ArticlePloS one2026
Shifting epidemiological patterns and strain replacement of hand, foot, and mouth disease in southern China, 2009-2022: A longitudinal study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Spatiotemporal dynamics and genotypic shift of Coxsackievirus A16 in Fujian, China, from 2010 to 2025.Frontiers in microbiology · 2026Article
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Authors and funding
14 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundChina launched a universal campaign of monovalent-inactivated EV-A71 vaccine in 2016. However, the monovalent-inactivated vaccine is ineffective against HFMD with other etiologies. To date, little is known about the epidemiological patterns and the replacement of the predominant pathogens that induce HFMD after the universal vaccination campaign.
methodsUsing HFMD surveillance and VP1 sequencing data in pre- and post-vaccination periods, time series analysis, and Wavelet approaches, we identified pathogen replacement, changes in the viral spectrum and epidemiological patterns of HFMD.
resultsA prolonged but lower peak of HFMD occurred in the spring, and a late, higher peak presented during fall in the post-vaccination period. The typical half-year transmission cycle disappeared, the one-year cycle did not change, and the CVA16 and CVA6 serotypes have the potential to replace EV-A71 as the predominant strains.
conclusionsThe epidemic pattern of HFMD has shifted after the vaccination campaign. While the EV-A71 vaccine reduced transmission in the spring season, it had little impact on reducing cases in fall. Meanwhile, potential new predominant strains have emerged. Public health system should incorporate enhanced surveillance by including whole genome sequencing to ensure close monitoring of serotype replacement and to assess the need for multivalent vaccines across Southern China.
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