Abstract
Hand, foot, and mouth disease (HFMD) has threatened East Asia for more than three decades and has become an important public health issue owing to its severe sequelae and mortality among children. The lack of effective treatment and vaccine for HFMD highlights the urgent need for efficiently integrated early warning surveillance systems in the region. In this study, we try to integrate the available surveillance and weather data in East Asia to elucidate possible spatiotemporal correlations and weather conditions among different areas from low to high latitude. The general additive model (GAM) was applied to understand the association between HFMD and latitude, as well as meteorological factors for islands in East Asia, namely, Japan, Taiwan, Hong Kong, and Singapore, from 2012 to 2014. The results revealed that latitude was the most important explanatory factor associated with the timing and amplitude of HFMD epidemics (P < 0.0001). Meteorological factors including higher dew point, lower visibility, and lower wind speed were significantly associated with the rise of epidemics (P < 0.01). In summary, weather conditions and geographic location could play some role in affecting HFMD epidemics. Regional integrated surveillance of HFMD in East Asia is needed for mitigating the disease risk.
Highlights
Hand, foot, and mouth disease (HFMD) is a syndrome which usually affects children below the age of five [1,2,3]
Some cases develop into severe clinical manifestations, such as encephalitis, aseptic meningitis, acute flaccid paralysis (AFP), neurogenic pulmonary edema, cardiopulmonary failure, and even death in the case of enterovirus 71 (EV71) infection [6,7,8,9]
This study aims (1) to determine whether the known meteorological factors associated with HFMD are appropriate to island-type countries and (2) to examine whether different geographical zones and latitudinal ranges are associated with the incidence of HFMD within or between those island countries
Summary
Foot, and mouth disease (HFMD) is a syndrome which usually affects children below the age of five [1,2,3]. Cases with HFMD, CNS manifestations, and death were associated with EV71 in Japan in 1973 and 1978 [9, 13]. In the late 20th century, a vast death toll related to HFMD occurred in Southeast Asia. An outbreak of around 1.5 million estimated HFMD cases occurred in Taiwan and led to 405 severe cases and 78 dead children [1]. Approximately 7.2 million probable cases of HFMD were reported in China during 2008 to 2012 [15]. HFMD and enterovirus-derived severe syndromes have resulted in a heavy disease burden, especially to children, in this area
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