Hand, Foot, And Mouth Disease Data Research Articles

Non-linear association between daily mean temperature and children’s hand foot and mouth disease in Chongqing, China

Chongqing was seriously affected by hand, foot, and mouth disease (HFMD), but the relationships between daily mean temperature and the incidence of HFMD remain unclear. This study used distributed lag nonlinear model to evaluate the effect of daily mean temperature on the incidence of HFMD in children aged < 5 years in Chongqing. Daily HFMD data from 2012 to 2019 in Chongqing were retrieved from the notifiable infectious disease surveillance system. A total of 413,476 HFMD cases aged < 5 years were reported in Chongqing from 2012 to 2019. The exposure–response curve of daily mean temperature and daily HFMD cases was wavy-shaped. The relative risks (RRs) increased as daily mean temperature below 5.66 °C or above 9.43 °C, with two peaks at 16.10 °C and 26.68 °C. The RRs reached the highest when the daily mean temperature at 26.68 °C on the current day (RR = 1.20, 95% CI 1.09–1.32), followed by the daily mean temperature at 16.10 °C at lag 5 days (RR = 1.07, 95% CI 1.05–1.08). The RRs for girls and daycare children were much higher than those for boys and scattered children, respectively. Taken together, daily mean temperature has strong effect on HFMD in children aged < 5 years old in Chongqing, particularly for girls and daycare children.

Effects of behaviour change on HFMD transmission

ABSTRACT We propose a hand, foot and mouth disease (HFMD) transmission model for children with behaviour change and imperfect quarantine. The symptomatic and quarantined states obey constant behaviour change while others follow variable behaviour change depending on the numbers of new and recent infections. The basic reproduction number R 0 of the model is defined and shown to be a threshold for disease persistence and eradication. Namely, the disease-free equilibrium is globally asymptotically stable if R 0 ≤ 1 whereas the disease persists and there is a unique endemic equilibrium otherwise. By fitting the model to weekly HFMD data of Shanghai in 2019, the reproduction number is estimated at 2.41. Sensitivity analysis for R 0 shows that avoiding contagious contacts and implementing strict quarantine are essential to lower HFMD persistence. Numerical simulations suggest that strong behaviour change not only reduces the peak size and endemic level dramatically but also impairs the role of asymptomatic transmission.

Epidemiological characteristics and Spatial-temporal clustering of hand, foot and mouth disease in Shanxi province, 2009-2020

Objective: To analyze the epidemiology and spatial-temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Shanxi province. Methods: The data of HFMD in Shanxi province from 2009 to 2020 were collected from notifiable disease management information system of Chinese information system for disease control and prevention and analyzed by descriptive epidemiology, Joinpoint regression, spatial autocorrelation analysis and spatio- temporal scanning analysis. Results: A total of 293 477 HFMD cases were reported in Shanxi province from 2009 to 2020, with an average annual incidence of 67.64/100 000 (293 477/433 867 454), severe disease rate of 5.36/100 000 (2 326/433 867 454), severe disease ratio of 0.79%(2 326/293 477), mortality of 0.015/100 000 (66/433 867 454), and fatality rate of 22.49/100 000 (66/293 477). The reported incidence rate, severe disease rate, mortality rate and fatality rate of HFMD showed decreasing trends. The main high-risk groups were scattered children and kindergarten children aged 0-5. The incidence of HFMD had obvious seasonal variation, with two peaks every year: the main peak was during June-July, the secondary peak was during September-October and the peak period is from April to November. A total of 13 942 laboratory cases were confirmed, with a diagnosis rate of 4.75% (13 942/293 477), including 4 438 (35.11%, 4 438/293 477) Enterovirus A71 (EV-A71) positive cases, 4 609 (33.06%, 4 609/293 477) Coxsackievirus A16 (CV-A16) positive cases, and 4 895 (31.83%, 4 895/293 477) other enterovirus positive cases. There was a spatial positive correlation (Moran's I ranged from 0.12 to 0.58, all P<0.05) and the spatial clustering was obvious. High-risk regions were mainly distributed in Taiyuan in central Shanxi province, Linfen and Yuncheng in southern Shanxi province, and Changzhi in southeastern Shanxi province. Spatial-temporal scanning analysis revealed 1 the most likely cluster and 8 secondary likely clusters, of which the most likely cluster (RR=2.65, LLR=22 387.42, P<0.001) located in Taiyuan and Jinzhong city, Shanxi province, including 12 counties (districts), and accumulated from April 1, 2009 to November 30, 2018. Conclusions: There was obvious spatial-temporal clustering of HFMD in Shanxi province, and the epidemic situation was in decline. The key areas were the districts in urban areas and the counties adjacent to it. Meanwhile, the monitoring and classification of other enterovirus types of HFMD should be strengthened.

Spatiotemporal characteristics of hand,foot and mouth disease and influencing factors in China from 2011 to 2018

Objective: To analyze the spatiotemporal characteristics of hand,foot and mouth disease (HFMD) in China, explore the association of socioeconomic, population and health services factors with the incidence of HFMD in China, and provide information for the prevention and control of HFMD. Methods: Bayesian spatiotemporal model was used to fit the data of HFMD, evaluate the spatiotemporal variation of HFMD, and identify the potential association between the risk of HFMD and social, economic, population and health services. Results: From 2011 to 2018, a total of 17 118 050 HFMD cases, including 2 283 deaths, were reported in China. The reported incidence showed a fluctuating increase trend from 2011 to 2014, and a fluctuating decrease trend from 2014 to 2018. Meanwhile, there was a fluctuating decrease trend of mortality rate. The incidence of HFMD had spatial clustering, with the highest incidence in southern China with hot spot and high risk areas, and the lowest incidence in northwestern China where cold spot and low risk areas were found. The risk for HFMD was associated with GDP per capita (RR=3.54), number of industrial enterprises above designated size of 10 000 people (RR=1.61), urbanization rate (RR=3.00), birth rate (RR=2.36), number of beds in medical institutions per 10 000 people (RR=3.40), and green area in parks per capita (RR=0.57). Conclusions: The hotspot area for HFMD prevention and control in China was in the southeast coastal provinces from 2011 to 2018. In order to reduce the incidence of HFMD, it is necessary to increase the green area in parks per capita while accelerating urbanization process.

The impact of anti-COVID-19 nonpharmaceutical interventions on hand, foot, and mouth disease-A spatiotemporal perspective in Xi'an, northwestern China.

Growing evidence has shown that anti‐COVID‐19 nonpharmaceutical interventions (NPIs) can support prevention and control of various infectious diseases, including intestinal diseases. However, most studies focused on the short‐term mitigating impact and neglected the dynamic impact over time. This study is aimed to investigate the dynamic impact of anti‐COVID‐19 NPIs on hand, foot, and mouth disease (HFMD) over time in Xi'an City, northwestern China. Based on the surveillance data of HFMD, meteorological and web search data, Bayesian Structural Time Series model and interrupted time series analysis were performed to quantitatively measure the impact of NPIs in sequent phases with different intensities and to predict the counterfactual number of HFMD cases. From 2013 to 2021, a total number of 172,898 HFMD cases were reported in Xi'an. In 2020, there appeared a significant decrease in HFMD incidence (−94.52%, 95% CI: −97.54% to −81.95%) in the first half of the year and the peak period shifted from June to October by a small margin of 6.74% compared to the previous years of 2013 to 2019. In 2021, the seasonality of HFMD incidence gradually returned to the bimodal temporal variation pattern with a significant average decline of 61.09%. In particular, the impact of NPIs on HFMD was more evident among young children (0–3 years), and the HFMD incidence reported in industrial areas had an unexpected increase of 51.71% in 2020 autumn and winter. Results suggested that both direct and indirect NPIs should be implemented as effective public health measures to reduce infectious disease and improve surveillance strategies, and HFMD incidence in Xi'an experienced a significant rebound to the previous seasonality after a prominent decline influenced by the anti‐COVID‐19 NPIs.

Impact of weather factors on hospital admission of hand, foot and mouth disease under climate change scenarios in Ho Chi Minh City.

Hand, foot, and mouth disease (HFMD) is one of the most common communicable diseases in Vietnam. The present study aims to examine the association between weather factors and HFMD in association with hospitalisation. Daily and weekly weather and HFMD data from 2013 to 2018 in Ho Chi Minh City were deployed. Poisson regression model combined with a distributed lag non-linear model (DLNM) was applied to examine the relationship between weather factors and HFMD. The forecasting model for HFMD was performed by using the Global Climate Model (GCM) and Yasushi Honda model. The result showed that the average daily temperature induces an increase in the risk of HFDM hospitalisation was 26°C- 30.1°C. The average daily humidity also caused increasing the risk of hospitalisation of HFMD was 75% - 85%. However, the average daily humidity <60% reduced the risk of getting HFMD. The study provides quantitative evidence that the incidence of HFMD cases was associated with meteorological variables including average daily temperature and daily humidity in Ho Chi Minh City. This findings implies that there is a need for building a public health policy for eliminating and mitigating climate change impact on community health in a resilient approach.

Trends of morbidity and mortality of hand foot and mouth disease in China, 2008–2017

Objective To analyze the trends of morbidity and mortality of hand foot and mouth disease (HFMD) in China from 2008 to 2017, and provide scientific evidence for the development of HFMD prevention and control strategies. Methods The morbidity and mortality data of HFMD in China during this period were collected from China Public Health Science Data Center and the demographic data were collected from National Bureau of Statistics. Software Excel 2016 was used to establish the morbidity and mortality database of HFMD reports. Software JoinPoint 4.9.0.0 was used for JoinPoint regression analysis to estimate the annual average percentage change (AAPC) of reported morbidity and mortality of HFMD in different age groups and in different provinces in China from 2008 to 2017, and analyze the changing trend of HFMD morbidity and mortality. Results A total of 18 183 889 cases of HFMD were reported from January 2008 to December 2017, the average annual reported morbidity was 134.75/100 000. A total of 3 632 deaths were reported, with an annual average reported mortality of 0.027/100 000. The morbidity and mortality were stable from 2008 to 2017 (P>0.05), but the mortality showed a decreasing trend from 2010 to 2017 (APC: −22.98%, 95%CI: −29.64% to −15.70%, P 0.05). The mortality in age group 0–7 years remained stable (P>0.05). Conclusion The overall HFMD morbidity and mortality in China from 2008 to 2017 were relatively stable, but the mortality showed a decreasing trend from 2010 to 2017. The morbidity of HFMD showed increasing trend in Southern China, Southwestern China, Central China and Eastern China, but the morbidity of HFMD declined in northern China and northeastern China. The morbidity of HFMD was higher in children aged 0 to 7 years. It is suggested that HFMD prevention and control should be strengthened according to the change of HFMD epidemic in different areas to reduce the morbidity and mortality of HFMD.

Analysis of the temporal and spatial distribution characteristics of hand-foot-and-mouth disease in Zhongshan City from 2013 to 2018

Objective To analyze the temporal-spatial clustering of hand-foot-and-mouth disease (HFMD) in Zhongshan City from 2013 to 2018, so as to provide a theoretical basis for prevention and control of HFMD. Methods The epidemic data of HFMD in Zhongshan City from 2013 to 2018 was collected. Combining spatial autocorrelation analysis and spatial-temporal scanning to realize spatial-temporal analysis, and visualize the analysis results. Results A total of 97 214 cases of HFMD were reported in Zhongshan City from 2013 to 2018, with an average annual incidence of 493.40/100 000. Children aged 0-5 years old accounted for 95.38% of the total cases. The distribution over time was obviously bimodal. Spatial autocorrelation analysis results showed that there was an obvious positive spatial correlation in HFMD incidence from 2015 to 2016. High risk clusterings were detect by year-by-year time-space scanning from 2013 to 2018, mainly in the suburban border towns on the west side of the central city. The high-incidence aggregation period was basically consistent with the trend of the incidence curve. Conclusions A certain characteristic of spatiotemporal clustering is shown in the HFMD incidence in Zhongshan City from 2013 to 2018. The clustering degree is higher at the turn of spring and summer, summer and autumn. And future prevention and control work should be strengthen at that time..

RISK FACTORS OF HAND, FOOT AND MOUTH DISEASE (HFMD) OUTBREAK CASES AMONG CHILDREN UNDER FIVE YEARS OLD IN NORTH EASTERN STATE OF MALAYSIA

Hand, foot and mouth disease (HFMD) outbreak is a contagious illness and typically occur in the children of less than five years old. The was a marked rise in the number of HFMD outbreak cases was observed in Kelantan, a north-eastern State of Malaysia in 2018. This study aimed to determine risk factors for HFMD outbreak cases to inform potential strategies for prevention and control to reduce the occurrence of outbreak in the population. The data of HFMD cases was collected from Communicable Disease Control Information System (CDCIS) e-Notifikasi, managed by the Disease Control Division, Ministry of Health Malaysia for 2018. Totally, 1026 HFMD data cases were retrieved in the descriptive study. Of the total cases, a comparative cross-sectional analysis was performed on 70 HFMD outbreak cases and 198 non-outbreak cases using simple random sampling. Multiple logistic regression test was done to identify factors associated with HFMD outbreak cases among the children aged under five years old. Home-care (aOR 0.008; 95% CI: 0.001, 0.067, p-value&lt;0.001), attendance to the kindergarten (aOR 0.330; 95% CI: 0.114, 0.957, p-value=0.041) and warm season (aOR 0.154; 95% CI: 0.043, 0.557, p-value=0.004) were found to have a significant association to lower the risk for HFMD outbreak cases in the study. This study was able to identify few significant factors associated with the HFMD outbreak which should be considered by the stakeholders. Further research to evaluate the epidemiology of the HFMD outbreak in Malaysia are needed.

Spatial-temporal heterogeneity and meteorological factors of hand-foot-and-mouth disease in Xinjiang, China from 2008 to 2016.

The study aims to depict the temporal and spatial distributions of hand-foot-and-mouth disease (HFMD) in Xinjiang, China and reveal the relationships between the incidence of HFMD and meteorological factors in Xinjiang. With the national surveillance data of HFMD in Xinjiang and meteorological parameters in the study area from 2008 to 2016, in GeoDetector Model, we examined the effects of meteorological factors on the incidence of HFMD in Xinjiang, China, tested the spatial-temporal heterogeneity of HFMD risk, and explored the temporal-spatial patterns of HFMD through the spatial autocorrelation analysis. From 2008 to 2016, the HFMD distribution showed a distinct seasonal pattern and HFMD cases typically occurred from May to July and peaked in June in Xinjiang. Relative humidity, precipitation, barometric pressure and temperature had the more significant influences on the incidence of HFMD than other meteorological factors with the explanatory power of 0.30, 0.29, 0.29 and 0.21 (P<0.000). The interaction between any two meteorological factors had a nonlinear enhancement effect on the risk of HFMD. The relative risk in Northern Xinjiang was higher than that in Southern Xinjiang. Global spatial autocorrelation analysis results indicated a fluctuating trend over these years: the positive spatial dependency on the incidence of HFMD in 2008, 2010, 2012, 2014 and 2015, the negative spatial autocorrelation in 2009 and a random distribution pattern in 2011, 2013 and 2016. Our findings revealed the correlation between meteorological factors and the incidence of HFMD in Xinjiang. The correlation showed obvious spatiotemporal heterogeneity. The study provides the basis for the government to control HFMD based on meteorological information. The risk of HFMD can be predicted with appropriate meteorological factors for HFMD prevention and control.

Application of seasonal auto regressive integrated moving average model in predicting incidence of hand foot and mouth disease in Nanyang

Objective To establish the prediction model for hand foot and mouth disease (HFMD) in Nanyang, Henan province, using time series analysis and provide the scientific evidence for the control strategies. Methods The monthly incidence data of HFMD in Nanyang from 2010 to 2018 were collected to establish a time series. SARIMA model was constructed using expert modeler to predict the incidence of HFMD in 2019, which was compared with the observed data. Results The monthly incidence of HFMD in Nanyang from 2010 to 2018 showed obvious seasonality. The optimal model was ARIMA(2, 0, 0)(0, 1, 1)12, with R2 of 0.827, RMSE of 2.240, MAE of 1.207 and BIC of 1.755. The prediction of the model for the incidence of HFMD in 2019 showed that the predicted values were consistent with the observed values. The absolute value of relative error was 0.01 at the minimum and 6.14 at the maximum. Conclusion SARIMA model could fit the incidence of HFMD in Nanyang and predict the incidence trend in the future and provide the basis for prevention and control of HFMD.

Control measures during the COVID-19 outbreak reduced the transmission of hand, foot, and mouth disease

Control measures during the coronavirus disease 2019 (COVID-19) outbreak may have limited the spread of infectious diseases. This study aimed to analyze the impact of COVID-19 on the spread of hand, foot, and mouth disease (HFMD) in China. A mathematical model was established to fit the reported data of HFMD in six selected cities in mainland China from 2015 to 2020. The absolute difference (AD) and relative difference (RD) between the reported incidence in 2020, and simulated maximum, minimum, or median incidence of HFMD in 2015–2019 were calculated. The incidence and Reff of HFMD have decreased in six selected cities since the outbreak of COVID-19, and in the second half of 2020, the incidence and Reff of HFMD have rebounded. The results show that the total attack rate (TAR) in 2020 was lower than the maximum, minimum, and median TAR fitted in previous years in six selected cities (except Changsha City). For the maximum, median, minimum fitted TAR, the range of RD (%) is 42·20–99·20%, 36·35–98·41% 48·35–96·23% (except Changsha City) respectively. The preventive and control measures of COVID-19 have significantly contributed to the containment of HFMD transmission.

Analysis on influence and lag effects of meteorological factors on incidence of hand, foot and mouth disease in Shijiazhuang, 2017-2019

Objective: To understand the influence and lag effect of meteorological factors on the incidence of hand, foot and mouth disease (HFMD) in Shijiazhuang. Methods: The daily incidence data of HFMD in Shijiazhuang during 2017-2019 were collected from Chinese Information System for Disease Control and Prevention. The hourly meteorological data were collected form meteorological stations of Shijiazhuang of Chinese meteorological data network. The distributed lag nonlinear model was built for statistical analysis by software R 3.6.2. Results: When the daily average temperature was 15-26 ℃, the risk of incidence of HFMD increased at lag 3-6 days. However, the risk was highest when the temperature was 25 ℃ at lag 3 days (RR=1.03,95%CI:1.00-1.06). When the daily average relative humidity was more than 80%, the risk of incidence of HFMD increased at lag 5-18 days. However, the risk was highest at lag 9 days (RR=1.04, 95%CI: 1.02-1.06).When the daily average air pressure ranged from 999 hPa to 1 007 hPa, the risk of incidence of HFMD increased at lag 5-8 days. However, the risk was highest at lag 6 days (RR=1.01, 95%CI: 1.00-1.02).When the daily average precipitation ranged from 15 to 32 mm, the risk of incidence of HFMD increased at lag 3-18 days. However, the risk was highest at lag 6 days (RR=1.11, 95%CI: 1.02-1.19). Conclusions: Meteorological factors increased the risk of incidence of HFMD such as higher daily average temperature (15-26 ℃), higher daily average humidity (>80%), lower daily average air pressure (999-1 007 hPa) and higher daily average precipitation (15-32 mm) in Shijiazhuang during 2017-2019. They were all correlated with the incidence of HFMD with certain lag days. It is suggested to use these meteorological indicators for the early warning of HFMD.

Control Measures During the COVID-19 Outbreak Reduced the Transmission of Hand, Foot, and Mouth Disease

Background: Control measures during the coronavirus disease 2019 (COVID-19) outbreak may have limited the spread of infectious diseases. This study aimed to analyse the impact of COVID-19 on the spread of hand, foot, and mouth disease (HFMD) in China. Methods: A mathematical model was established to fit the reported data of HFMD in six selected cities in mainland China from 2015 to 2020. The absolute difference (AD) and relative difference (RD) between the reported incidence in 2020, and simulated maximum, minimum, or median incidence of HFMD in 2015-2019 were calculated. Findings: The incidence and Reff of HFMD have decreased in six selected cities since the outbreak of COVID-19, and in the second half of 2020, the incidence and R eff of HFMD have rebounded. The results show that the total attack rate (TAR) in 2020 was lower than the maximum, minimum, and median TAR fitted in previous years in six selected cities (except Changsha city). For the maximum, median, minimum fitted TAR, the range of RD (%) is 42·20-99·20%, 36·35-98·41% 48·35-96·23% (except Changsha city) respectively. Interpretation: Based on the incidence data of six cities from 2015 to 2019, the SEIAR model demonstrated a significant effect on the incidence of HFMD. During the period of COVID-19, the incidence and R eff of HFMD decreased, the prevention and control measures taken during the period of COVID-19, such as school suspension, home quarantine, closing all kinds of leisure places, wearing masks, advocating frequent hand washing, etc., have not only effectively suppressed the spread of COVID-19 epidemic, but also have significantly contributed to the containment of HFMD transmission.Funding Statement: This study was partly supported by the Bill & Melinda Gates Foundation (INV-005834).Declaration of Interests: The authors declare no conflicts of interests.

Etiological characteristics of hand, foot and mouth disease in Yangzhou from 2015 to 2019

To understand the prevalence and etiological characteristics of hand, foot and mouth disease(HFMD) in Yangzhou, so as to provide scientific basis for prevention and control of HFMD. HFMD cases from six sentinel hospitals in Yangzhou from January 2015 to December 2019 were taken as the subject of study. The epidemiological data of HFMD were analyzed by descriptive epidemiology method, the enterovirus were detected using RT-PCR method and the etiological characteristics were analyzed. The data were collected by Excel 2007 and statistically analyzed by SPSS22.0 software. A total of 1 151 positive cases were detected from all 2 129 HFMD clinical specimens collected in Yangzhou from 2015 to 2019, with a total positive rate of 54.06%, including 148 cases of EV71(6.95%), 382 cases of CA16(17.94%) and 621 cases of other enterovirus(29.17%). The difference of positive rate in different years(χ2=99.28, P<0.05), different months(χ2=92.09, P<0.05) and different districts(χ2=71.39, P<0.05)was statistically significant. Each subtype of enterovirus showed alternating prevalence in different years. The peak period of detection rate was from April to September (720 cases, 62.55%). The reported incidence for males was higher than females, with the male-female ratio of 1.58∶1 and children under six (971 cases, 84.36%) as the major attacked population. There were obvious seasonal, regional and population characteristics of HFMD in Yangzhou City from 2015 to 2019. It reminds us that surveillance of HFMD should be continually implemented, more attention should be paid to the prevention and control of key population in high-risk seasons, and the booming HFMD cases caused by other enterovirus should be emphasized especially.

Epidemic characteristics of hand, foot and mouth disease (HFMD) and the lag effect of average daily temperature on the epidemic of HFMD in Beijing

Objective: To analyze the epidemic characteristics of hand, foot and mouth disease (HFMD) in Beijing and explore the short-term lag effect of daily average temperature on HFMD. Methods: The incidence data and meteorological data of HFMD were collected from Xicheng District, Chaoyang District, and Changping District of Beijing between January 2009 and December 2018. The dose-response relationship and short-term lag effect of temperature and HFMD incidence were explored by the distributed lag non-linear model (DNLM). Results: From 2009 to 2018, a total of 97 210 cases of HFMD were confirmed in Xicheng District, Chaoyang District, and Changping District of Beijing. The incidence rate of HFMD in Xicheng district was 71.83/100 000, which was the lowest in three districts. The total annual average incidence was 146.89/100 000 in the three districts. The cases were concentrated from May to July, with a small peak in October to November. The ratio of male to female was 1.49∶1, and the median age of the patients was 3.08 (1.89, 4.39) years old, which showed a decreasing trend in children under 6 years old (Z=-30.11, P<0.01). The DNLM showed that the cumulative relative risk (RR) curve had a bimodal distribution, with RR of 1.36 (95%CI: 1.05-1.76) and 1.35 (95%CI: 1.10-1.66), and the peak values appeared at 4 ℃ and 26 ℃, respectively. Conclusions: The incidence rate of HFMD in Xicheng was the lowest in three districts of Beijing. In addition, the incidence of HFMD is seasonal, and the incidence is higher in spring and summer than that in autumn and winter. Daily average temperature had a lag effect on HFMD, which was different between high temperature and low temperature.

Application of moving epidemic method in establishing epidemic intensity threshold of hand, foot, and mouth disease in southern China

Objective: To evaluate the incidence intensity of hand, foot, and mouth disease (HFMD) in 2018/2019 season in southern China by Moving Epidemic Method (MEM), and compare the intensity among provinces, so as to provide basis for optimizing the allocation of public health resources. Methods: The weekly incidence data of HFMD of children under 5 years old in 15 provinces of southern China from March 1, 2012 to February 28, 2019 were collected from Disease Surveillance Reporting System of Chinese Center for Disease Control and Prevention, and the epidemic intensity threshold of each province in southern China during this period was calculated and evaluated by MEM. Results: In the first incidence peak of 2018/2019 HFMD season, in 15 provinces in the south China, 6 provinces (Jiangsu, Zhejiang, Jiangxi, Chongqing, Sichuan and Yunnan) reported very high incidence rates in children under 5 years old while Guangdong, Guangxi and Hainan provinces had low incidence level. In the second incidence peak, the incidences in 6 provinces (Shanghai, Jiangsu, Zhejiang, Chongqing, Sichuan and Yunnan) reached very high levels. The incidences in remaining provinces also reached medium or high levels. In most provinces, the thresholds in the first incidence peak were higher than those in the second incidence peak, but Chongqing and Sichuan were different. The results of model validation showed that the sensitivity and specificity of MEM were higher than 70% except for Hainan, Chongqing and Yunnan. Conclusions: For southern provinces with two incidence peaks in HFMD season, MEM can be used to determine the epidemic intensity thresholds of different incidence peaks by dividing the disease season to analyze the incidence intensity of HFMD in different stages. The epidemic intensity threshold established by MEM integrates the historical data, and the province (city) with extremely high epidemic level identified represents that the province (city) has an abnormal increase compared with the historical incidence level, which requires more attention from all areas and timely implementation of prevention and control measures.

Epidemiological characteristics and spatial-temporal clusters of hand, foot, and mouth disease in Qingdao City, China, 2013-2018.

BackgroundHand, foot, and mouth disease (HFMD) has become one of the most important infectious diseases recent years. Qingdao City has suffered from serious HFMD epidemic. This study aimed to describe epidemiological characteristics and investigate spatial-temporal distribution at town level in Qingdao City.MethodThe surveillance data of HFMD during 2013–2018 were collected from the National Notifiable Disease Surveillance System. The global Moran’s I statistic was used to detect the spatial autocorrelation of HFMD cases by ArcGis 10.0 software. Purely spatial and spatial-temporal analysis was used to detect epidemic clusters by SatScanTM v9.6 software.ResultsThe annual average incidence of HFMD cases in Qingdao City from 2013 to 2018 was 123.16 per 100000, while the incidence rate of children≤5years old was 2879.80 per 100000. The majority (88.97%) of HFMD cases were aged within 0–5 years old and the males were 60.20%. Other enterovirus (EV), enteriovirus 71(EV71), and Coxsackievirus A16 (CA16) accounted for 48.75%, 30.91% and 20.34%. The seasonal peak was between May and October. HFMD had positive spatial autocorrelation at town level with global Moran’s I from 0.19 to 0.31(P<0.001). Spatial-temporal cluster analysis detected six most likely clusters and three secondary clusters from 2013 to 2018. The most likely cluster was located in urban and urban-rural fringe areas.ConclusionsUrban and urban-rural fringe areas were the major locations of the clusters with other EV as the dominant pathogen between May and October. The findings suggested that the prevention and control of HFMD in Qingdao City should be focus on these high-risk periods and locations which had important public health significance for the allocation of public health resources.

Joinpoint regression model analysis on epidemiological trends of hand, foot and mouth disease in Guangdong, 2008–2017

ObjectiveTo analyze the change in the epidemiological trends of hand, foot and mouth disease (HFMD)in Guangdong province. MethodsThe incidence data of HFMD in Guangdong during 2008–2017 were collected from National Notifiable Infectious Disease Reporting Information System, and population data in Guangdong during this period were collected from Guangdong Statistical Yearbook. The epidemiological trends of HFMD were analyzed by using Joinpoint regression model. ResultsThe incidence trend of HFMD began to change in 2012. From 2008 to 2012, the incidence rate of HFMD increased sharply (β1＝72.552, P＝0.001), and from 2012 to 2017, the incidence increased with slight fluctuation, the difference had no significance (β2＝6.647, P＝0.588). The incidence change trend was not parallel between males and females, the change extent in males exceeded that in females. The incidence increase sharply from January to May and peaked in May, then it began to decline, the monthly annual percent change (APC) was 138.33%(P＝0.002). From May to December, the incidence of HFMD declined slightly, the monthly APC was –19.19% (P＝0.002). Two joinpoints were detected among the trend change of the monthly incidence rate of HFMD in 2008、2013 and 2017 years respectively and only one joinpoint was found in the other years. The age specific incidence was characterized by high level in age group from 0– to 2– years (Age group APC＝17.32%, P＝0.001), decrease rapidly from age group 2– years to 15–19 years (APC＝−44.81%, P＝0.000), and keeping at very low level from age group 15–19 years to ≥85 years (APC＝−2.66%, P＝0.148). ConclusionThe annual incidence of HFMD in Guangdong first showed a rapid increase and then slight increase with fluctuation during 2008–2017. The trend change of annual incidence rate was significantly different between male and female. Two models were found in the trend change of monthly incidence rate and there were significant seasonal variations. Very most of the HFMD case were among young children, so they were the key object for prevention and control. Prevention and control measures should be more targeted.

Bayesian spatiotemporal analysis for association of environmental factors with hand, foot, and mouth disease in Guangdong, China

Hand, foot, and mouth disease (HFMD) remains a significant public health and economic burden in parts of China, particularly Guangdong Province. Although the association between meteorological factors and HFMD has been well documented, significant gaps remain in our understanding of the potential impact of environmental factors. Using county-level monthly HFMD data from China CDC and environmental data from multiple sources, we used spatiotemporal Bayesian models to evaluate the association between HFMD and environmental factors including vegetation index, proportion of artificial surface, road capacity, temperature and humidity, and assessed the spatial and temporal dynamic of the association. Statistically significant correlation coefficients from −0.056 to 0.36 (all P < 0.05) were found between HFMD incidence and all environmental factors. The contributions of these factors for HFMD incidence were estimated to be 16.32%, 12.31%, 14.61%, 13.53%, and 2.63%. All environmental factors including vegetation index (Relative Risk: 0.889; Credible Interval: 0.883–0.895), artificial surface (1.028; 1.022–1.034), road capacity (1.033; 1.028–1.038), temperature (1.039; 1.028–1.05), and relative humidity (1.015; 1.01–1.021) were statistically retained in the final spatiotemporal model. More comprehensive environmental factors were identified as associating with HFMD incidence. Taking these environmental factors into consideration for prevention and control strategy might be of great practical significance.