Hand, Foot And Mouth Disease Occurrence Research Articles

The impacts of meteorological factors on the incidence of hand, foot, and mouth disease in China: An interactive perspective

Hand, foot, and mouth disease (HFMD) is a contagious illness and a matter of public health concern globally. It has a widespread impact in China, where it poses a significant risk to the health of young children. Previous research has discovered that the occurrence and spread of HFMD are closely linked to meteorological factors, but the specifics of these intricate nonlinear relationships and how they interact with the incidence of HFMD are still uncertain. In the present study, we filled this gap in knowledge by first obtaining data on hand, foot, and mouth disease from the National Health Commission of China alongside real-time surveillance data from meteorological stations. We then used Spearman's correlation analysis to identify the variables significantly related to HFMD, investigating the existence of co-curvilinearity among the contributing factors by using the independent effects model in the generalized additive model to analyze both the contribution of individual factors and their combined effects on the incidence of HFMD. The interactions between meteorological factors were then modeled to investigate their influence on HFMD. The results showed that, in descending order of effect size, air temperature (AT), sunshine duration (SD), wind speed (WS), and barometric pressure (BP) had a significant nonlinear impact on the incidence of HFMD, which displayed a fluctuating increase in line with rising temperatures. The interactions of (1) high temperature and low air pressure and (2) low wind speed and poor sunshine had the largest influence on HFMD. In descending order, the strengths of the interaction effects between factors were as follows: AT ∼ SD > AT ∼ WS > AT ∼ BP > WS ∼ BP > WS ∼ SD > BP ∼ SD. Our findings will inform policy initiatives contributing to the Healthy China strategy and assist in the prevention and control of HFMD by enabling the prediction and early warning of disease outbreaks.

Seasonal Pattern of Hand Foot and Mouth Disease in an Out-patient Clinic of a Tertiary Care Pediatric Hospital at Dhaka

Background & Objective: Hand, foot and mouth disease (HFMD) is a contagious disease of children, occurs primarily under five years of age, characterized by a history of brief febrile illness and a typical skin rash over hands and feet with or without sores in mouth, caused usually by Coxsackievirus A16 viruses. It is mainly the disease of tropical and subtropical countries and bears a complex-relation with meteorological variables, like temperature, rainfall and relative humidity, although no study has yet been done in Bangladesh to explain the complex relationship of the disease with these variables. This study sought to describe the occurrence of HFMD and its association with meteorological factors in Dhaka city.
 Methods: The present cross-sectional study collected data of 231 HFMD cases from the records of the daily register of Out-patient Department of Dhaka Shisu Hospital, Dhaka between January 2018 to December 2019. According to the study protocol a child was identified as having HFMD who had a history of brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Total number of cases treated monthly at OPD during the period were also recorded. Meteorological data were provided by Bangladesh Meteorological Department, which among others, included monthly average temperature, relative humidity and amount of rainfall. While the outcome variable was monthly number of HFMD cases, the predictive variables were average temperature, humidity and rainfall during the study period.
 Result: Majority (85.3%) children in the present study was < 5 years old. A male preponderance was observed in the series (60%) with male to ratio being 3:2. A clustering of HFMD cases was observed to occur between June to October when monthly average temperature, total rainfall and humidity all were at their maximum compared to those found between November to April. The clustering of cases was more intense in the year 2019 than that in the year 2018. During the period average monthly temperature was 29.20C, average rainfall was 62.6% (238 mm) of the total annual precipitation and mean relative humidity was 79%. The proportion of HFMD cases out of total cases treated during the period was 2.2% in 2018 and was 4.1% in 2019, which in the dry season (November to April) was 0.4% and 0.5% in 2018 and 2019 respectively.
 Conclusion: The study concluded that majority of the HFMD cases occur under five years of age and boys are more likely to have the infection than the girls. A seasonality of HFMD occurrence is observed with a higher number of cases occurring in the monsoon season and fewer cases in the dry season. Clustering of HFMD cases occur between May to October when monthly average temperature, total rainfall and humidity all are at peak compared to those in November to April of the year.
 Ibrahim Card Med J 2021; 11 (1): 14-20

A Systematic Review of the Statistical Methodology Used in Establishing the Link Between Climate Factors and HFMD Incidence

Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by two main viruses, namely Coxsackievirus A16 and Human Enterovirus 71. It has been a significant public health disease and a substantial burden all over the world since 1969. Prior studies have shown that climate factors are significantly associated with HFMD cases by using various statistical methods. Therefore, this study aims to review the scientific studies related to climate and HFMD and hence, address the analytical techniques used. This study only includes quantitative studies from peer-reviewed and original papers published in international and national journals from the years 1957 to 2020. In total, there were 522 articles identified; however, there were only 29 studies that linked climate change and HFMD. Based on the articles reviewed, the modelling analysis technique, which includes the Generalized Linear Model (GLM), the Generalized Additive Model (GAM), and the Generalized Additive Mixed Model (GAMM), represents the most popular analysis in identifying the association between HFMD and climate factors. The temperature and humidity showed the greatest impact on the occurrence of HFMD, and the suitable incubation period for all climatic factors was not more than three weeks.

Seasonal Pattern of Hand Foot and Mouth Disease in an Out-patient Clinic of a Tertiary Care Pediatric Hospital, Dhaka

Background : Hand, foot and mouth disease (HFMD) is a contagious disease of children, occurs primarily under five years of age, characterized by a history of brief febrile illness and a typical skin rash over hands and feet with or without sores in mouth, caused usually by Coxsackie virus[1]A16 viruses. It is mainly the disease of tropical and subtropical countries and bears a complex-relation with meteorological variables like temperature, rainfall and relative humidity, although no study has yet been done in Bangladesh to explain the complex relationship of the disease with these variables.
 Objective : This study sought to describe the occurrence of HFMD and its association with meteorological factors in Dhaka city.
 Methods : The present cross-sectional study collected data of 231 HFMD cases from the records of the daily register of Out-patient Department of Dhaka Shishu Hospital, Dhaka between January 2018 to December 2019. According to the study protocol a child was identified as having HFMD who had a history of brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Total numbers of cases treated monthly at OPD during the period were also recorded. Meteorological data were provided by Bangladesh Meteorological Department, which among others, included monthly average temperature, relative humidity and amount of rainfall. While the outcome variable was monthly number of HFMD cases, the predictive variables were average temperature, humidity and rainfall during the study period.
 Results : Majority (85.3%) children in the present study was < 5 years old. A male preponderance was observed in the series (60%) with male to female ratio being 3:2. A clustering of HFMD cases was observed to occur between June to October when monthly average temperature, total rainfall and humidity all were at their maximum compared to those found between November to April. The clustering of cases was more intense in the year 2019 than that in the year 2018. During the period average monthly temperature was 29.20C, average rainfall was 62.6% (238 mm) of the total annual precipitation and mean relative humidity was 79%. The proportion of HFMD cases out of total cases treated during the period was 2.2% in 2018 and was 4.1% in 2019, which in the dry season (November to April) was 0.4% and 0.5% in 2018 and 2019 respectively.
 Conclusions : The study concluded that majority of the HFMD cases occur under five years of age and boys are more likely to have the infection than the girls. A seasonality of HFMD occurrence is observed with a higher number of cases occurring in the monsoon season and fewer cases in the dry season.Clustering of HFMD cases occur between May to October when monthly average temperature, total rainfall and humidity all are at peak compared to those in November to April of the year.
 Northern International Medical College Journal Vol.11 (2) Jan 2020: 453-457

Spatial and Temporal Characteristics of Hand-Foot-and-Mouth Disease and Their Influencing Factors in Urumqi, China

Hand, foot, and mouth disease (HFMD) remains a serious health threat to young children. Urumqi is one of the most severely affected cities in northwestern China. This study aims to identify the spatiotemporal distribution characteristics of HFMD, and explore the relationships between driving factors and HFMD in Urumqi, Xinjiang. Methods: HFMD surveillance data from 2014 to 2018 were obtained from the China Center for Disease Control and Prevention. The center of gravity and geographical detector model were used to analyze the spatiotemporal distribution characteristics of HFMD and identify the association between these characteristics and socioeconomic and meteorological factors. Results: A total of 10,725 HFMD cases were reported in Urumqi during the study period. Spatially, the morbidity number of HFMD differed regionally and the density was higher in urban districts than in rural districts. Overall, the development of HFMD in Urumqi expanded toward the southeast. Temporally, we observed that the risk of HFMD peaked from June to July. Furthermore, socioeconomic and meteorological factors, including population density, road density, GDP, temperature and precipitation were significantly associated with the occurrence of HFMD. Conclusions: HFMD cases occurred in spatiotemporal clusters. Our findings showed strong associations between HFMD and socioeconomic and meteorological factors. We comprehensively considered the spatiotemporal distribution characteristics and influencing factors of HFMD, and proposed some intervention strategies that may assist in predicting the morbidity number of HFMD.

Spatiotemporal analysis of hand, foot and mouth disease data using time-lag geographically-weighted regression.

Hand, Foot, and Mouth Disease (HFMD) is a common and widespread infectious disease. Previous studies have presented evidence that climate factors, including the monthly averages of temperature, relative humidity, air pressure, wind speed and Cumulative Risk (CR) all have a strong influence on the transmission of HFMD. In this paper, the monthly time-lag geographically- weighted regression model was constructed to investigate the spatiotemporal variations of effect of climate factors on HFMD occurrence in Inner Mongolia Autonomous Region, China. From the spatial and temporal perspectives, the spatial and temporal variations of effect of climate factors on HFMD incidence are described respectively. The results indicate that the effect of climate factors on HFMD incidence shows very different spatial patterns and time trends. The findings may provide not only an indepth understanding of spatiotemporal variation patterns of the effect of climate factors on HFMD occurrence, but also provide helpful evidence for making measures of HFMD prevention and control and implementing appropriate public health interventions at the county level in different seasons.

Association of environmental factors and high HFMD occurrence in northern Thailand

BackgroundThe major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand.MethodsA case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews.ResultsTwo variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention.ConclusionsThe number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs.

Comparison of Climatic Factors Contributing to Hand-Foot-and-Mouth Disease Outbreak in the Northern and the Central Regions of Thailand

Background: Hand-foot-and-mouth disease (HFMD) has been noted as one of the most common contagious diseases in Thailand. Each year the highest reported cases have been mostly found in the Northern and the Central regions. These regions are quite different in terms of topography and climate. Therefore, the interest of this research was to compare the climatic factors that affect the incidence of HFMD outbreak.
 
 Objective: The research objective was to identify the climatic factors influencing HFMD in the two regions.
 
 Methods: The research applied spatial autocorrelation via the stepwise regression analysis to elaborate the influence of climatic factors on HFMD outbreaks during 2006-2016.
 
 Results: The HFMD distribution patterns mapping in this study indicated that there were large infectious areas in almost every province in both the Northern and the Central regions during 2012-2016. The stepwise  regression analysis evaluated all possible combinations of the explanatory input candidate variables, including average temperature, average rainfall, air pressure, and relative humidity. The study finds found that the major climate factors pertaining to HFMD occurrence in the Northern region were temperature and humidity (R2 = 0.56), whereas humidity and rainfall (R2 = 0.49) played important roles in the Central region. The results confirmed the meteorological factors which were statistically significant in association with HFMD cases in seasonal of Thailand.
 
 Conclusion: It was concluded that the use of spatial autocorrelation in GIS and stepwise regression approach should be encouraged in epidemiology in estimating the involvement of meteorological indicators on the spatial distribution of HFMD and health geography in climate change situation.

Meteorological factors associated with hand, foot and mouth disease in a Central Highlands province in Viet Nam: an ecological study.

BackgroundHand, foot and mouth disease (HFMD) is a public health problem in Viet Nam, and studies have reported seasonal fluctuation in the occurrence of HFMD. This study sought to describe the occurrence of HFMD and its associated meteorological factors in Dak Lak province, Viet Nam.MethodsMonthly data on HFMD cases were collected from all commune health stations in Dak Lak province from 2012 through 2013. An HFMD case was defined as a brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Average temperature, maximum temperature, minimum temperature, humidity, rainfall, evaporation, sunshine duration and wind speed were recorded monthly at five local meteorological stations throughout Dak Lak.Data were aggregated at the district level, and the association between these meteorological factors and HFMD cases were examined by Poisson regression.ResultsIn 2012 through 2013, there were 7128 HFMD patients in Dak Lak. The number of HFMD cases increased during the rainy season. An increased risk of HFMD was associated with higher average temperature (risk ratio and 95% confidence interval: 1.06; 1.03–1.08 per 1 °C increase), higher rainfall (1.19; 1.14–1.24 per 200 mm increase) and longer sunshine duration (1.14; 1.07–1.22 per 60 hours increase). The risk of HFMD was inversely associated with wind speed (0.77; 0.73–0.81 per 1 m/s increase).ConclusionThis study suggests that there is a significant association between HFMD occurrence and climate. Temperature, rainfall, wind speed and sunshine duration could be used as meteorological predictors of HFMD occurrence in Viet Nam’s Central Highlands region. Intensified surveillance for HFMD during the rainy season is recommended.

Disease relative risk downscaling model to localize spatial epidemiologic indicators for mapping hand, foot, and mouth disease over China

Given the limitations of current approaches for disease relative risk mapping, it is necessary to develop a comprehensive mapping method not only to simultaneously downscale various epidemiologic indicators, but also to be suitable for different disease outcomes. We proposed a three-step progressive statistical method, named disease relative risk downscaling (DRRD) model, to localize different spatial epidemiologic relative risk indicators for disease mapping, and applied it to the real world hand, foot, and mouth disease (HFMD) occurrence data over Mainland China. First, to generate a spatially complete crude risk map for disease binary variable, we employed ordinary and spatial logistic regression models under Bayesian hierarchical modeling framework to estimate county-level HFMD occurrence probabilities. Cross-validation showed that spatial logistic regression (average prediction accuracy: 80.68%) outperformed ordinary logistic regression (69.75%), indicating the effectiveness of incorporating spatial autocorrelation effect in modeling. Second, for the sake of designing a suitable spatial case–control study, we took spatial stratified heterogeneity impact expressed as Chinese seven geographical divisions into consideration. Third, for generating different types of disease relative risk maps, we proposed local-scale formulas for calculating three spatial epidemiologic indicators, i.e., spatial odds ratio, spatial risk ratio, and spatial attributable risk. The immediate achievement of this study is constructing a series of national disease relative risk maps for China’s county-level HFMD interventions. The new DRRD model provides a more convenient and easily extended way for assessing local-scale relative risks in spatial and environmental epidemiology, as well as broader risk assessment sciences.

Exploration of potential risks of Hand, Foot, and Mouth Disease in Inner Mongolia Autonomous Region, China Using Geographically Weighted Regression Model

To quantify the associations between the spatial characteristics of hand, foot, and mouth disease (HFMD) epidemic and meteorological factors (average temperature (AT), relative humidity (RH), average pressure (AP), average wind speed (AW) and average rainfall (AR)), child population density (CPD) and Per capita GDP (GDP) in Inner Mongolia Autonomous Region, China, and to detect the variation of influence in different seasons and counties, geographically weighted regression (GWR) model was constructed. The monthly cumulative incidence (CI) of HFMD was worked out for children ≤9 years from June to December, 2016. The results revealed that GWR model had a far superior goodness-of-fit for describing the relationship between the risk factors and HFMD incidence. Meteorological factors had different significance in their effect on HFMD incidence depending on the season. AT and AR had the greatest impact on HFMD in summer. The influence of RH on HFMD was significant in early autumn. AW was negatively correlated with HFMD in summer and positively correlated in autumn and winter. The effects of AW and AP on the incidence of HFMD were statistically significant in winter. GDP and CPD were not significantly related to HFMD occurrence for most time periods.

Exploring spatiotemporal nonstationary effects of climate factors on hand, foot, and mouth disease using Bayesian Spatiotemporally Varying Coefficients (STVC) model in Sichuan, China

BackgroundPediatric hand, foot, and mouth disease (HFMD) has generally been found to be associated with climate. However, knowledge about how this association varies spatiotemporally is very limited, especially when considering the influence of local socioeconomic conditions. This study aims to identify multi-sourced HFMD environmental factors and further quantify the spatiotemporal nonstationary effects of various climate factors on HFMD occurrence. MethodsWe propose an innovative method, named spatiotemporally varying coefficients (STVC) model, under the Bayesian hierarchical modeling framework, for exploring both spatial and temporal nonstationary effects in climate covariates, after controlling for socioeconomic effects. We use data of monthly county-level HFMD occurrence and data of related climate and socioeconomic variables in Sichuan, China from 2009 to 2011 for our experiments. ResultsCross-validation experiments showed that the STVC model achieved the best average prediction accuracy (81.98%), compared with ordinary (68.27%), temporal (72.34%), spatial (75.99%) and spatiotemporal (77.60%) ecological models. The STVC model also outperformed these models in the Bayesian model evaluation. In this study, the STVC model was able to spatialize the risk indicator odds ratio (OR) into local ORs to represent spatial and temporal varying disease-climate relationships. We detected local temporal nonlinear seasonal trends and spatial hot spots for both disease occurrence and disease-climate associations over 36 months in Sichuan, China. Among the six representative climate variables, temperature (OR = 2.59), relative humidity (OR = 1.35), and wind speed (OR = 0.65) were not only overall related to the increase of HFMD occurrence, but also demonstrated spatiotemporal variations in their local associations with HFMD. ConclusionOur findings show that county-level HFMD interventions may need to consider varying local-scale spatial and temporal disease-climate relationships. Our proposed Bayesian STVC model can capture spatiotemporal nonstationary exposure-response relationships for detailed exposure assessments and advanced risk mapping, and offers new insights to broader environmental science and spatial statistics.

Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: a multi-city time-series analysis.

BackgroundLiterature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors.MethodsBased on daily time-series data in eight major cities in Guangdong, China during 2009–2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors.ResultsThere were a total of 400,408 pediatric HFMD cases (children aged 0–14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30–1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00–1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city’s latitude and longitude with an explained heterogeneity of 32 %.ConclusionsDaily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1846-y) contains supplementary material, which is available to authorized users.

Effect of Climatic Factors on Hand, Foot, and Mouth Disease in South Korea, 2010-2013.

Hand, foot, and mouth disease (HFMD) causes characteristic blisters and sores mainly in infants and children, and has been monitored in South Korea through sentinel surveillance since 2009. We described the patterns of HFMD occurrence and analyzed the effect of climatic factors on national HFMD incidence. Weekly clinically diagnosed HFMD case rates (per 1,000 outpatients) in sentinel sites and weekly climatic factors, such as average temperature, relative humidity, duration of sunshine, precipitation, and wind speed from 2010 to 2013, were used in this study. A generalized additive model with smoothing splines and climatic variables with time lags of up to 2 weeks were considered in the modeling process. To account for long-term trends and seasonality, we controlled for each year and their corresponding weeks. The autocorrelation issue was also adjusted by using autocorrelation variables. At an average temperature below 18°C, the HFMD rate increased by 10.3% for every 1°C rise in average temperature (95% confidence interval (CI): 8.4, 12.3%). We also saw a 6.6% increase in HFMD rate (95% CI: 3.6, 9.7%) with every 1% increase in relative humidity under 65%, with a 1.5% decrease in HFMD rate observed (95% CI: 0.4, 2.7%) with each 1% humidity increase above 65%. Modeling results have shown that average temperature and relative humidity are related to HFMD rate. Additional research on the environmental risk factors of HFMD transmission is required to understand the underlying mechanism between climatic factors and HFMD incidence.

Different effects of meteorological factors on hand, foot and mouth disease in various climates: a spatial panel data model analysis.

BackgroundMajor outbreaks of hand, foot and mouth disease (HFMD) have been reported in China since 2008, posing a great threat to the health of children. Although many studies have examined the effect of meteorological variables on the incidence of HFMD, the results have been inconsistent. This study aimed to quantify the relationship between meteorological factors and HFMD occurrence in different climates of mainland China using spatial panel data models.MethodsAll statistical analyses were carried out according to different climate types. We firstly conducted a descriptive analysis to summarize the epidemic characteristics of HFMD from May 2008 to November 2012 and then detected the spatial autocorrelation of HFMD using a global autocorrelation statistic (Moran’s I) in each month. Finally, the association between HFMD incidence and meteorological factors was explored by spatial panel data models.ResultsThe 353 regions were divided into 4 groups according to climate (G1: subtropical monsoon climate; G2: temperate monsoon climate; G3: temperate continental climate; G4: plateau mountain climate). The Moran’s I values were significant with high correlations in most months of group G1 and G2 and some months of group G3 and G4. This suggested the existence of a high spatial autocorrelation with HFMD. Spatial panel data models were more appropriate to describe the data than fixed effect models. The results showed that HFMD incidences were significantly associated with average atmospheric pressure (AAP), average temperature (AT), average vapor pressure (AVP), average relative humidity (ARH), monthly precipitation (MP), average wind speed (AWS), monthly total sunshine hours (MSH), mean temperature difference (MTD), rain day (RD) and average temperature distance (ATD), but the effect of meteorological factors might differ in various climate types.ConclusionsSpatial panel data models are useful and effective when longitudinal data are available and spatial autocorrelation exists. Our findings showed that meteorological factors were related to the occurrence of HFMD, which were also affected by climate type.

Short term effect of weather patterns on the incidence of hand foot and mouth disease aged ≤5 years old in Jinan city

To investigate the effect of weather patterns on the incidence of hand foot and mouth disease (HFMD) in Jinan. HFMD confirmed cases aged ≤5 years old for the period of 2012-2014 were collected from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data, including daily average temperature, relative humidity, atmospheric pressure, wind velocity, rainfall and duration of sunshine were obtained from the website of Jinan meteorological bureau. A negative binomial multivariable regression was used to identify the relationship between meteorological variables and HFMD. During the study period, a total of 40 405 HFMD cases aged ≤5 years old were reported. The incident peak occurred from May to July, a total of 22 254 cases were reported during this period, which accounted for 55.08% of whole cases. After adjusting by "year", each 1 °C rise of weekly average temperature corresponded to an increase of 6.70% (95%CI:6.35% to 7.06%) in the weekly number of HFMD cases, while a 1 kPa rise of weekly average atmospheric pressure corresponded to a decrease in the number of cases by 44.77% (95%CI: -46.23% to -41.91%). Likewise, a one percent rise in weekly average relative humidity corresponded to an increase of 1.96% (95%CI: 1.84% to 2.09%), a 1 m/h rise in weekly average wind velocity corresponded to an increase of 16.63% (95% CI:14.08% to 19.25%), a hour add in weekly duration of sunshine corresponded to a decrease of 0.82% (95% CI : -0.93% to -0.72%), in the weekly number of HFMD cases. Weather factors including temperature, atmospheric pressure, relative humidity, wind velocity, and duration of sunshine had a significant influence on occurrence and transmission of HFMD in Jinan city.

An epidemic analysis of hand, foot, and mouth disease in Zunyi, China between 2012 and 2014.

Objectives:To re-evaluate the epidemiology of hand, foot, and mouth disease (HFMD) in a non-vaccinated population in Zunyi, China.Methods:We used laboratory-based data from the Third Affiliated Hospital of Zunyi Medical College, Zunyi, China to assess the epidemiology of the HFMD caused by enteroviruses between January 2012 and November 2014. Real-time polymerase chain reaction was used to determine human enteroviruses from a total of 12313 probable cases enrolled in this retrospective study. All analyses were stratified by enterovirus serotype, gender, and age.Results:Virological results were available for 12313 cases of probable HFMD. A total of 5750 cases were positive for viral detection, and the positive rates of infection caused by other enteroviruses was 46.7%, EV71 9%, and CVA16 4.7%. During the study period there was a substantial increase in the occurrence of HFMD. Most of the HFMD patients (87.4%) were aged 0-59 months (median 24; range 0-59). Males showed a higher HFMD prevalence rate (62.4%) than females (37.6%).Conclusion:Enterovirus infection remains an important public health problem and other entroviruses are emerging as the major causative agent of the HFMD in Zunyi, China.

Spatio-temporal analysis of the relationship between climate and hand, foot, and mouth disease in Shandong province, China, 2008-2012.

BackgroundHand, foot, and mouth disease (HFMD) is the most common communicable disease in China. Shandong Province is one of the most seriously affected areas. The distribution of HFMD had spatial heterogeneity and seasonal characteristic in this setting. The aim of this study was to explore the associations between climate and HFMD by a Bayesian approach from spatio-temporal interactions perspective.MethodsThe HFMD data of Shandong Province during 2008–2012 were derived from the China National Disease Surveillance Reporting and Management System. And six climatic indicators were obtained from the Meteorological Bureau of Shandong Province. The global spatial autocorrelation statistic (Moran’s I) was used to detect the spatial autocorrelation of HFMD cases in each year. The optimal one among four Bayesian models was further adopted to estimate the relative risk of the occurrence of HFMD via Markov chain Monte Carlo.ResultsThe annual average incidence rate of HFMD was 104.40 per 100,000 in Shandong Province. Positive spatial autocorrelation appeared at county level (Moran’s I ≥0.30, P < 0.001). The best fitting Spatio-temporal interactive model showed that annual average temperature, annual average pressure, annual average relative humidity, annual average wind speed and annual sunshine hours were significantly positive related to the occurrence of HFMD. The estimated relative risk of 36, 87, 91, 79, 65 out of 140 counties for 2008–2012 respectively were significantly more than 1.ConclusionsThere were obvious spatio-temporal heterogeneity of HFMD in Shandong Province, and the climatic indicators were associated with the epidemic of HFMD. Bayesian approach should be recommended to capture the spatial-temporal pattern of HFMD.

Epidemiological and etiological characteristics of hand, foot, and mouth disease in Henan, China, 2008-2013.

Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by enteroviruses. HFMD outbreaks and reported cases have sharply increased in China since 2008. Epidemiological and clinical data of HFMD cases reported in Henan Province were collected from 2008 to 2013. Clinical specimens were obtained from a subset of these cases. Descriptive epidemiological methods were used to analyze the time, region and population distribution. The VP1 gene from EV71 and CA16 isolates was amplified, and the sequences were analyzed. 400,264 cases of HFMD were reported in this study, including 22,309 severe and 141 fatal cases. Incidence peaked between April and May. Laboratory confirmation was obtained for 27,692 (6.9%) cases; EV71, CA16, and other enteroviruses accounted for 59.5%, 14.1%, 26.4%, respectively. Phylogenetic analysis revealed that EV71 belonged to the C4a evolution branch of C4 sub-genotype and CA16 belonged to subtype B1a or B1b. The occurrence of HFMD in Henan was closely related to season, age and region distribution. Children under five were the most affected population. The major pathogens causing HFMD and their genotypes have not notably changed in Henan. The data strongly support the importance of EV71 vaccination in a high population density area such as Henan, China.

Epidemiological characteristics and temporal-spatial clustering analysis of hand, foot and mouth disease in Nanchang city 2008–2012

Objective: To describe the epidemiological characteristics of hand, foot and mouth disease (HFMD) in Nanchang city during 2008–2012 and to detect potential temporal-spatial clusters. Methods: Data on HFMD in Nanchang City during 2008–2012 were derived from the National Notifiable Infectious Disease Reporting System (NNIDRS). We used descriptive methods to describe the epidemiological characteristics of HFMD. Space-time scan statistic, based on the Space-Time Permutation model, was adopted to determine the presence of space-time interaction clusters of HFMD in Nanchang. Results: There were 29 062 HFMD cases reported in Nanchang during 2008–2012. The annual average incidence rate was 118.56 per 100 000 inhabitants. There were two peaks in HFMD occurrence. Children aged 0–5 years accounted for 92.91% of cases. Scattered children (children not in nursery or kindergarten) accounted for 73.72%. There was a male predominance, with a male-to-female ratio of 1.82:1. Three space-time interaction clusters were explored including one most likely cluster and two secondary clusters from 2008 to 2012. Conclusions: Males and preschool children, especially in the 0–5-year age group, were more susceptible to HFMD and we should take measures to control their vulnerability. There were two peaks in HFMD occurrence, one during the summer (between April and July) and one in the autumn (between September and December). Northwest, middle east, and north Nanchang were the spatial-temporal clusters, so future public health planning and resource allocation should be focused on these areas.