Abstract
Hand, foot and mouth disease (HFMD) was an emerging viral infectious disease in recent years in Shenzhen. The underlying risk factors have not yet been systematically examined. This study analyzed the short-term effect of El Niño-Southern Oscillation on pediatric HFMD in Shenzhen, China. Daily count of HFMD among children aged below 15 years old, Southern Oscillation Index (SOI), and weather variables were collected to construct the time series. A distributed lag non-linear model was applied to investigate the effect of daily SOI on pediatric HFMD occurrence during 2008–2010. We observed an acute effect of SOI variation on HFMD occurrence. The extremely high SOI (SOI = 45, with 0 as reference) was associated with increased HFMD, with the relative risk (RR) being 1.66 (95% Confidence Interval [CI]: 1.34–2.04). Further analyses of the association between HFMD and daily mean temperature and relative humidity supported the correlation between pediatric HFMD and SOI. Meteorological factors might be important predictors of pediatric HFMD occurrence in Shenzhen.
Highlights
Hand, foot and mouth disease (HFMD) is an emerging viral infection that usually affects infants and children
The most causes of HFMD are coxsackievirus A16 (CA16) and enterovirus 71 (EV71) [3,4], among which, EV71 is more commonly linked with severe symptoms, including central nervous system disorders, and even death resulting from pulmonary edema in a small proportion of children, those aged 5 years and younger [5,6]
We found that high relative humidity at lag 1 day was associated with increased HFMD occurrence (for example relative risk (RR) for relative humidity being 90% was 1.13 with 70.8% as a reference)
Summary
Foot and mouth disease (HFMD) is an emerging viral infection that usually affects infants and children. The disease is mild and self-limiting, but more severe clinical symptoms with neurological abnormalities such as meningitis, encephalitis, and polio-like paralysis may occur [2]. The most causes of HFMD are coxsackievirus A16 (CA16) and enterovirus 71 (EV71) [3,4], among which, EV71 is more commonly linked with severe symptoms, including central nervous system disorders, and even death resulting from pulmonary edema in a small proportion of children, those aged 5 years and younger [5,6]. A bimodal seasonal pattern was reported in UK with peaks in summer and late autumn/early winter [8], while the highest incidence of HFMD in Taiwan was in summer [2]. In Hong Kong, it has been suggested that the changing epidemiology of HFMD (a new peak in winter) might be due to temperature increase in winter season [10]. Considering the seasonal pattern of HFMD, it was reasonable to hypothesize that short-term changes in weather variables may affect the transmission dynamic of HFMD
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