhaoli Wang:School of Public Health, Anhui University of Science and Technology, Hefei, Anhui Province, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Shanshan Yan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the World Medical Association\u0026rsquo;s Declaration of Helsinki. The research protocol was reviewed and approved by the Ethics Committee of Wanzai County Center for Disease Control and Prevention (Reference Number: Not applicable). Since this study was based on retrospective, anonymized public health surveillance data\u0026mdash;collected as part of routine disease control activities\u0026mdash;the Ethics Committee waived the requirement for individual informed consent. All data were de-identified prior to analysis to ensure participant confidentiality and privacy. No personal identifiable information was accessed or used in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCox B, Levent F. Hand, foot, and mouth disease. JAMA. 2018;320:2492. https://doi.org/10.1001/jama.2018.17288.\u003c/li\u003e\n\u003cli\u003eZeng X-W, Bloom MS, Dharmage SC, Lodge CJ, Chen D, Li S, et al. Prenatal exposure to perfluoroalkyl substances is associated with lower hand, foot and mouth disease viruses antibody response in infancy: Findings from the guangzhou birth cohort study. Sci Total Environ. 2019;663:60\u0026ndash;7. https://doi.org/10.1016/j.scitotenv.2019.01.325.\u003c/li\u003e\n\u003cli\u003eXing W, Liao Q, Viboud C, Zhang J, Sun J, Wu JT, et al. Hand, foot, and mouth disease in China, 2008-12: An epidemiological study. The Lancet. 2014;14:308\u0026ndash;18. https://doi.org/10.1016/s1473-3099(13)70342-6.\u003c/li\u003e\n\u003cli\u003eZhu F, Xu W, Xia J, Liang Z, Liu Y, Zhang X, et al. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China. N Engl J Med. 2014;370:818\u0026ndash;28. https://doi.org/10.1056/nejmoa1304923.\u003c/li\u003e\n\u003cli\u003eShimizu H, Nakashima K. Surveillance of hand, foot, and mouth disease for a vaccine. Lancet Infect Dis. 2014;14:262\u0026ndash;3. https://doi.org/10.1016/s1473-3099(13)70330-x.\u003c/li\u003e\n\u003cli\u003eŚlebioda Z, Dorocka-Bobkowska B. Hand, foot and mouth disease as an emerging public health problem: Case report of familial child-to-adult transmission. Dent Med Probl. 2018;55:99\u0026ndash;104. https://doi.org/10.17219/dmp/80995.\u003c/li\u003e\n\u003cli\u003eClinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease.,the lancet - X-MOL. https://www.x-mol.com/paper/2924144?adv. Accessed 2 Oct 2025.\u003c/li\u003e\n\u003cli\u003eLee DS, Lee YI, Ahn JB, Kim MJ, Kim JH, Kim NH, et al. Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease. Korean J Pediatr. 2015;58:112. https://doi.org/10.3345/kjp.2015.58.3.112.\u003c/li\u003e\n\u003cli\u003eHand, foot and mouth disease (HFMD): Emerging epidemiology and the need for a vaccine strategy.,medical microbiology and immunology - X-MOL. https://www.x-mol.com/paper/1212908755186688012?adv. Accessed 2 Oct 2025.\u003c/li\u003e\n\u003cli\u003eHan Y, Zheng K, Chen Z, Li X, Kong J, Duan X, et al. Epidemiological characteristics of hand, foot, and mouth disease before the introduction of enterovirus 71 vaccines in chengdu, China. Int J Infect Dis. 2020;101:347. https://doi.org/10.1016/j.ijid.2020.09.912.\u003c/li\u003e\n\u003cli\u003eKoh WM, Badaruddin H, La H, Chen MI-C, Cook AR. Severity and burden of hand, foot and mouth disease in asia: A modelling study. BMJ Glob Health. 2018;3:e000442. https://doi.org/10.1136/bmjgh-2017-000442.\u003c/li\u003e\n\u003cli\u003eChang L-Y, Lin T-Y, Hsu K-H, Huang Y-C, Lin K-L, Hsueh C, et al. Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. The Lancet. 1999;354:1682\u0026ndash;6. https://doi.org/10.1016/s0140-6736(99)04434-7.\u003c/li\u003e\n\u003cli\u003eHan Y, Chen Z, Zheng K, Li X, Kong J, Duan X, et al. Epidemiology of hand, foot, and mouth disease before and after the introduction of enterovirus 71 vaccines in chengdu, China, 2009-2018. Pediatr Infect Dis J. 2020;39:969\u0026ndash;78. https://doi.org/10.1097/inf.0000000000002745.\u003c/li\u003e\n\u003cli\u003eHong J, Liu F, Qi H, Tu W, Ward MP, Ren M, et al. Changing epidemiology of hand, foot, and mouth disease in China, 2013\u0026minus;2019: A population-based study. Lancet Reg Health - West Pac. 2022;20:100370. https://doi.org/10.1016/j.lanwpc.2021.100370.\u003c/li\u003e\n\u003cli\u003eJia W, Zhang X, Sun R, Li P, Song C. Impact of the COVID-19 outbreak and interventions on hand, foot and mouth disease in zhengzhou, China, 2014\u0026ndash;2022: A retrospective study. BMC Infect Dis. 2024;24. https://doi.org/10.1186/s12879-024-09244-w.\u003c/li\u003e\n\u003cli\u003eXu C. Spatio-temporal pattern and risk factor analysis of hand, foot and mouth disease associated with under-five morbidity in the beijing-tianjin-hebei region of China. Int J Environ Res Public Health. 2017;14:416. https://doi.org/10.3390/ijerph14040416.\u003c/li\u003e\n\u003cli\u003eLiu X, Hou W, Zhao Z, Cheng J, Beeck EF van, Peng X, et al. A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial. J Infect. 2019;78:19\u0026ndash;26. https://doi.org/10.1016/j.jinf.2018.08.009.\u003c/li\u003e\n\u003cli\u003eWang M, Chen T, Peng J, Luo Y, Du L, Lu Z, et al. The spatial\u0026ndash;temporal distribution and etiological characteristics of hand-foot-and-mouth disease before and after EV‑A71 vaccination in kunming, China, 2017\u0026ndash;2020. Sci Rep. 2022;12. https://doi.org/10.1038/s41598-022-21312-2.\u003c/li\u003e\n\u003cli\u003eZou X, Zhang X, Wang B, Qiu Y. Etiologic and epidemiologic analysis of hand, foot, and mouth disease in guangzhou city: A review of 4,753 cases. Braz J Infect Dis. 2012;16:457\u0026ndash;65. https://doi.org/10.1016/j.bjid.2012.08.001.\u003c/li\u003e\n\u003cli\u003eZhu P, Ji W, Li D, Li Z, Chen Y, Dai B, et al. Current status of hand-foot-and-mouth disease. J Biomed Sci. 2023;30. https://doi.org/10.1186/s12929-023-00908-4.\u003c/li\u003e\n\u003cli\u003eBaek S, Park S, Park HK, Chun BC. The epidemiological characteristics and spatio-temporal analysis of childhood hand, foot and mouth disease in korea, 2011-2017. PLOS ONE. 2020;15:e0227803. https://doi.org/10.1371/journal.pone.0227803.\u003c/li\u003e\n\u003cli\u003eZhao J, Li X. Determinants of the transmission variation of hand, foot and mouth disease in China. PLOS ONE. 2016;11:e0163789. https://doi.org/10.1371/journal.pone.0163789.\u003c/li\u003e\n\u003cli\u003eDu Z, Lawrence WR, Zhang W, Zhang D, Yu S, Hao Y. Bayesian spatiotemporal analysis for association of environmental factors with hand, foot, and mouth disease in guangdong, China. Sci Rep. 2018;8:15147. https://doi.org/10.1038/s41598-018-33109-3.\u003c/li\u003e\n\u003cli\u003eCoates SJ, Davis MDP, Andersen LK. Temperature and humidity affect the incidence of hand, foot, and mouth disease: A systematic review of the literature \u0026ndash; a report from the international society of dermatology climate change committee. Int J Dermatol. 2019;58:388\u0026ndash;99. https://doi.org/10.1111/ijd.14188.\u003c/li\u003e\n\u003cli\u003eNguyen HX, Chu C, Tran QD, Rutherford S, Phung D. Temporal relationships between climate variables and hand-foot-mouth disease: A multi-province study in the mekong delta region, vietnam. Int J Biometeorol. 2019;64:389\u0026ndash;96. https://doi.org/10.1007/s00484-019-01824-9.\u003c/li\u003e\n\u003cli\u003eLiu J, Wang H, Zhong S, Zhang X, Wu Q, Luo H, et al. Spatiotemporal changes and influencing factors of hand, foot, and mouth disease in guangzhou, China, from 2013 to 2022: Retrospective analysis. JMIR Public Health Surveill. 2024;10:e58821. https://doi.org/10.2196/58821.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hand, foot and mouth disease, Wanzai County, Epidemiological characteristics, Precision prevention and control","lastPublishedDoi":"10.21203/rs.3.rs-8279931/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8279931/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in Wanzai County from 2010 to 2024, identify key influencing factors, and provide evidence for local prevention and control strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected reported HFMD case data and demographic information in Wanzai County from January 2010 to December 2024. Descriptive epidemiological methods were used to analyze temporal, spatial, and population distributions. Trend regression analysis was applied to incidence data, and pathogen composition changes were examined.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 8,101 HFMD cases were reported during the study period, with an average annual incidence rate of 101.71 per 100,000. Case numbers peaked in 2015 and 2018, followed by a continuous decline after 2019. Seasonal distribution showed a bimodal pattern in most years, with the main peak from May to July and a secondary peak in October. From 2021 to 2023, an increasing trend was observed from November to December. Spatial analysis revealed significant clustering, with Kangle Town and Zhutan Town as high-incidence areas. Children aged 1\u0026ndash;3 years constituted the high-risk group, and scattered children were the main affected population, though the proportion of cases among childcare facility children increased after 2020. Male incidence was significantly higher than female incidence (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a sex ratio declining in recent years. Pathogen analysis indicated significant gender differences in infection with different enterovirus strains (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHFMD in Wanzai County demonstrates distinct temporal, spatial, and population clustering. Prevention and control efforts should be intensified in high-incidence areas, targeted towards key demographic groups, and reinforced during peak seasons through enhanced surveillance and health education.\u003c/p\u003e","manuscriptTitle":"Epidemic disease characteristics and control system of HFMD in Wanzai County, Yichun City, Jiangxi Province (2010-2024)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:07:22","doi":"10.21203/rs.3.rs-8279931/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-10T10:18:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T13:30:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T04:14:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282966548123159671582976895156135900999","date":"2026-03-06T01:16:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T04:47:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124113193441362041905183700963586788339","date":"2026-03-03T07:13:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84823747189905813345803391989159973482","date":"2026-03-03T06:57:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T07:10:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-21T15:21:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T09:45:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T08:35:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-12-24T08:30:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf421dfa-57e8-4f79-bcf1-287fd9007696","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-10T10:24:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:07:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8279931","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8279931","identity":"rs-8279931","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}