Detecting spatial-temporal cluster of hand foot and mouth disease in Beijing, China, 2009-2014.

Haikun Qian,Jie Li,Baiwei Liu,Da Huo,Quanyi Wang,Xiaona Wu,Xitai Li,Yi Tian,Xiaoli Wang,Lei Jia,Zhiyong Gao

doi:10.1186/s12879-016-1547-6

Abstract

BackgroundThe incidence of hand, foot, and mouth disease (HFMD) is extremely high, and has constituted a huge disease burden throughout Beijing in recent years. This study aimed to determine the spatiotemporal distribution and epidemic characteristics of HFMD.MethodsDescriptive statistics was used to analyze the data and estimate the epidemic peaks in 2009–2014. Space–time scanning detected spatiotemporal clusters and identified high-risk locations. Global and local Moran’s I statistics were used to measure the spatial autocorrelation. Geocoding was performed in ArcGIS, based on the present address codes of the patients and the centroids of the towns. Maps were created in ArcGIS to show the geographic spread of HFMD.ResultsIn total, 220,451probable cases of HFMD were reported in Beijing between January 2009 and December 2014: 12,749 (5.78 %) were laboratory confirmed, and 35 (0.02 %) were fatal. The median age of reported cases was 3.12 years (interquartile range 1.96–4.39). Coxsackievirus A16 (CV-A16), enterovirus 71 (EV-A71), and other enteroviruses accounted for 39.31, 35.36, and 25.33 % of the 12,749 confirmed cases, respectively. Many more severe cases were caused by EV-A71 (χ2 = 186.41, df = 1, P < 0.001) and other enteroviruses (χ2 = 156.44, df = 1, P < 0.001) than by CV-A16. A large single distinct peak occurred between May and July each year. Spatiotemporal clusters of HFMD were identified in Beijing during 2009–2014. The most likely clusters were detected and tended to move from the southwest (Fengtai and Daxing) southeastwards to Daxing and Tongzhou in 2009–2014. The incidence of HFMD was not randomly distributed, but showed global and local spatial autocorrelations.ConclusionsThere were obvious spatiotemporal clusters of HFMD in Beijing in 2009–2014. High-incidence areas mainly occurred at the junctions of urban and rural zones. More attention should be paid to the epidemiological and spatiotemporal characteristics of HFMD to establish new strategies for its control. Health issues should be especially promoted in kindergartens and at urban–rural junctions.

Highlights

The incidence of hand, foot, and mouth disease (HFMD) is extremely high, and has constituted a huge disease burden throughout Beijing in recent years
Hand, foot, and mouth disease (HFMD) is an infectious disease caused by a number of enteroviruses, predominantly enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) [1]
A “laboratory-confirmed case” was defined as a probable case with laboratory evidence of HFMD based on nucleic acid amplification, virus isolation, or the detection of neutralizing antibodies

Summary

Introduction

The incidence of hand, foot, and mouth disease (HFMD) is extremely high, and has constituted a huge disease burden throughout Beijing in recent years. Foot, and mouth disease (HFMD) is an infectious disease caused by a number of enteroviruses, predominantly enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) [1]. As a self-limiting illness, typically including fever, skin eruptions on the hands and feet, and vesicles in the mouth, HFMD is common in children younger than 5 years, especially those aged 12–23 months [2]. In 1997, an outbreak of HFMD with 4253 cases and 41 deaths were reported in Malaysia [7]. In 1998, the largest EV-A71 epidemic reported 129,106 cases occurred and 78 died in Taiwan [8]. In Vietnam, more than 200,000 cases and 207 died were reported between 2011 and 2012 [11]

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