Abstract
BackgroundHand, foot, and mouth disease (HFMD) outbreaks leading to clinical and fatal complications have increased since late 1990s; especially in the Asia Pacific Region. Outbreaks of HFMD peaks in the warmer season of the year, but the underlying factors for this annual pattern and the reasons to the recent upsurge trend have not yet been established. This study analyzed the effect of short-term changes in weather on the incidence of HFMD in Singapore.MethodsThe relative risks between weekly HFMD cases and temperature and rainfall were estimated for the period 2001–2008 using time series Poisson regression models allowing for over-dispersion. Smoothing was used to allow non-linear relationship between weather and weekly HFMD cases, and to adjust for seasonality and long-term time trend. Additionally, autocorrelation was controlled and weather was allowed to have a lagged effect on HFMD incidence up to 2 weeks.ResultsWeekly temperature and rainfall showed statistically significant association with HFMD incidence at time lag of 1–2 weeks. Every 1°C increases in maximum temperature above 32°C elevated the risk of HFMD incidence by 36% (95% CI = 1.341–1.389). Simultaneously, one mm increase of weekly cumulative rainfall below 75 mm increased the risk of HFMD by 0.3% (CI = 1.002–1.003). While above 75 mm the effect was opposite and each mm increases of rainfall decreased the incidence by 0.5% (CI = 0.995–0.996). We also found that a difference between minimum and maximum temperature greater than 7°C elevated the risk of HFMD by 41% (CI = 1.388–1.439).ConclusionOur findings suggest a strong association between HFMD and weather. However, the exact reason for the association is yet to be studied. Information on maximum temperature above 32°C and moderate rainfall precede HFMD incidence could help to control and curb the up-surging trend of HFMD.
Highlights
Hand foot and mouth disease (HFMD) is caused by a number of different enteroviruses, among which are enterovirus 71 (EV71) and coxsackie A16 (CA16)
The HFMD incidence was significantly associated with short term variability of weekly temperature difference (Tp), minimum temperature, maximum temperature, and cumulative rainfall at time lag of 1–2 weeks
Our findings showed that high weekly maximum temperature and a large difference of minimum and maximum temperature increased the risk of HFMD incidence in the subsequent 1–2 weeks
Summary
Hand foot and mouth disease (HFMD) is caused by a number of different enteroviruses, among which are enterovirus 71 (EV71) and coxsackie A16 (CA16). HFMD inflicts mainly children with mild clinical symptoms include fever, blisters and sores in mouth, palms and soles following 3–7 days of incubation period and a patient generally recovers in 7–10 days. HFMD can be asymptomatic and it is possible for a recovered person to be infected again by different serotypes of enteroviruses [1]. There is no specific treatment or vaccine available; preventive measures such as avoid direct contact with infective patients, disinfection of viral contaminated items or premises, and good personal hygiene practices remain the only effective methods to disrupt disease transmission. Foot, and mouth disease (HFMD) outbreaks leading to clinical and fatal complications have increased since late 1990s; especially in the Asia Pacific Region.
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