Abstract
BackgroundLiterature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors.MethodsBased on daily time-series data in eight major cities in Guangdong, China during 2009–2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors.ResultsThere were a total of 400,408 pediatric HFMD cases (children aged 0–14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30–1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00–1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city’s latitude and longitude with an explained heterogeneity of 32 %.ConclusionsDaily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1846-y) contains supplementary material, which is available to authorized users.
Highlights
Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities
This study aims to investigate the meteorological effects on pediatric HFMD occurrences, and to examine potential effect modification by geographic factors in eight major cities in Guangdong, China
During the 5-year period from 1 January, 2009 to 31 December, 2013, there were a total of 400,408 HFMD cases, with an annual morbidity of 16.6 cases per 1,000 children
Summary
Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors. Foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children under five, characterized with typical symptoms of fever, skin eruptions on hands and feet, and vesicles in oropharynx [1]. In mainland China, HFMD is monitored as a class “C” notifiable disease with 2,712,925 reported cases and 384 deaths in 2014 [2]. The biggest province in South China, has suffered frequently from HFMD epidemics, because of the large population density and mobility and the typical tropical or subtropical climate
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