{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:31:44Z","timestamp":1790285504655,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>The burden of hand, foot, and mouth disease (HFMD) in children under five is substantial, with the greatest burden in China. Most cases are mild, although some are severe and even fatal. A vaccine against EV\u2010A71, the pathogen most commonly associated with severe HFMD, was licensed in China in Dec 2015 but not introduced into the National Immunisation Programme (NIP). It was hence not covered by routine national vaccine surveillance and its coverage remained unknown for the years following its initial licensure. Here we report the results of a novel data collection and analysis approach to address this knowledge gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Local public health entities were invited to report county\u2010specific numbers of EV\u2010A71 vaccine doses administered between 2016 and 2019 in mainland China. A cohort model was then used to estimate vaccine coverage. The association between county\u2010level factors (epidemiological, socioeconomic, demographic, and environmental) and vaccine coverage was assessed using zero\u2010inflated beta regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>We received responses from 2,248 out of 3,252 counties in 23 of 31provinces in mainland China. The median county\u2010level EV\u2010A71 vaccine coverage was 10.17% [IQR: 3.50%, 19.39%] in 2018 and 16.70% [IQR: 8.78%, 27.45%] in 2019. However, the median absolute differences in coverage (i.e., max\u2010min) within\u2010prefecture were ~30%. Results from the regression model indicate that low vaccine coverage was associated with low socioeconomic status, small populations and high proportions of young children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Coverage of EV\u2010A71 vaccines was low in China prior to the COVID\u201019 pandemic, with substantial geographical disparities over 4 years after the initial vaccine licensure. Our results illustrate the private market response to a new childhood vaccine that is licensed but not centrally funded. Despite economic growth, vaccine coverage among marginalised populations will likely be low without targeted policy and financial support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jmv.70776","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T03:52:39Z","timestamp":1766980359000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimating the Uptake of and Factors Associated With a New Vaccine Outside of the National Immunisation Programme: A Case Study of the EV\u2010A71 Vaccine Against Hand, Foot, and Mouth Disease"],"prefix":"10.1002","volume":"98","author":[{"given":"Fengfeng","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, Key Laboratory of Surveillance and Early\u2010Warning on Infectious Disease Chinese Center for Disease Control and Prevention Beijing PR China"},{"name":"Department of Health Policy and Management, School of Public Health Peking University Beijing PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9592-4286","authenticated-orcid":false,"given":"Fuqiang","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health Peking University Beijing PR China"},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education"},{"name":"Department of Laboratorial Science and Technology &amp; Vaccine Research Center, School of Public Health Peking University Beijing PR China"},{"name":"Center for Infectious Diseases and Policy Research &amp; Global Health and Infectious Diseases Group Peking University Beijing PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billy J.","family":"Quilty","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, Key Laboratory of Surveillance and Early\u2010Warning on Infectious Disease Chinese Center for Disease Control and Prevention Beijing PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Tong","sequence":"additional","affiliation":[{"name":"School of Public Health Fudan University Shanghai PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Flasche","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jit","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London UK"},{"name":"Department of Global and Environmental Health, School of Global Public Health New York University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongjie","family":"Li","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences &amp; Peking Union Medical College Beijing PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaorui","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, Key Laboratory of Surveillance and Early\u2010Warning on Infectious Disease Chinese Center for Disease Control and Prevention Beijing PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1853"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12929-019-0573-2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43088-022-00258-4"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001242"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bsheal.2019.02.005"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1304923"},{"key":"e_1_2_10_8_1","unstructured":"GNI per capita Atlas method (current US$)\u2013China. 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