Hand, Foot, and Mouth Disease in China: Critical Community Size and Spatial Vaccination Strategies.
Hand, Foot, and Mouth Disease in China: Critical Community Size and Spatial Vaccination Strategies.
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中国的手足口病：关键社区规模和空间疫苗接种策略
DOI：
10.1038/srep25248
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发表时间：
2016-04-29
影响因子：
4.6
通讯作者：
Grenfell BT
中科院分区：
文献类型：
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作者：
Van Boeckel TP;Takahashi S;Liao Q;Xing W;Lai S;Hsiao V;Liu F;Zheng Y;Chang Z;Yuan C;Metcalf CJ;Yu H;Grenfell BT
手足口病（HFMD）对中国的卫生保健系统构成了相当大的负担。然而，这一负担显示出重要的地理异质性，直接影响到该疾病在当地的持续性和动态，从而影响到通过疫苗接种活动控制该疾病的能力。在这里，我们使用详细的地理监测数据和流行病模型来估计HFMD相关的肠道病毒血清型CV-A16和EV-A71的临界社区规模（CCS），我们探索什么样的空间疫苗接种策略可以最好地减少HFMD的负担。我们发现CCS范围从336，979（± 225，866）到722，372（± 150，562），其中与EV-A71相关的最低估计值在中国南部地区，此前已确定多个传播季节。我们的研究结果表明，存在一个由城市中心驱动的区域移民-城市化动态。如果EV-A71疫苗剂量有限，这些疫苗最好部署在人口密集的城市中心和高流行地区。如果将手足口病疫苗纳入中国的国家免疫规划以实现高覆盖率（>85%），新生儿常规疫苗接种在很大程度上优于新生儿常规疫苗接种和整个社区脉冲疫苗接种之间等量分配的策略。
Hand Foot and Mouth Disease (HFMD) constitutes a considerable burden for health care systems across China. Yet this burden displays important geographic heterogeneity that directly affects the local persistence and the dynamics of the disease, and thus the ability to control it through vaccination campaigns. Here, we use detailed geographic surveillance data and epidemic models to estimate the critical community size (CCS) of HFMD associated enterovirus serotypes CV-A16 and EV-A71 and we explore what spatial vaccination strategies may best reduce the burden of HFMD. We found CCS ranging from 336,979 (±225,866) to 722,372 (±150,562) with the lowest estimates associated with EV-A71 in the southern region of China where multiple transmission seasons have previously been identified. Our results suggest the existence of a regional immigration-recolonization dynamic driven by urban centers. If EV-A71 vaccines doses are limited, these would be optimally deployed in highly populated urban centers and in high-prevalence areas. If HFMD vaccines are included in China’s National Immunization Program in order to achieve high coverage rates (>85%), routine vaccination of newborns largely outperforms strategies in which the equivalent number of doses is equally divided between routine vaccination of newborns and pulse vaccination of the community at large.