Using a Bayesian belief network model for early warning of death and severe risk of HFMD in Hunan province, China

Yilan Liao,Shixiong Hu,Lidong Gao,Xiaochi Liu,Kaiwei Luo,Jinfeng Wang,Wei Huang,Bing Xu

doi:10.1007/s00477-018-1547-8

Abstract

Hand, foot, and mouth disease (HFMD) is a global infectious disease resulting in millions of cases and even hundreds of deaths. Although a newly developed formalin-inactivated EV71 (FI-EV71) vaccine is effective against EV71, which is a major pathogen for HFMD, no vaccine against HFMD itself has yet been developed. Therefore, establishing a sensitive and accurate early warning system for HFMD is important. The early warning model for HFMD in the China Infectious Disease Automated-alert and Response System combines control chart and spatial statistics models to detect spatiotemporal abnormal aggregations of morbidity. However, that type of early warning for HFMD just involves retrospective analysis. In this study, we apply a Bayesian belief network (BBN) to estimate the increased risk of death and severe HFMD in the next month based on pathogen detection and environmental factors. Hunan province, one of the regions with the highest prevalence of HFMD in China, was selected as the study area. The results showed that compared with the traditional early warning model for HFMD, the proposed method can achieve a very high performance evaluation (the average AUC tests were more than 0.92). The model is also simple and easy to operate. Once the structure of the BBN is established, the increased risk of death and severe HFMD in the next month can be estimated based on any one node in the BBN.

Highlights

Hand, foot, and mouth disease (HFMD) is a viral illness common in infants and children younger than 5 years old
A newly developed formalin-inactivated EV71 (FI-EV71) vaccine is effective against EV71, which is a major pathogen for HFMD, no vaccine against HFMD itself has yet been developed
The results showed that compared with the traditional early warning model for HFMD, the proposed method can achieve a very high performance evaluation

Summary

Introduction

Foot, and mouth disease (HFMD) is a viral illness common in infants and children younger than 5 years old. Most countries there have reported HFMD epidemics in the past 30 years, including Australia (Burry et al 1968), Japan (Daisuke and Masahiro 2011), South Korea (Ryu et al 2010), Malaysia (Chua and Kasri 2011), Singapore (Ang et al 2009), Thailand (Puenpa et al 2011), Vietnam (Tu et al 2007), and China. During 2008–2013, 9,048,244 probable cases of HFMD were reported to the Chinese Center for Disease Control and Prevention (China CDC), of which 355,563 (3.9%) were laboratory confirmed, 92,503 (1.02%) were severe, and 2,707 (0.03%) were fatal (Xing et al 2014a, b). Pathogen detection results have shown that EV71 causes approximately 50% of cases of HFMD in China and that it is a significant cause of morbidity and mortality (Pallansch and Roos 2007; Lin et al 2002). The early detection of the aberration of infectious disease occurrence and the estimated disease outbreak risk is significant for slowing down the epidemic spread and reducing the morbidity and death caused by the disease

Methods

Results

Conclusion