Abstract
BackgroundThere have been large-scale outbreaks of hand, foot and mouth disease (HFMD) in Mainland China over the last decade. These events varied greatly across the country. It is necessary to identify the spatial risk factors and spatial distribution patterns of HFMD for public health control and prevention. Climate risk factors associated with HFMD occurrence have been recognized. However, few studies discussed the socio-economic determinants of HFMD risk at a space scale.MethodsHFMD records in Mainland China in May 2008 were collected. Both climate and socio-economic factors were selected as potential risk exposures of HFMD. Odds ratio (OR) was used to identify the spatial risk factors. A spatial autologistic regression model was employed to get OR values of each exposures and model the spatial distribution patterns of HFMD risk.ResultsResults showed that both climate and socio-economic variables were spatial risk factors for HFMD transmission in Mainland China. The statistically significant risk factors are monthly average precipitation (OR = 1.4354), monthly average temperature (OR = 1.379), monthly average wind speed (OR = 1.186), the number of industrial enterprises above designated size (OR = 17.699), the population density (OR = 1.953), and the proportion of student population (OR = 1.286). The spatial autologistic regression model has a good goodness of fit (ROC = 0.817) and prediction accuracy (Correct ratio = 78.45%) of HFMD occurrence. The autologistic regression model also reduces the contribution of the residual term in the ordinary logistic regression model significantly, from 17.25 to 1.25 for the odds ratio. Based on the prediction results of the spatial model, we obtained a map of the probability of HFMD occurrence that shows the spatial distribution pattern and local epidemic risk over Mainland China.ConclusionsThe autologistic regression model was used to identify spatial risk factors and model spatial risk patterns of HFMD. HFMD occurrences were found to be spatially heterogeneous over the Mainland China, which is related to both the climate and socio-economic variables. The combination of socio-economic and climate exposures can explain the HFMD occurrences more comprehensively and objectively than those with only climate exposures. The modeled probability of HFMD occurrence at the county level reveals not only the spatial trends, but also the local details of epidemic risk, even in the regions where there were no HFMD case records.
Highlights
There have been large-scale outbreaks of hand, foot and mouth disease (HFMD) in Mainland China over the last decade
The results indicate that both climate and socio-economic factors were significant spatial risk factors for HFMD occurrence in Mainland China in May 2008
Our study revealed that the climate factors, such as the air temperature, relative humidity, wind speed and the precipitation, are risk factors associated with the occurrence of HFMD, which is consistent with the conclusions of previous studies in Mainland China, Taiwan and Hong Kong [2,4,19]
Summary
There have been large-scale outbreaks of hand, foot and mouth disease (HFMD) in Mainland China over the last decade. These events varied greatly across the country. Enterovirus 71 (EV71) is a common cause of hand, foot, and mouth disease (HFMD), may cause severe neurological diseases, such as encephalitis and poliomyelitis-like paralysis. Foot and mouth disease associated with EV71 infections have occurred in the Asia Pacific region since 1997 [1]. Outbreaks of HFMD have been reported many times in the countries of Western Pacific Region over the last decade [4,5,6,7]. HFMD can produce a pandemic in a short period of time due to its highly infectious characteristic, poses a serious threat to the public health
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