Abstract
Hand, foot and mouth disease (HFMD) has high prevalence around the world, with serious consequences for children. Due to the long survival period of HFMD virus in ambient air, air pollutants may play a critical role in HFMD epidemics. We collected data on daily cases of HFMD among children aged 0-14 years in Ningbo City between 2014 and 2016. Distributed lag nonlinear models were used to assess the effects of particulate matter (PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) on the daily incidence of HFMD among children, with analyses stratified by gender and age. Compared with moderate levels of air pollution, high SO2 levels had a relative risk (RR) of 2.32 (95% CI 1.42-3.79) and high NO2 levels had a RR of 2.01 (95% CI 1.22-3.31). The RR of O3 was 2.12 (95% CI 1.47-3.05) and that of PM2.5 was 0.77 (95% CI 0.64-0.92) at moderate levels of air pollution. Specifically, high levels of SO2 and NO2 had RRs of 2.39 (95% CI 1.44-3.96) and 2.02 (95% CI 1.21-3.39), respectively, among 0-4-year-old children, while high O3 had an RR of 2.31 (95% CI 1.09-4.89) among 5-14-year-old children. Our findings suggest significant associations of high SO2 and NO2 levels and moderate O3 levels in HFMD epidemics, and also indicate that air pollution causes lagged effects on HFMD epidemics. Our study provides practical and useful data for targeted prevention and control of HMFD based on environmental evidence.
Highlights
Hand, foot and mouth disease (HFMD) is a common illness caused by a variety of enteroviruses, such as enterovirus 71 or Coxsackie, and usually affects children [1]
During the period from 2014 to 2016, a total of 48 209 HFMD cases occurred in Ningbo city, 28 606 (59.34%) of which were
Previous studies have indicated that temperature and some air pollutants including PM10 are associated with risk of HFMD [18, 29, 30], few focus on analysis of the effects of PM2.5 accompanied by the other air pollutants such as SO2, NO2 and O3
Summary
Foot and mouth disease (HFMD) is a common illness caused by a variety of enteroviruses, such as enterovirus 71 or Coxsackie, and usually affects children [1]. A series of reports on individual cases of HFMD and larger outbreaks have been published across the world. Experimental studies have indicated that this disease is self-limiting and the clinical symptoms are mild, such as rashes or mucosal herpes, severe complications, such as meningitis or encephalitis, occasionally occur. These can result in death, among young children under 5 years of age [9]. Determining the risk factors so that we can establish an early warning system remains a crucial part of the measures to prevent and control HFMD outbreaks, and reduce the burden of the disease for children [12]
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