title: Hand, Foot, and Mouth Disease in China: Critical Community Size and Spatial Vaccination Strategies.
abstract: 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.
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.|Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Van Boeckel
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
authors.forename: Saki
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Qiaohong
authors.initials: Q
authors.lastname: Liao
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Weijia
authors.initials: W
authors.lastname: Xing
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|Department of Geography and Environment, University of Southampton, Southampton, UK.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Lai
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Hsiao
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Fengfeng
authors.initials: F
authors.lastname: Liu
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yaming
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Chang
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.|Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA.
authors.forename: C Jessica E
authors.initials: CJ
authors.lastname: Metcalf
authors.affiliation: Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.|Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Grenfell
mesh_terms: D002681:China / Q000453:epidemiology; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D062665:Epidemiological Monitoring; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015233:Models, Statistical; D062206:Spatial Analysis; D019371:Topography, Medical; D014611:Vaccination / Q000706:statistics & numerical data*