Abstract
BackgroundHand, foot, and mouth disease (HFMD) raises an urgent public health issue in the Asia-Pacific region, especially in China. The associations between weather factors and HFMD have been widely studied but with inconsistent results. Moreover, previous studies utilizing ecological design could not rule out the bias of exposure misclassification and unobserved confounders.MethodsWe used case-crossover analysis to assess the associations of weather factors on HFMD. Individual HFMD cases from 2009 to 2012 in Guangdong were collected and cases located within 10 km of the meteorological monitoring sites were included. Lag effects were examined through the previous 7 days. In addition, we explored the variability by changing the distance within 20 km and 30 km.ResultsWe observed associations between HFMD and weather factors, including temperature and relative humidity. An approximately U-shaped relationship was observed for the associations of temperature on HFMD across the same day and the previous 7 days, while an approximately exponential-shaped was seen for relative humidity. Statistically significant increases in rates of HFMD were associated with each 10-unit increases in temperature [Excess rate (ER): 7.7%; 95% Confidence Interval (CI): 3.9, 11.7%] and relative humidity (ER: 1.9%; 95% CI: 0.7, 3.0%) on lag days 0–6, when assessing within 10 km of the monitoring sites. Potential thresholds for temperature (30.0 °C) and relative humidity (70.3%) detected showed associations with HFMD. The associations remained robust for 20 km and 30 km.ConclusionsOur study found that temperature and relative humidity are significantly associated with the increased rates of HFMD. Thresholds and lag effects were observed between weather factors and HFMD. Our findings are useful for planning on targeted prevention and control of HFMD.
Highlights
Hand, foot, and mouth disease (HFMD) raises an urgent public health issue in the Asia-Pacific region, especially in China
Of the 921,499 HFMD cases during the study period, 10.92% of cases were included within 10 km of the monitoring sites, 30.49% cases for 20 km, and 53.23% cases for 30 km
Our study contributes to the limited knowledge of quantifying weather effects on HFMD at the individual level using a case-crossover design
Summary
Foot, and mouth disease (HFMD) raises an urgent public health issue in the Asia-Pacific region, especially in China. The associations between weather factors and HFMD have been widely studied but with inconsistent results. At least in mainland China, HFMD was reported as the infectious disease with highest yearly incidence with a 9 year average (114.48 per 100,000) from 2004 to 2013 [2]. Weather factors (e.g., temperature and relative humidity) have been widely reported as having associations with HFMD in previous studies. One of our preceding studies found that temperature (relative risk, RR: 1.039; 95% CI: 1.028, 1.050) and relative humidity (RR: 1.015; 95% CI: 1.010, 1.021) were statistically associated with HFMD incidence using a Bayesian spatiotemporal model [6]
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