[Epidemiological characteristics, spatial autocorrelation and pathogen spectrum of hand,foot and mouth disease in Liaoning Province, 2009-2024].

Objective: To analyze the epidemiological characteristics and pathogen spectrum changes of hand, foot and mouth disease (HFMD) in Liaoning Province from 2009 to 2024, and provide evidence for the development of prevention and control strategies. Methods: The data from Chinese Information System for Disease Control and Prevention, Infectious Disease Surveillance Information System, and the etiological data from the Liaoning HFMD laboratory network were used for statistical description and spatial autocorrelation analysis by using software R Studio. Cluster maps were generated by using software ArcGIS 10.8. Results: A total of 362 334 HFMD cases, including 1 750 severe cases and 30 deaths, were reported in Liaoning from 2009 to 2024, the average annual incidence rate was 52.31/100 000. The incidence trend showed a decline trend from 2009 to 2019 and an increase trend in from 2021 to 2024, with a significant increase in 2023. Temporally, one annual incidence peak was observed from 2009 to 2023, while two annual incidence peaks were firstly observed in 2024. Geographically, the cases were highly distributed in Dalian, Shenyang and Anshan. Local autocorrelation analysis revealed more "high-high" clustering areas mainly in 7 districts/counties of Dalian, including Ganjingzi and Jinzhou, and less "low-low" clustering areas mainly in Jinzhou and Fuxin, but "high-low" or "low-high" clustering areas were rare. The cases were mainly children aged ≤5 years, with those aged 3 years being most affected, and the male to female ratio of the cases was 1.49∶1. The pathogen spectrum analysis showed that enterovirus A71 (EV-A71) was the predominant pathogen from 2009 to 2011, but the predominance gradually became weaker and declined to an extremely low level after 2018. Since 2018 other enteroviruses had become predominant. Conclusions: The incidence of HFMD in Liaoning showed time, area and population clustering characteristics, with the predominant pathogen shifting from EV-A71 to other enteroviruses. It is necessary to strengthen multi-pathogen surveillance and precision prevention and control in child care settings to address the risk of HFMD epidemic.