目的 分析肠道病毒71型（enterovirus A71，EV-A71）灭活疫苗上市后我国手足口病（hand foot mouth disease，HFMD）的病原体、重症病例及人群分布特征情况，为HFMD的预防及控制提供参考。方法 纳入中国知网中2016—2025年公开发表、明确涉及EV-A71疫苗应用效果评价且包含疫苗应用前后病原体的变化、重症病例或发生率、人群分布特征等基础数据的文献，采用卡方检验对其结果进行综合分析。结果 EV-A71灭活疫苗推广使用前、后，HFMD病例的人群分布均表现为散居儿童占比最高、幼托儿童次之、学生及其他人群占比最低；EV-A71疫苗应用后，散居儿童在HFMD病例中的构成较疫苗应用前下降了11.35%，幼托儿童增加了25.62%，学生及其他占比增加了61.38%，疫苗应用前后3组人群分布差异均具有统计学意义（χ²=15 659.45、11 208.25、3 587.36，P<0.001）。EV-A71疫苗推广使用后，EV-A71所致HFMD病例平均减少了56.17%，而柯萨奇病毒A组16型（coxsackie virus A16，CVA16）及其他肠道病毒所致病例平均分别增加了8.08%和62.37%，差异均有统计学意义（χ²= 41.94、310.80、39.37，P<0.001），非EV-A71肠道病毒（如CVA16、CVA6及CVA10等）成为优势病原体。疫苗应用后，重症病例平均减少了42.70%、重症病例中EV-A71所致者占比下降17.89%，差异均有统计学意义（χ²=4 087.32、4 215.92，P<0.001）；疫苗使用后仍有约59%的重症病例由EV-A71感染所致，提示EV-A71依然是导致危重型HFMD的最主要病原体。结论 EV-A71疫苗极大降低了HFMD的重症发生率，EV-A71仍然是导致重症病例的主要病原体，同时CVA16、CVA6及CVA10等非EV-A71肠道病毒已经成为优势病原体。

Objective To analyze pathogens, severe cases and population distribution characteristics of hand foot mouth disease (HFMD) after the launch of inactivated enterovirus A71 (EV-A71) vaccine in China, and to provide references for the prevention and control of HFMD in China.Methods The literature published openly from 2016 to 2025, explicitly involving the application effect evaluation of EV-A71 vaccine and containing basic data such as the changes of pathogens before and after the application of vaccine, severe cases or incidence rates, and population distribution characteristics, was collected from China National Knowledge Infrastructure and comprehensively analyzed by chi-square test.Results The population distribution of HFMD cases before and after the use of EV-A71 inactivated vaccine showed that scattered children accounted for the highest proportion, followed by children in kindergartens and nurseries, and students and other groups accounted for the lowest proportion. However, after the application of EV-A71 vaccine, the composition of scattered children in HFMD cases decreased by 11.35% compared with that before the vaccine application, the proportion of children in kindergartens and nurseries increased by 25.62%, and the proportion of students and others increased by 61.38%. The differences in population distribution before and after the vaccine application were all statistically significant (χ²=15 659.45, 11 028.25, 3 587.36; P<0.001). After the application of EV-A71 vaccine, the average number of HFMD cases caused by EV-A71 decreased by 56.17%, while the average number of cases caused by coxsackie virus A16 (CVA16) and other enteroviruses increased by 8.08% and 62.37%, respectively, and the differences were all statistically significant (χ²=41.94, 310.80, 39.37; P<0.001). Non-EV-A71 enteroviruses (such as CVA16, CVA6 and CVA10, etc.) became dominant pathogens. After the application of vaccine, the average number of severe cases decreased by 42.70%, and the proportion of those caused by EV-A71 in severe cases dropped by 17.89%. The differences were statistically significant (χ²=4 087.32, 4 215.92；P< 0.001). However, approximately 59% of severe cases were still caused by EV-A71 infection after the use of the vaccine, suggesting that EV-A71 remained the main pathogen leading to critical HFMD.Conclusion EV-A71 vaccine has significantly reduced the incidence of severe HFMD cases, but EV-A71 remains the primary pathogen causing severe cases, while non-EV-A71 enteroviruses have become dominant pathogens.