木雅人的手长宽、足长宽与身高的关系

目的探讨四川木雅人手长、手宽、足长、足宽与身高的关系,为人类学、法医学及临床医学提供参考,同时为中国人体质调查积累资料。方法按人类学规定的方法和标准,对年龄在20~70岁四川省木雅人157人(男77名,女80名)的手长、手宽、足长、足宽和身高进行测量统计学分析。结果得出手长、手宽、足长、足宽、身高的均数及相关系数,各组相关系数r在0.279~0.623之间,手长与身高、手宽与身高、足长与身高、足宽与身高呈现相关性,其r分别为:男性0.285,女性0.345;男性0.500,女性0.379;男性0.623,女性0.620;男性0.359,女性0.279。结论由此推算出的8个回归方程可推算出四川木雅人身高。     

Coordination of coupled hand and foot movements during childhood

To acquire further insight into the neural mechanisms governing the association of voluntary oscillations of ipsilateral hand and foot we investigated when and how coordination of such coupling develops in children 7-10 years old. Sixty-six children were asked to rhythmically oscillate their right hand and foot, paired in-phase or anti-phase (i.e. rotating in the same or in the opposite angular direction). Angular displacement was monitored by a potentiometric technique, and EMGs from extensor carpi radialis (ECR) and tibialis anterior (TA) were recorded. All subjects were able to couple in-phase oscillations, but 13 of them failed to perform the anti-phase task. Maximal frequency of oscillation was found to be positively correlated with age. Phase-relations between hand and foot oscillations and between onsets of the EMG activity in hand and foot movers were measured in 37 of the children. During in-phase coupling limb oscillations were kept in an almost perfect synchrony by three different modalities of muscle recruitment. Ten of the youngest children activated TA before ECR, while 13 of the oldest subjects activated ECR before TA, as do adults. The remaining 14 children (7-8 years old) activated the two muscles almost synchronously. During anti-phase coupling, most of the younger children (20) showed a strict phase-opposition between both EMG onsets and movements. The remaining 10 (9-10 years old) activated the ECR first. The hand frequency-response (i.e. the phase-relation between the onset of the EMG and the related movement) showed age-related changes, corresponding to the behaviour of a mass-spring model (with lumped parameters) decreasing its resonant frequency. Instead, the foot frequency-response remained unchanged. The age-related modifications of the hand frequency-response adequately explain the changes of the interlimb relations described above. These results show that central structures controlling hand and foot coupling are still immature before 10 years of age and reinforce the view that in-phase and anti-phase coupling require separate neural controls.     

Human interlimb reflexes evoked by electrical stimulation of cutaneous nerves innervating the hand and foot

There is some discrepancy over the extent to which reflex pathways from different cutaneous nerves in the hand and foot link the cervical and lumbar spinal cord in neurologically intact humans. The present experiments were designed to determine whether stimulation of a cutaneous nerve in the foot or in the hand evoked reflexes in the non-stimulated limbs (interlimb reflexes). Reflexes were elicited by stimulating (5x1-ms pulses at 300 Hz) the superficial peroneal (SP; innervates the foot dorsum) or superficial radial (SR; innervates the dorsolateral portion of the hand) nerve while subjects (n=10) performed focused contractions of different upper and lower limb muscles. Reflex responses were divided into early (<75 ms), middle (75-120 ms), and late (>120 ms) epochs as determined from averages of 50 sweeps of stimulus-locked electromyographic activity. Significant interlimb reflexes were found at the early latency in 44/106 and 44/103 muscles sampled after SP and SR nerve stimulation, respectively. At the middle latency, significant interlimb reflexes were seen in 89/106 and 87/103 muscles sampled after SP and SR nerve stimulation, respectively. Interlimb reflexes were seen when stimulating at the wrist (i.e. SR nerve) and when stimulating at the ankle (i.e. SP nerve) with an equal probability. The results show that interlimb cutaneous reflexes are widely distributed in humans. The mean latency of the earliest response was quite short and may be mediated by a propriospinal pathway. Functionally, these pathways may provide a substrate for transferring information to coordinate movements between the limb segments.     

辽宁农村汉族成人手长、足长与身高的关系

目的 探讨辽宁农村地区汉族成人手长、足长与身高的关系。方法 按规定的测量方法测量了辽宁农村地区977名(男487名,女490名)20～80岁汉族成人的手长、足长和身高,并将原始数据进行医学统计学处理。按年龄组和性别组计算出各组手长、足长和身高的均值,并提出由手长、足长推算身高的回归方程。结果 除40～49岁组手长外,各组手长、足长和身高的性别差异均有显著性(P<0.01);由手长推算的回归方程中,男性除30～39岁组、女性除20～29岁和30～39岁组外,其他回归方程成立,由足长推算的回归方程均成立(P<0.001)。结论 足长与身高显著相关,通过足长及用回归方程来推测辽宁农村成人身高更具可靠性和适用性。     

游离隐动脉皮瓣修复手足部皮肤软组织缺损

目的报道游离隐动脉皮瓣修复手足部皮肤软组织缺损的临床效果。方法 2003年2月～2009年2月,对8例手部皮肤软组织缺损患者,5例足部皮肤软组织缺损患者,采用游离隐动脉皮瓣修复术。13例患者均伴有肌腱、骨、神经血管外露,皮瓣面积7cm×6cm～12cm×9cm,1例小儿患者足跟部皮肤软组织缺损伴有跟腱缺损,2例皮瓣供区采用直接缝合,11例皮瓣供区采用下腹部全厚皮片植皮。结果术后13例患者皮瓣均一期成活,供区伤口一期愈合。经随访6～36个月,平均随访9个月。皮瓣质地优良,外观不臃肿,感觉恢复S2～S4,手部功能恢复满意,足部行走功能无影响。2例供区直接缝合者供区遗留线状瘢痕,瘢痕无增生及挛缩,11例供区植皮者植皮区松软,外观可,无瘢痕挛缩。结论游离隐动脉皮瓣修复手足部皮肤软组织缺损,具有解剖恒定,手术操作安全、简便,可满足手足部创面覆盖的需要。     

Interactions of different body parts in peripersonal space: how vision of the foot influences tactile perception at the hand

The body schema, a constantly updated representation of the body and its parts, has been suggested to emerge from body part-specific representations which integrate tactile, visual, and proprioceptive information about the identity and posture of the body. Studies using different approaches have provided evidence for a distinct representation of the visual space ~30 cm around the upper body, and predominantly the hands, termed the peripersonal space. In humans, peripersonal space representations have often been investigated with a visual–tactile crossmodal congruency task. We used this task to test if a representation of peripersonal space exists also around the feet, and to explore possible interactions of peripersonal space representations of different body parts. In Experiment 1, tactile stimuli to the hands and feet were judged according to their elevation while visual distractors presented near the same limbs had to be ignored. Crossmodal congruency effects did not differ between the two types of limbs, suggesting a representation of peripersonal space also around the feet. In Experiment 2, tactile stimuli were presented to the hands, and visual distractors were flashed either near the participant’s foot, near a fake foot, or in distant space. Crossmodal congruency effects were larger in the real foot condition than in the two other conditions, indicating interactions between the peripersonal space representations of foot and hand. Furthermore, results of all three conditions showed that vision of the stimulated body part, compared to only proprioceptive input about its location, strongly influences crossmodal interactions for tactile perception, affirming the central role of vision in the construction of the body schema.

Is there a preferred coordinate system for perception of hand orientation in three-dimensional space?

Summary The purpose of this experiment was to determine the preferred coordinate system for representation of hand orientation in 3-dimensional space. The ability of human subjects to perceive angles of the hand in 3-dimensional space (elevation, yaw, roll angles extrinsic coordinate system) was compared to their ability to perceive hand angles relative to the proximal upper limb segments (wrist joint angles, forearm pronation intrinsic coordinate system). With eyes closed, subjects performed a matching task in which the experimenter positioned the left arm, forearm and hand and the right arm and forearm. Subjects were then told to match an angle in one of the two coordinate systems by moving only the right hand at the wrist or the forearm as in pronation or roll matching. Absolute constant error (ACE), variable error (VE) and normalized variable error (NVE-normalized to tested range of motion) of matching were quantified for each subject for each of the six angles matched. It was hypothesized that matching angles in a preferred coordinate system would be associated with lower ACE, VE and NVE. Overall, ACE and VE were lower for matching hand angles in the intrinsic coordinate system. This suggests that the preferred coordinate system involved specification of hand angles relative to forearm and arm angles (joint angles) rather than the hand angles relative to axes external to the upper limb. However, matching of pronation angles was associated with larger VE and NVE than roll angle matching. There were no significant differences in ACE between pronation and roll matching. In a second experiment subjects with their forearms constrained at different elevations matched hand elevation and wrist flexion angles. Thus, errors in matching the angles in the non preferred coordinate system were predictable if the subjects were biased toward matching angles in the preferred coordinate system. Trends in the data suggested that subjects preferred matching hand elevation angles but these trends were not consistent within or between subjects. Thus a preferred intrinsic coordinate system for wrist flexion matching was not observed in this experiment. We suggest that matching angles when proximal limb segments are constrained is a simpler task for the subjects (VE lower than in the first experiment) and may bias the matching toward the extrinsic coordinate system. Thus, hand orientation in 3-dimensional space may be perceived as follows: wrist flexion and abduction angles together with forearm elevation and yaw are used to specify hand elevation and yaw; these together with hand roll angle, completely specify the hand angle in 3-dimensional space.     

Haptic localization and the internal representation of the hand in space

As the hand actively explores the environment, contact with an object leads to neuronal activity in the topographic maps of somatosensory cortex. However, the brain must combine this somatotopically encoded tactile information with an internal representation of the hand's location in space if it is to determine the position of the object in three-dimensional space (3-D haptic localization). To investigate the fidelity of this internal representation in human subjects, a small tactual stimulator, light enough to be worn on the subject's hand, was used to present a brief mechanical pulse (6-ms duration) to the right index finger before, during, or after a fast, visually evoked movement of the right hand. In experiment 1, subjects responded by pointing to the perceived location of the mechanical stimulus in 3-D space. Stimuli presented shortly before or during the visually evoked movement were systematically mislocalized, with the reported location of the stimulus approximately equal to the location occupied by the hand 90 ms after stimulus onset. This pattern of errors indicates a representation of the movement that fails to account for the change in the hand's location during somatosensory delays and, in some subjects, inaccurately depicts the velocity of the actual movement. In experiment 2, subjects were instructed to verbally indicate the perceived temporal relationship of the stimulus and the visually evoked movement (i.e., by reporting whether the stimulus was presented before, during, or after the movement). On average, stimuli presented in the 38-ms period before movement onset were more likely to be perceived as having occurred during rather than before the movement. Similarly, stimuli in the 145-ms period before movement termination were more likely to be perceived as having occurred after rather than during the movement. The analogous findings of experiments 1 and 2 indicate that the same inaccurate representation of dynamic hand position is used to both localize tactual stimuli in 3-D space and construct the perception of arm movement.     

肠道病毒71型手足口病的疫苗筛选和观察

目的 筛选安全有效新型EV71候选疫苗,为将来EV71疫苗开发应用奠定基础.方法 以重组蛋白VP1为疫苗设计靶点,不同候选疫苗包括灭活疫苗、DNA疫苗、VP1蛋白疫苗在0、2周、4周分别按照不同剂量和肌内注射途径免疫BALB/c雌性小鼠,在0、2周、4周、6周、8周、10周、16周分别采集小鼠尾静脉血,16周处死小鼠,收集小鼠脾脏细胞,检测小鼠体液免疫和细胞免疫功能,筛选评价候选疫苗的疗效和安全性.结果 灭活病毒疫苗、VP1 DNA质粒疫苗、VP1蛋白疫苗免疫小鼠2周后IgG抗体滴度即开始升高,4周后明显升高,8周后达高峰,至少维持16周以上;IgG亚类以IgG2a和IgG1为主.三种疫苗能诱导以γ-IFN和IL-4为主的细胞免疫反应.灭活疫苗疗效优于其他候选疫苗,未发现疫苗相关不良反应.结论 灭活病毒疫苗、VP1 DNA质粒疫苗、VP1蛋白疫苗均能诱导持久的特异性细胞免疫和中和抗体反应,以灭活病毒疫苗疗效较好,需要将来攻毒实验可进一步验证其免疫力.     

菏泽市2011年手足口病病原学检测分析

目的 明确2011年引起菏泽市手足口病(HFMD)的病原体型别及分布特征.方法 采集临床诊断为手足口病病例的粪便或咽拭子样本,用Real-time PCR方法进行肠道病毒通用(EV)型、EV71型、CoxA16型的核酸检测,并对结果进行分析.结果 389例HFMD临床诊断病例样本检测,肠道病毒核酸阳性376例,检出率9...     

手足口病患儿血浆循环DNA水平的变化

目的 探讨循环DNA能否作为手足口病（hand foot and mouth disease,HFMD）重要脏器早期损害的实验室指标.方法 采集78例HFMD患儿发病3日内和恢复期静脉血,采用双重荧光定量PCR技术检测血浆DNA水平,同时检测血糖、超敏C反应蛋白（high-sensitive CRP,hs-CRP）及血白细胞.同期采集30例健康体检儿童静脉血作为对照组.结果 健康儿童血浆循环DNA水平为（6.57±4.67） ng/ml,普通病例和重症病例HFMD患儿治疗前循环DNA水平分别为（11.51±7.75）和（ 20.59±10.67） ng/ml.普通病例和重症病例循环DNA水平均显著高于健康儿童（P =0.021;0.000）,而且重症病例显著高于普通病例（P=0.011）.重症HFMD患儿治疗后循环DNA水平显著降低（P=0.033）,而普通型患儿治疗后循环DNA水平无显著变化.重症HFMD患儿血糖和hs-CRP 水平在治疗前均显著高于普通病例（P=0.045,0.011）,普通病例血白细胞、血糖和hs-CRP水平在治疗前后均无显著变化.HFMD患儿外周循环DNA水平与hs-CRP呈显著正相关（P =0.021）,但与血糖、白细胞无显著相关性.结论 血浆循环DNA不但可以作为重症HFMD病例早期识别的指标,也可作为重症病例疗效的监测指标.     

Haptic discrimination of object shape in humans: contribution of cutaneous and proprioceptive inputs

Using two-dimensional (2D) angles composed of two straight, 8-cm-long arms that formed an angle, we investigated the importance of cutaneous feedback from the exploring index finger, and proprioceptive feedback from the shoulder (scanning movements made with the outstretched arm), to the human ability to discriminate small differences in the angles. Using a two-alternative forced-choice paradigm, subjects identified the larger angle in each pair explored (standard angle, 90 degrees; comparison angles, 91 degrees to 103 degrees). Subjects were tested under four experimental conditions: (1) active touch (reference condition); (2) active touch with digital anaesthesia; (3) passive touch (a computer-controlled device displaced the angle under the subject's immobile digit); and (4) passive touch with digital anaesthesia. When only proprioceptive feedback from the shoulder was available (condition 2), there was a significant increase in discrimination threshold, from 4.0 degrees in the reference condition (condition 1) to 7.2 degrees, indicating that cutaneous feedback from the exploring digit contributed to task performance. When only cutaneous feedback from the finger was available (condition 3), there was also a significant increase in threshold from 4.2 degrees in the active condition to 8.7 degrees. This suggested that proprioceptive feedback from the shoulder, potentially from a variety of deep (muscle and joint) but also cutaneous receptors, contributed to the ability to discriminate small changes in 2D angles. When both sources of feedback were eliminated (condition 4), subjects were unable to discriminate even the largest difference presented (13 degrees). The results suggest that this sensory task is truly an integrative task drawing on sensory information from two different submodalities and so, following the definition of Gibson, is haptic in nature. The results are discussed in relation to the potential neural mechanisms that might underlie a task that requires integration across two anatomically separate body parts and two distinct modalities.     

Invariant temporal characteristics of manipulative hand movements

Summary The measurement of eight manipulative serial hand movements showed a clear distribution of their temporal characteristics into two distinct groups. When the hand was used as a sense organ during active touch the finger movements across objects were restricted to a slow performance range below 2 Hz. Recordings from single mechanoreceptive afferents and calculations of their receptor densities indicated that these movements have to be slow to match the temporal requirements of the sequential sampling process from the mechanoreceptor populations. In contrast, manual skills not associated with the collection of sensory information like handwriting, typing or pencil shading, were performed rapidly. Their frequencies were close to those of fastest possible tapping. Evidence is provided that the different frequency groups are associated with distinct sensory control processes. The low frequency group represents movements involving focal sensory control (Julesz 1984). The high frequency group is not performed open-loop but monitored by preattentive sensory processes. The results indicate a dual sensory control mode operating in separate frequency domains of movement.     

烟台地区手足口病931例流行病学及临床特征分析

目的 了解烟台地区手足口病住院病例的流行病学及临床特征.方法 回顾性分析我院2009-2010年住院的手足口病患儿的流行病学及临床资料.结果 931例中,5岁以下儿童881例,占94.6％,男女之比为1.5∶1;全部患儿(100.0％)均有皮疹,840例(90.2％)患儿发热,神经系统受累者121(13.0％)例.病例集中就诊于4-9月份,共计828例,占88.9％;月病例数与月平均气温呈正相关(r =0.887,P＜0.001).单因素分析显示,22(2.4％)例重症病例中农村儿童比例、发热持续时间、血清CRP水平和空腹血糖水平均显著高于普通病例;多因素分析发现,只有发热持续时间和空腹血糖水平是重症病例的独立预测因素,其比值比OR(95％ CI)分别为1.491(1.170～1.901)和1.124(1.016～1.245),P值分别为0.001和0.024.结论 本地区手足口病好发于5岁以下儿童,发病高峰为4～9月份,与本地区月平均气温正相关;发热持续时间和空腹血糖水平是重症病例的独立预测因素.多数患儿只要早诊断、早治疗,预后一般良好.     

烟台地区手足口病931例流行病学及临床特征分析

目的了解烟台地区手足口病住院病例的流行病学及临床特征。方法回顾性分析我院2009--2010年住院的手足口病患儿的流行病学及临床资料。结果931例中,5岁以下儿童881例,占94．6％,男女之比为1．5：1;全部患儿（100．0％）均有皮疹,840例（90．2％）患儿发热,神经系统受累者121（13,0％）例。病例集中就诊于4—9月份,共计828例,占88．9％;月病例数与月平均气温呈正相关（r=0．887,P〈0．001）。单因素分析显示,22（2．4％）例重症病例中农村儿童比例、发热持续时间、血清CRP水平和空腹血糖水平均显著高于普通病例;多因素分析发现,只有发热持续时间和空腹血糖水平是重症病例的独立预测因素,其比值比OR（95％CI）分别为1．491（1．170—1．901）和1．124（1．016～1．245）,P值分别为0．001和0．024。结论本地区手足口病好发于5岁以下儿童,发病高峰为4～9月份,与本地区月平均气温正相关;发热持续时间和空腹血糖水平是重症病例的独立预测因素。多数患儿只要早诊断、早治疗,预后一般良好。     

2008年深圳地区手足口病病原学调查

目的 研究2008年深圳地区手足口病病原体EV71和CoxA16感染情况,为手足口病的防治提供依据.方法 应用RT-PCR技术检测307例手足口病患儿标本病原体EV71、CoxA16基因,将PCR产物测序,并应用ChstaIW2在线分析软件进行序列分析、进化树分析.结果 不同标本中EV71的阳性率分别为:大便标本24.4%(75/307)、咽拭子为7.8%(24/307)、外周血12.5%(1/8);CoxA16的阳性率分别为,大便13.8%(28/203),咽拭子11.0%(20/181),其中EV71和CoxA16同时为阳性的有3份(0.98%);脑脊液标本未检测到EV71和CoxA16.与标准株BrCr序列比对分析,测序的14例标本中,8例的EV71新出现多个位点变异,其中2例标本的A2528G变异导致氨基酸改变,即N595D,1例标本的A2714G变异引起氨基酸改变,即1658V.进化树分析显示,有2例标本的病毒株与anhui毒株亲缘关系较近,与标准株BrCr及深圳株SHH02-6、SHZH02-40、SHZH03-58等亲缘关系较远;而其余12株与上述毒株亲缘关系较远.根据文献报道的EV71基因分型方法分析,测序的14株EV71基因型为C型.结论 在引起2008年深圳手足口病病原体中相当的比例是EV71,且可能部分是anhui病毒株的入侵.     

维C银翘片对小儿手足口病治疗效果的临床分析

目的 观察维C银翘片对小儿手足口病(Hand,foot and mouth disease,HFMD)的临床治疗效果.方法 选取来我院儿科就诊并确诊为手足口病的患儿100例为研究对象,按完全随机原则分为两组:研究组和对照组,每组50例.对照组采用利巴韦林进行治疗,研究组则采用维C银翘片进行治疗,比较两组患儿的流行病学资料和临床治疗效果指标.结果 此次研究共收集男性手足口病患儿65例,女性患儿35例.患者的年龄范围为10个月～7岁,平均年龄为(2.8±1.8)岁,所有患儿中均有皮疹的发生,其中研究组患儿皮疹持续时间为(2.5±1.6)天,对照组患儿皮疹持续时间为(2.2±1.0)天.两组患儿中仅有48名在皮疹出现时伴随着发热症状,其中研究组有28名,发热持续时间为(2.2±1.1)天,对照组有20名,发热持续时间为(2.1±1.0)天.两组患儿在年龄、皮疹持续时间和发热持续时间上均无统计学差异(P＜0.05).经治疗后两组的有效治愈率无统计学差异(X2=1.382,P＞0.05).研究组患儿的退热时间(t=-4.734,P＜0.05)和退疹时间(t=-3.311,P＜0.05)均要短于对照组,但两组在口腔溃疡的痊愈时间上无明显的统计学差异(t=-1.169,P＞0.05).结论 在取得和抗病毒西药产生的同样治疗效果的基础上,维C银翘片可以明显缩短患儿退热和退疹时间,但在患儿口腔溃疡痊愈时间方面无明显优势.     

The effect of selective attention on the gamma-band auditory steady-state response

Studies have demonstrated that selective attention can modulate the steady-state evoked potential to repetitive visual and tactile stimulation. However, examinations of the effect of attention on the auditory steady-state response (ASSR) have proven equivocal. The current experiment therefore utilized EEG to examine the effect of attention on the ASSR in healthy humans (n = 15). Auditory click trains in the beta (20 Hz) and gamma (40 Hz) ranges were randomly presented binaurally in an oddball discrimination paradigm (each frequency served as the oddball (target) in each of two blocks). A Fast Fourier Transform was used to assess the effect of attention on the ASSR (signal power), and phase consistency across trials was assessed using the phase-locking factor (PLF). As expected, both 20 and 40 Hz targets elicited a robust P300 response, with maximal amplitudes over parietal regions. For the ASSR, it was found that EEG signal power was larger to 40 Hz targets compared to 40 Hz frequent stimuli across all frontocentral electrodes. No differences in signal power were observed during 20 Hz stimulation. Finally, increased PLF values were observed for 40 Hz targets compared to frequent trials. These results provide evidence that selective attention can enhance signal power and phase-locking of the ASSR, particularly to auditory stimulation in the gamma range.     

手足口病住院患儿流行病学和临床特征分析

目的探讨手足口病住院患儿入院时流行病学和临床特征。方法回顾性总结2008年5—8月份手足口病高发季节我院收治的239例住院患儿病例资料。结果住院〉5天患儿年龄偏小（P=0．025）,3岁以下儿童构成比较高（P=0．012）;入院时体温、心率和呼吸频率均偏高（P=0．015;P=0．031或P=0．013）,最高体温I〉38℃的患儿构成比较高（P=0．023）。与年龄〉3岁患儿比较,年龄≤3岁患儿并发急性支气管炎、支气管肺炎的发生率较高（P=0．011或P=0．008）,出现心肌损害及神经系统损害表现发生率也均较高（P=0．036或P=0．017）,且出现2种以上并发症状比例更高（P=0．003）。结论应密切观察低龄儿童的病情变化,及时控制低龄患儿并发症的发生和进展。     

Cost-effectiveness of bivalent versus monovalent vaccines against hand,foot and mouth disease

ObjectivesEnterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010–2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China.MethodsWe used a static model parameterized with the national HFMD surveillance data during 2010–2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010–2013 and caregiver survey data of costs and health quality of life during 2012–2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy.ResultsIn the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2–5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively.ConclusionsBivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.