Abstract
BackgroundLarge-scale outbreaks of hand-foot-mouth disease (HFMD) have occurred frequently and caused neurological sequelae in mainland China since 2008. Prediction of the activity of HFMD epidemics a few weeks ahead is useful in taking preventive measures for efficient HFMD control.MethodsSamples obtained from children hospitalized with HFMD in Zhengzhou, Henan, China, were examined for the existence of pathogens with reverse-transcriptase polymerase chain reaction (RT-PCR) from 2008 to 2012. Seasonal Autoregressive Integrated Moving Average (SARIMA) models for the weekly number of HFMD, Human enterovirs 71(HEV71) and CoxsackievirusA16 (CoxA16) associated HFMD were developed and validated. Cross correlation between the number of HFMD hospitalizations and climatic variables was computed to identify significant variables to be included as external factors. Time series modeling was carried out using multivariate SARIMA models when there was significant predictor meteorological variable.Results2932 samples from the patients hospitalized with HFMD, 748 were detected with HEV71, 527 with CoxA16 and 787 with other enterovirus (other EV) from January 2008 to June 2012. Average atmospheric temperature (T{avg}) lagged at 2 or 3 weeks were identified as significant predictors for the number of HFMD and the pathogens. SARIMA(0,1,0)(1,0,0)52 associated with T{avg} at lag 2 (T{avg}-Lag 2) weeks, SARIMA(0,1,2)(1,0,0)52 with T{avg}-Lag 2 weeks and SARIMA(0,1,1)(1,1,0)52 with T{avg}-Lag 3 weeks were developed and validated for description and predication the weekly number of HFMD, HEV71-associated HFMD, and Cox A16-associated HFMD hospitalizations.ConclusionSeasonal pattern of certain HFMD pathogens can be associated by meteorological factors. The SARIMA model including climatic variables could be used as an early and reliable monitoring system to predict annual HFMD epidemics.
Highlights
Hand-foot-mouth disease (HFMD) is a common infectious illness in young children, those less than 5 years old
We further evaluated whether alternative Seasonal Autoregressive Integrated Moving Average (SARIMA) models incorporating climate variables as external regressors have greater predictive power
Classification of Pathogens in the Patients with hand-foot-mouth disease (HFMD) Of the 3380 subjects admitted to the isolation wards for treatment between January 2008 and June 2012, 48 were excluded from the protocol analysis for failing to meet inclusion criteria with respect definition of HFMD. 3332 hospitalized with HFMD cases, 2932 children provided stool samples for testing, 201 were severe and 5 died of HFMD. 93.5% patients were under 5 years old, the youngest was 5 months old and the oldest was 12.5 years old
Summary
Hand-foot-mouth disease (HFMD) is a common infectious illness in young children, those less than 5 years old. Numerous large outbreaks of HFMD have occurred in Eastern and Southeastern Asian countries, including Singapore, Malaysia, Japan, and China since 1997 [1,2,3,4,5], which have caused death and neurological sequelae, and have become a growing public health threat. Human enterovirus 71 (HEV71) and Coxsackievirus A16 (CoxA16) are the major causative agents of this disease [6,7]. Warning of HFMD outbreaks could improve the efficiency of control campaigns and help to take prevention actions to delay the epidemic, reducing its impact on health system. Large-scale outbreaks of hand-foot-mouth disease (HFMD) have occurred frequently and caused neurological sequelae in mainland China since 2008. Prediction of the activity of HFMD epidemics a few weeks ahead is useful in taking preventive measures for efficient HFMD control
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