Abstract
Severe outbreaks of hand, foot and mouth disease (HFMD) have occurred in China for decades. Our understanding of the HFMD transmission process and its determinants is still limited. In this paper, factors that affect the local variation of HFMD transmission process were studied. Three classes of factors, including meteorological, demographic and public health intervention factors, were carefully selected and their effects on HFMD transmission were investigated with Pearson’s correlation coefficient and multiple linear regression models. The determining factors for the variation of HFMD transmission were different for the southeastern and the northwestern regions of China. In the northwest, fadeouts occurred yearly, and the average age at infection and the fadeout were negatively correlated with the population density. In the southeast, HFMD transmission was governed by the combined effects of the birth rate, the relative humidity and the interaction of the Health System Performance and the log of the population density. When the Health System Performance was low, HFMD transmission increased with the population density, but when the Health System Performance was high, the better health performance counteracted the transmission increase due to the higher population density.
Highlights
Hand foot and mouth disease (HFMD) is a childhood infectious disease that is principally caused by enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16)
Since the average age at infection is inversely related to the transmission rate, we used it as a transmissibility index for HFMD to investigate the determinants of HFMD transmission
We studied the response of HFMD transmission to meteorological, demographic and public health intervention factors using the average age at infection calculated from age-specific incidence data at the province level
Summary
Hand foot and mouth disease (HFMD) is a childhood infectious disease that is principally caused by enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16). In China, HFMD shows characteristic spatial incidence patterns [3,4]. The annual peak timing of incidence seasonality varied from April in the southern region to July in the northernmost region [3]; the number of HFMD cases reported varied greatly from the south to the north and from the east to west [5,6]. Research effort about HFMD spatio-temporal patterns in China has mainly focused on spatial clustering in a locale [7,8], effects of meteorological factors on cases seasonality [9,10]. There has been only a few studies on the factors that determine the spatial incidence patterns [3,4,5,6,11,12], and these investigations have focused on the association of the climatic or social factors with the nationwide variation in the number of reported cases
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