Abstract
Hand, foot and mouth disease (HFMD) has been a substantial burden throughout the Asia-Pacific countries over the past decades. For the purposes of disease prevention and climate change health impact assessment, it is important to understand the temperature–disease association for HFMD in different geographical locations. This study aims to assess the impact of temperature on HFMD incidence in an inland city and a coastal city and investigate the heterogeneity of temperature–disease associations. Daily morbidity data and meteorological variables of the study areas were collected for the period from 2007 to 2012. A total of 108,377 HFMD cases were included in this study. A distributed lag non-linear model (DLNM) with Poisson distribution was used to examine the nonlinear lagged effects of daily mean temperature on HFMD incidence. After controlling potential confounders, temperature showed significant association with HFMD incidence and the two cities demonstrated different impact modes (I2 = 96.1%; p < 0.01). The results highlight the effect of temperature on HFMD incidence and the impact pattern may be modified by geographical localities. Our findings can be a practical reference for the early warning and intervention strategies of HFMD.
Highlights
Hand, foot and mouth disease (HFMD) is a viral infection caused by a group of enteroviruses, mainly coxsackievirus A16 (CA16) and enterovirus 71 (EV71) [1,2]
We mainly focused on child HFMD cases (0–5 years), which accounted for the majority of the total cases and were vulnerable to the temperature
This is the first study in China to assess the relationship between temperature and HFMD incidence in different areas using a distributed lag non-linear model (DLNM) on a daily basis, including properly evaluating the nonlinear associations and cumulative risks related to temperatures for different lag days
Summary
Foot and mouth disease (HFMD) is a viral infection caused by a group of enteroviruses, mainly coxsackievirus A16 (CA16) and enterovirus 71 (EV71) [1,2]. The disease is characterized by a distinct clinical presentation of fever, or vesicular exanthema on the hands, feet, mouth, or buttocks [3]. Serious complications can result from infection such as meningitis and encephalitis, which can lead to death [4]. HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal–oral transmission. Infected persons are most contagious during the first week of the illness, but the period of communicability can last for several weeks. It was estimated that the number of patients with neurological or cardiopulmonary complications was 16,500 each year in
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