{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:15:05Z","timestamp":1790342105250,"version":"4.1.0"},"reference-count":31,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Hand, foot, and mouth disease (HFMD), a common childhood illness caused by various enteroviruses, poses a significant public health threat in the Asia-Pacific region, where severe cases associated with enterovirus A71 (EV71) are a major concern. The EV71 vaccination program was introduced in China in late 2016. Although randomized controlled trials have established the robust efficacy and safety of these vaccines, assessing their real-world performance remains crucial. Subsequent studies have evaluated its real-world effectiveness in several provinces, including Zhejiang and Guangdong. However, evidence on its real-world impact in reducing EV71-associated HFMD in Jiangsu Province remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to describe HFMD epidemiological characteristics and to evaluate the population-level effectiveness of the EV71 vaccination program in Jiangsu Province.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We characterized the temporal distribution of EV71-related HFMD cases based on longitudinal surveillance data collected through the National Notifiable Diseases Surveillance System in Jiangsu Province from 2012 to 2019 and assessed the impact of vaccination using a Bayesian structural time series model under a counterfactual framework. The intervention effect of the EV71 vaccine was estimated by comparing the observed data with predictions from a counterfactual model scenario without vaccination.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 932,274 HFMD cases were reported in Jiangsu from 2012 to 2019, including 5190 (0.56%) severe cases. An estimated 140,876 (15.11%) cases were attributed to EV71. EV71-associated HFMD cases showed a marked decline, with estimated numbers of 22,303, 9796, and 3900 in 2017, 2018, and 2019, respectively. We estimated that 30,117 EV71 cases (95% credible interval \u22121777 to 93,601) were prevented by the vaccination program from 2017 to 2019, corresponding to a reduction of 45.55% (95% credible interval \u22125.19% to 72.22%). The effectiveness of vaccination increased annually, with reductions of \u22121.03% (95% credible interval \u221294.85% to 48.29%) in 2017, 55.54% (95% credible interval 13.94%-77.56%) in 2018, and 82.28% (95% credible interval 65.77%-90.89%) in 2019. Furthermore, we observed that children younger than 4 years obtained greater benefits compared with those older than 4 years, with the greatest reduction of 57.68% (95% credible interval 13.04%-79.65%) in the 3- to 4-year age group, followed by a 48.09% (95% credible interval 28.00%-62.98%) reduction in the 0- to 2-year age group. In contrast, the reduction was markedly lower, at 16.75 % (95% credible interval \u221296.53% to 65.47%) in children older than 4 years during the 2017 to 2019 period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n EV71 vaccination is an effective measure to prevent HFMD. The sharp decline in EV71-associated HFMD cases following the implementation of the EV71 vaccination program suggests a potential causal relationship. Therefore, strengthening vaccine coverage remains a public health priority.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/85604","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T20:22:26Z","timestamp":1773174146000},"page":"e85604-e85604","source":"Crossref","is-referenced-by-count":2,"title":["Population-Level Impact of the Enterovirus A71 Vaccination Program on Hand, Foot, and Mouth Disease: Ecological Time-Series Study"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1332-0471","authenticated-orcid":false,"given":"Ye","family":"Tong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6839-0717","authenticated-orcid":false,"given":"Huan","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9644-0236","authenticated-orcid":false,"given":"Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3712-9075","authenticated-orcid":false,"given":"Xinru","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-134X","authenticated-orcid":false,"given":"Xiaoqing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0546-1338","authenticated-orcid":false,"given":"Changjun","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0636-4089","authenticated-orcid":false,"given":"Liguo","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-580X","authenticated-orcid":false,"given":"Hong","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5968-6874","authenticated-orcid":false,"given":"Xiang","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3659-7","article-title":"Surveillance for severe hand, foot, and mouth disease from 2009 to 2015 in Jiangsu province: epidemiology, etiology, and disease burden","volume":"19","author":"Ji","journal-title":"BMC Infect Dis"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s43088-022-00258-4","article-title":"Global emergence of enterovirus 71: a systematic review","volume":"11","author":"Nayak","journal-title":"Beni Suef Univ J Basic Appl Sci"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","DOI":"10.3390\/v10040155","article-title":"Antiviral and inflammatory cellular signaling associated with enterovirus 71 infection","volume":"10","author":"Jin","journal-title":"Viruses"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","DOI":"10.1038\/emi.2016.73","article-title":"EV-A71 vaccine licensure: a first step for multivalent enterovirus vaccine to control HFMD and other severe diseases","volume":"5","author":"Mao","journal-title":"Emerg Microbes Infect"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1086\/314032","article-title":"Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. 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