Hand, foot and mouth disease incidence in mainland China: temporal trends and projections to 2030

Hand, foot and mouth disease (HFMD) was an acute infectious disease. This study aimed to estimate the development trend of HFMD.

The incidence surveillance data of HFMD from 2005 to 2019 mainly came from the Public Health Sciences Data Center of China. Bayesian age-period-cohort (BAPC) model was compared with other models to evaluate the accuracy of the incidence of HFMD and to predict its incidence up to 2030.

A total of 22,559,406 cases of HFMD were reported. The test results showed that BAPC model may be better than Auto-regressive integrated moving average (Auto_arima), Exponential smoothing (ETS), Prophet and Earth models on mean absolute error (MAE), symmetric mean absolute percentage error (SMAPE), mean square error (MSE) and root mean square error (RMSE) indicators. From 2005 to 2019, there was a trend toward increasing HFMD incidence (Average Annual Percent Change (AAPC) = 45.9, 95% CI 15.5, 84.3, p < 0.1) by joinpoint regression analysis. But BAPC model showed that the annual reported incidence of HFMD in mainland China appeared to be on a downward trend by 2030 (954,069.79 cases, 67.3966 cases per 100,000). Spatial-temporal aggregation analysis detected four high-risk areas of a "most likely" cluster (southern central region), a secondary cluster (eastern region) and two tertiary clusters (northern region, southwestern region).

It was important to protect the population, especially children in high-risk areas of HFMD. In high Gross Domestic Product (GDP) per capita areas, especially urban areas, health departments should advise to reduce gathering activities that may cause the spread of HFMD. In areas such as train stations, bus stations, and airports with more floating population, health department should advise travelers not to stay in these areas for a long time.