Incidence Of Hand-foot-mouth Disease Research Articles

Molecular epidemiology and clinical characteristics of enteroviruses associated HFMD in Chengdu, China, 2013–2022

ObjectivesThis study aims to investigate molecular epidemiology and clinical characteristics of enterovirus associated hand-foot-mouth disease (HFMD) in Chengdu, China, 2013–2022. Monitoring the molecular epidemiology and clinical features of HFMD for up to 10 years may provide some ideas for future protection and control measures.MethodsWe conducted a retrospective analysis of the medical records of all patients with laboratory-confirmed HFMD-related enterovirus infection at the West China Second University Hospital from January 2013 to December 2022. We described the characteristics in serotype, age, sex distribution and hospitalization of enterovirus infection cases using data analysis and graphic description.ResultsA total of 29,861 laboratory-confirmed cases of HFMD-related enterovirus infection were reported from 2013 to 2022. There was a significant reduction in the number and proportion of EV-A71 cases after 2016, from 1713 cases (13.60%) in 2013–2015 to 150 cases (1.83%) in 2017–2019. During the COVID-19 pandemic, EV-A71 cases even disappeared. The proportion of CV-A16 cases decreased from 13.96% in 2013–2015 to 10.84% in 2017–2019 and then to 4.54% in 2020–2022. Other (non-EV-A71 and non-CV-A16) serotypes accounted for 95.45% during 2020–2022, with CV-A6 accounting for 50.39% and CV-A10 accounting for 10.81%. Thus, CV-A6 and CV-A10 became the main prevalent serotypes. Furthermore, There was no significant difference in the enterovirus prevalence rate between males and females. The hospitalization rate of EV-A71 patients was higher that of other serotypes. In general, the proportion of HFMD hospitalizations caused by other pathogens except for EV-A71, CV-A16, CV-A10 and CV-A16 was second only to that caused by EV-A71. The proportion of children over 4 years old infected with enterovirus increased.ConclusionThe incidence of HFMD associated with enterovirus infection has decreased significantly and CV-A6 has been the main pathogen of HFMD in Chengdu area in recent years. The potential for additional hospitalizations for other untested enterovirus serotypes suggested that attention should also be paid to the harms of infections with unknown enterovirus serotypes. Children with HFMD were older. The development of new diagnostic reagents and vaccines may play an important role in the prevention and control of enterovirus infection.

Epidemiological characteristics of hand, foot, and mouth disease in China: A meta-analysis.

Background:To study the epidemic features of hand-foot-mouth disease (HFMD) in mainland China through systematic review and meta-analysis so as to provide evidence for the future prevention and control of HFMD.Methods:Articles on the epidemic features of HFMD in mainland China, written in English or Chinese and released between January 1, 2015 and January 1, 2020, were searched from English literature databases including Embase, Web of Science, PubMed, Cochrane library, Google academic, and Chinese literature databases including China national knowledge infrastructure (CNKI), Wanfang, and China Biology Medicine (CBM). Papers were selected according to the inclusion and exclusion criteria, and quality scoring was performed. Meta-analysis, sensitivity analysis, and identification of publication bias were finished through STATA version 12.0 software.Results:A total of 23 articles were included in this study, the total number of cases was 377,083, of which the total number of male cases was 231,798 and the total number of female cases was 145,285, the sex ratio was about 1.6:1, and the incidence of HFMD in China was 1.61‰ (95% confidence interval [CI]: 1.21‰–1.94‰). The results of the subgroup analysis showed that the incidence of HFMD in mainland China was the highest in South China, in 2014, in 1-year-old group and in other types of enteroviruses, respectively, with the rate of 3.48‰ (95% CI: 1.22‰–5.73‰), 1.81‰ (95% CI: 1.06‰–2.57‰), 15.20‰ (95% CI: 5.00‰–25.30‰), and 1.83‰ (95% CI: 1.32‰–2.33‰), respectively. The differences among the above 4 subgroups were statistically significant (P < .05). There were no publication bias in this study, and the sensitivity analysis results suggested that the meta-analysis results were robust.Conclusion:There were differences in the distribution of region, time, population, and etiology of HFMD in mainland China. Health departments should adopt key strategies and measures for key populations in key areas to prevent and control the development of HFMD, and improve the ability of pathogen detection and typing in laboratories.

Epidemiological characteristics of hand-foot-mouth disease before and after the introduction of EV71 vaccine in Baiyun District, Guangzhou

Objective To explore the influence of EV71 vaccine on the epidemiological characteristics of hand-foot-mouth disease (HFMD) in Baiyun District, and we develop prevention and control strategies. Methods Hand-foot-mouth disease (HFMD) report information and EV71 vaccine data were obtained from the Chinese Disease Prevention and Control Information System and the Childhood Immunization Program Information System, and descriptive epidemiological analysis was conducted. Results A total of 83 574 cases of HFMD were reported from 2014 to 2019, among which 5 309 cases were laboratory diagnosed, with an average annual incidence of 573.85 / 100 000. After vaccination, the incidence of HFMD decreased from 2016 to 2018, but increased slightly in 2019. The annual time distribution showed bimodal prevalence, which was high in summer and autumn. The regional distribution was characterized by high population density and high incidence of towns and streets. The population distribution was more male than female, mainly occurred in children under 5 years old, and children living in diaspora were the majority. No significant changes were observed in the high incidence season, high-risk population and high incidence area. In terms of etiological characteristics, the dominant pathogens were other enterovirus and the composition ratio of EV71 generally showed a downward trend. From 2016 to 2019, a total of 287 375 doses of EV71 vaccine were administered in Baiyun District. Conclusion The overlap of EV71 vaccination peak and HFMD incidence peak reflects the low vaccination level of EV71 vaccine and the weak vaccination awareness of the public in Baiyun District, so the effect of controlling EV71 infection of HFMD is still limited. The high incidence was found in urban villages, which may be related to factors such as large population migration, high residential density and poor health awareness. The high incidence was among children under 5 years old, which may be related to low immunity level, unformed hygiene habits, and more exposure opportunities. Therefore, it is necessary to promote health education and health promotion in communities and families in order to improve the public awareness of vaccination and hygiene, improve the living and health environment, and form hygiene habits, so as to achieve the goal of comprehensive prevention and control of HFMD. 摘要：目的 探索广州市白云区EV71疫苗对手足口病流行病学特征影响, 为制定防控策略提供依据。 方法 通 过中国疾病预防控制信息系统与儿童免疫规划信息系统获取手足口病报告信息与EV71疫苗数据并进行描述性流行 病学分析。 结果 2014—2019年共报告手足口病病例83 574例, 其中实验室诊断病例共5 309例, 年平均发病率为 573.85/10万, EV71疫苗接种后2016—2018年手足口病发病率下降, 2019年略上升；时间分布上每年呈双峰流行, 具有 夏秋季高发的特点;地区分布上呈人群密集度高的镇街高发的特点;人群分布上男性多于女性 , 主要发生在5岁以下儿 童 , 散居儿童为主, 高发季节 、 高危人群及高发地区未见明显变化;病原学特征上优势病原体为其他肠道病毒, EV71构 成比总体呈下降趋势;2016—2019年白云区累计接种EV71疫苗287 375剂次。 结论 EV71疫苗接种高峰与手足口病 发病高峰重叠反映白云区EV71疫苗低接种水平、公众接种意识不强, 故控制EV71感染手足口病效果尚有限。城中村 为高发地点, 可能与人群流动性大、居住密度高、卫生意识差等因素有关。高发人群为5岁以下低龄儿童, 可能与免疫 力水平低、卫生习惯未形成、暴露机会多等因素有关。故需推动社区和家庭的健康教育与健康促进以提高公众的疫苗 接种意识与卫生意识、改善居住卫生环境、养成卫生习惯, 最终达到综合防控手足口病的目标。

A method for hand-foot-mouth disease prediction using GeoDetector and LSTM model in Guangxi, China

Hand-foot-mouth disease (HFMD) is a common infectious disease in children and is particularly severe in Guangxi, China. Meteorological conditions are known to play a pivotal role in the HFMD. Previous studies have reported numerous models to predict the incidence of HFMD. In this study, we proposed a new method for the HFMD prediction using GeoDetector and a Long Short-Term Memory neural network (LSTM). The daily meteorological factors and HFMD records in Guangxi during 2014–2015 were adopted. First, potential risk factors for the occurrence of HFMD were identified based on the GeoDetector. Then, region-specific prediction models were developed in 14 administrative regions of Guangxi, China using an optimized three-layer LSTM model. Prediction results (the R-square ranges from 0.39 to 0.71) showed that the model proposed in this study had a good performance in HFMD predictions. This model could provide support for the prevention and control of HFMD. Moreover, this model could also be extended to the time series prediction of other infectious diseases.

Temporal relationships between climate variables and hand-foot-mouth disease: a multi-province study in the Mekong Delta Region, Vietnam.

Hand-foot-mouth disease (HFMD) is an emerging infectious disease that affects thousands of children every year in Vietnam, especially in the Mekong Delta Region (MDR). This study aims to analyse both provincial and regional level effects of climate factors on HFMD in multiple provinces of this high-risk region. Generalized linear models were used to analyse the daily effects of average temperature, humidity and rainfall on HFMD incidence in each province (provincial-level effects), and random-effect meta-analysis was used to estimate the pooled effect size of these climate-HFMD associations (regional-level effects). Daily effects of the climate factors on HFMD were found at both provincial level and regional level. At provincial level, temperature and humidity had statistically significant positive associations with HFMD while rainfall had both positive and negative associations with HFMD at different lag days. At regional level, temperature and humidity were positively associated with HFMD at lag 0 days (1.7%; 95%CI 0.1%-3.3%) and at lag 3 days (0.3%; 95%CI 0.1%-0.5%), respectively. In contrast, rainfall was found to be negatively associated with HFMD at lag 5 days (- 0.3%; 95%CI - 0.4% to - 0.1%). Heterogeneities of the effects of rainfall on HFMD were found to be higher than those of temperature or humidity. This is the first study to address the climate-HFMD associations in multiple provinces of the MDR. These associations draw attention to climate-related health issues and will help in developing an environment-based early warning system for HFMD prevention and control.

Development and comparison of forecast models of hand-foot-mouth disease with meteorological factors

Hand-foot-mouth disease (HFMD) is an acute intestinal virus infectious disease which is one of major public health problems in mainland China. Previous studies indicated that HFMD was significantly influenced by climatic factors, but the associated factors were different in different areas and few study on HFMD forecast models was conducted. Here, we analyzed epidemiological characteristics of HFMD in Yiwu City, Zhejiang Province and constructed three forecast models. Overall, a total of 32554 HFMD cases were reported and 12 cases deceased in Yiwu City, Zhejiang Province. The incidence of HFMD peaked every other year and the curve of HFMD incidence had an approximately W-shape. The majority of HFMD cases were children and 95.76% cases aged ≤5 years old from 2008 to 2016. Furthermore, we constructed and compared three forecast models using autoregressive integrated moving average (ARIMA) model, negative binomial regression model (NBM), and quasi-Poisson generalized additive model (GAM). All the three models had high agreements between predicted values and observed values, while GAM fitted best. The exposure-response curve of monthly mean temperature and HFMD was approximately V-shaped. Our study explored epidemiological characteristics of HFMD in Yiwu City and provided accurate methods for early warning which would be great importance for the control and prevention of HFMD.

A descriptive analysis of the Spatio-temporal distribution of intestinal infectious diseases in China

BackgroundIntestinal infectious diseases (IIDs) have caused numerous deaths worldwide, particularly among children. In China, eight IIDs are listed as notifiable infectious diseases, including cholera, poliomyelitis, dysentery, typhoid and paratyphoid (TAP), viral Hepatitis A, viral Hepatitis E, hand-foot-mouth disease (HFMD) and other infectious diarrhoeal diseases (OIDDs). The aim of the study is to analyse the spatio-temporal distribution of IIDs from 2006 to 2016.MethodsData on the incidence of IIDs from 2006 to 2016 were collected from the public health science data centre issued by the Chinese Center for Disease Control and Prevention. This study applied seasonal decomposition analysis, spatial autocorrelation analysis and space-time scan analysis. Plots and maps were constructed to visualize the spatio-temporal distribution of IIDs.ResultsRegarding temporal analysis, the incidence of HFMD and Hepatitis E showed a distinct increasing trend, while the incidence of TAP, dysentery, and Hepatitis A presented decreasing trends over the last decade. The incidence of OIID remained steady. Summer is the season with the greatest number of cases of different IIDs. Regarding the spatial distribution, approximately all p values for the global Moran’s I from 2006 to 2016 were less than 0.05, indicating that the incidences of the epidemics were unevenly distributed throughout the country. The high-risk areas for HFMD and OIDD were located in the Beijing-Tianjin-Tangshan (BTT) region and south China. The high-risk areas for TAP were located in some parts of southwest China. A higher incidence rates for dysentery and Hepatitis A were observed in the BTT region and some west provincial units. The high-risk areas for Hepatitis E were the BTT region and the Yangtze River Delta area.ConclusionsBased on our temporal and spatial analysis of IIDs, we identified the high-risk periods and clusters of regions for the diseases. HFMD and OIDD exhibited high incidence rates, which reflected the negligence of Class C diseases by the government. At the same time, the incidence rate of Hepatitis E gradually surpassed Hepatitis A. The authorities should pay more attention to Class C diseases and Hepatitis E. Regardless of the various distribution patterns of IIDs, disease-specific, location-specific, and disease-combined interventions should be established.

Application of a combined model with seasonal autoregressive integrated moving average and support vector regression in forecasting hand-foot-mouth disease incidence in Wuhan, China.

Hand-foot-mouth disease (HFMD) is a serious public health problem with increasing cases and substantial financial burden in China, especially in Wuhan city. Hence, there is an urgent need to construct a model to predict the incidence of HFMD that could make the prevention and control of this disease more effective.The incidence data of HFMD of Wuhan city from January 2009 to December 2016 were used to fit a combined model with seasonal autoregressive integrated moving average (SARIMA) model and support vector regression (SVR) model. Then, the SARIMA-SVR hybrid model was constructed. Subsequently, the fitted SARIMA-SVR hybrid model was applied to obtain the fitted HFMD incidence from 2009 to 2016. Finally, the fitted SARIMA-SVR hybrid model was used to forecast the incidence of HFMD of the year 2017. To assess the validity of the model, the mean square error (MSE) and mean absolute percentage error (MAPE) between the actual values and predicted values of HFMD incidence (2017) were calculated.From 2009 to 2017, a total of 107636 HFMD cases were reported in Wuhan City, Hubei Province, and the male-to-female ratio is 1.60:1. The age group of 0 to 5 years old accounts for 95.06% of all reported cases and scattered children made up the large proportion (accounted for 56.65%). There were 2 epidemic peaks, from April to July and September to December, respectively, with an emphasis on the former. High-prevalence areas mainly emerge in Dongxihu District, Jiangxia District, and Hongshan District. SARIMA (1,0,1)(0,0,2)[12] is the optimal model given with a minimum Akaike information criterion (AIC) (700.71), then SVR model was constructed by using the optimum parameter (C = 100000, =0.00001, =0.01). The forecasted incidences of single SARIMA model and SARIMA-SVR hybrid model from January to December 2017 match the actual data well. The single SARIMA model shows poor performance with large MSE and MAPE values in comparison to SARIMA-SVR hybrid model.The SARIMA-SVR hybrid model in this study showed that accurate forecasting of the HFMD incidence is possible. It is a potential decision supportive tool for controlling HFMD in Wuhan, China.

Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China

BackgroundPrevious studies have always focused on the impact of various meteorological factors on Hand–foot–mouth disease (HFMD). However, only few studies have investigated the simultaneous effects of climate and air pollution on HFMD incidence. MethodsDaily HFMD counts among children aged 0–14 years in Guilin city were collected from 2014 to 2016. Distributed lag nonlinear models (DLNM) were used to assess the effects of extreme meteorological factors and air pollution indicators, as well as the effects of different lag days on HFMD incidence. Furthermore, this study explored the variability across gender and age groups. ResultsExtreme temperatures, high precipitation and low-O3 concentration increased the risk of HFMD. Hot effect was stronger and longer lasting than cold effect. Risks of rainy effect and low-O3 effect continued to increase as lag days extended, with the maximum RR values: 1.60 (1.38, 1.86) (90th vs median) and 1.48 (1.16, 1.89) (1th vs median) at 0–14 lag days, respectively. By contrast, extremely high wind speed, low precipitation, low PM2.5 and high O3 exerted a certain protective effect on HFMD incidence. The corresponding minimum RR values were: 0.85 (0.74, 0.98) (90th vs median) at 0–14 lag days, 0.98 (0.97, 0.99) (10th vs median) at 0–14 lag days, 0.73 (0.61, 0.88) (1th vs median) at 0–14 lag days and 0.81 (0.73, 0.90) (99th vs median) at 0–7 lag days, respectively. Male children and children aged 0–1 years (followed by 1–3 years) were the most susceptible subgroups to extreme climatic effects and air pollution. ConclusionsOur results indicated that daily meteorological factors and air pollution exert non-linear and delayed effects on pediatric HFMD, and such effects vary depending on gender and age. These findings may serve as a reference for the development of an early warning system and for the adoption of specific interventions for vulnerable groups.

Analysis on epidemiological characteristics of enterovirus 71 cases of hand-foot-mouth disease based on the active monitoring in Guangdong Province in 2011-2015

Objective: To analyze the hand-foot-mouth disease (HFMD) enterovirus 71 (EV-A71) infection epidemic characteristics of Guangdong Province from 2011 to 2015. Methods: We colleted data on common cases of hand-foot-mouth disease infected with EV-A71 reported from eight sentinel hospitals in Guangdong Province from January 2011 to December 2015, through the "Guangdong Province Acute Infectious Disease Surveillance Information Platform System" , including the age and incidence of cases. Time and etiological data, etc.We also collected data on the number of reported cases of HFMD disease and the number of laboratory-confirmed cases, through the "China Disease Prevention and Control Information System" , including data on common cases of HFMD disease, data on epidemics of severe cases and deaths, and the age, onset time, and pathogens of cases. Learning data, etc.The data from two sources were used to estimate the incidence of HFMD in EV-A71 and describe its distribution characteristics.Chi-square test was used to compare the positive rate of HF-A71 infection in hand-foot-mouth disease and the difference in estimated incidence among different age groups and months. Results: Eight sentinel hospitals from 2011 to 2015 reported a total of 1 855 common cases of EV-A71 infection, of which the highest was in 2014 (31.6%, 605/1 916) and the lowest was in 2015 (6.8%, 134/1 971) (χ(2)=521.85, P<0.001).According to the Disease Surveillance Reporting Information System, 1 772 516 cases of HFMD disease were reported from 2011 to 2015 in Guangdong Province, and 1 902 cases of severe and fatal cases of EV-A71 infection.The composition ratio of EV-A71 infected was 72.6% (1 775/2 444) and 97.0% (127/131) of severe HFMD disease in Guangdong province during 2011-2015.The average annual incidence of HF-A71 infection in all age groups showed a decreasing trend with age (χ(2trend)=990 273.20, P<0.001), and it was the highest in the 1-year-old group, which was 1 697.67/100 000, and the lowest in the 4-year-old group, which was 705.46/100 000. The difference of monthly average incidence of EV-A71 infection in HF-A71 in each month was statistically significant (χ(2)=401.23, P<0.001), the highest in May at 15.51 per 100 000, and the lowest in July at 9.42 per 100 000. Conclusion: EV-A71 infection rate of ordinary HFMD varies in different years. The most severe and death cases of HFMD were EV-A71 infected. 1 year old children were the high-risk group of infected with EV-A71 HFMD. April was the epidemic months of EV-A71 HFMD infection.

Hand-foot-mouth disease and use of steroids, intravenous immunoglobulin, and traditional Chinese herbs in a tertiary hospital in Shantou, China

BackgroundIn contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, however, unclear. We aimed to describe their use in and the clinical outcomes of hospitalized HFMD cases.MethodsA retrospective review of hospital medical records for HFMD cases during 2008–2016 was conducted in a medical school-affiliated tertiary hospital in Shantou, Guangdong, China.ResultsHospitalized children with the discharge diagnosis of HFMD (n = 3778), comprising mild (58.4%), severe (41.5%), and very severe (0.1%) cases, were enrolled in the study. Steroids, IVIG, and antiviral TCH Lan-Qin were respectively prescribed in 60.5, 37.1, and 71.0% of cases. Most cases (99.8%) recovered and six died. Recovery rate was lower with the use of IVIG and higher with Lan-Qin (alone or in combination with steroid) in the mild cases (Ps < 0.05). Longer hospital stay was observed with steroid/IVIG with or without Lan-Qin in the severe cases (Ps < 0.05).ConclusionsThis nine-year retrospective review shows 1) an increase in the incidence of HFMD as well as the use of steroids, IVIG, and TCH over time, 2) no significant advantage of using steroids and IVIG, either alone or in combination, in the management of mild HFMD cases, and 3) a higher recovery rate in mild HFMD cases with the use of antiviral TCH (Lan-Qin). Our findings need verification in a larger prospect study with cases from hospitals in other regions of China. Lan-Qin efficacy should be evaluated in randomized trials. Meanwhile, caution should be exercised in the extensive use of steroids and IVIG in HFMD management.

Application of seasonal auto-regressive integrated moving average model in forecasting the incidence of hand-foot-mouth disease in Wuhan, China

Outbreaks of hand-foot-mouth disease (HFMD) have occurred many times and caused serious health burden in China since 2008. Application of modern information technology to prediction and early response can be helpful for efficient HFMD prevention and control. A seasonal auto-regressive integrated moving average (ARIMA) model for time series analysis was designed in this study. Eighty-four-month (from January 2009 to December 2015) retrospective data obtained from the Chinese Information System for Disease Prevention and Control were subjected to ARIMA modeling. The coefficient of determination (R 2), normalized Bayesian Information Criterion (BIC) and Q-test P value were used to evaluate the goodness-of-fit of constructed models. Subsequently, the best-fitted ARIMA model was applied to predict the expected incidence of HFMD from January 2016 to December 2016. The best-fitted seasonal ARIMA model was identified as (1,0,1)(0,1,1)12, with the largest coefficient of determination (R 2=0.743) and lowest normalized BIC (BIC=3.645) value. The residuals of the model also showed non-significant autocorrelations (P Box-Ljung (Q)=0.299). The predictions by the optimum ARIMA model adequately captured the pattern in the data and exhibited two peaks of activity over the forecast interval, including a major peak during April to June, and again a light peak for September to November. The ARIMA model proposed in this study can forecast HFMD incidence trend effectively, which could provide useful support for future HFMD prevention and control in the study area. Besides, further observations should be added continually into the modeling data set, and parameters of the models should be adjusted accordingly.

Epidemiologic features of hand-foot-mouth disease in Haikou city from 2008 to 2015

Objective: To analyze the epidemiologic features of hand-foot-mouth disease (HFMD) in Haikou city from 2008 to 2015. Methods: Descriptive methods on epidemiology and detection on pathogens were conducted in Haikou city from 2008 to 2015. Results: A total of 71 611 patients were diagnosed as HFMD in Haikou city from 2008 to 2015, including 728 severe cases, accounting for 1.02% among all the cases. The average annual incidence was 458.89/100 000. A total of 11 deaths were caused by the disease, with the average annual mortality rate as 0.07/100 000. Two peaks of incidence were seen, from April to July and from September to November. Age of the patients mainly fell in children aged 5 and below, taking up 95.78% of the total cases. Among all the patients, 1-year-olds presented the highest incidence as 12 881.24/100 000. The reported incidence for males was higher than that in females. There were 4 districts in Haikou city that reported the disease. Residential areas of the patients were scattered around, with a percentage of 79.89%. Spectrums of pathogens that causing the prevalence of HFMD were EV71 type, Cox A16 type and other enteroviruses, which prevailing in turns, since 2011. Conclusions: Haikou city had been an area with high incidence of HFMD. The incidence started to show a rising trend recently. It is suggested that programs as surveillance, case management, health education and comprehensive prevention and control of disease on HFMD targeting on key population should be intensively implemented to reduce the mortality of the disease.

Epidemiological situation and temporal-spatial clustering changes of hand-foot-mouth disease from 2009 to 2015 in Hunan

To investigate the epidemiological situation and temporal-spatial clustering changes of hand-foot-mouth disease (HFMD) in Hunan. Spatial autocorrelation and temporal-spatial clustering analysis were used to analyze the HFMD in Hunan. The incidence rates of HFMD ranged from 54.31/10 million to 318.06/10 million between 2009 and 2015 in Hunan. Cases mainly displayed in 5-year-old or even younger children and there were two epidemic periods each year. HFMD cases did not show a random distribution but with significant spatial aggregation. When local autocorrelation analysis was applied at the county/district level, 4 hot spots in Changsha, Yiyang, Loudi and Zhuzhou were discovered. The tendency for temporal and spatial clustering existed among HFMD cases in Hunan. The temporal dimension of HFMD was from April to July annually. Clustering areas gathered in the northern regions in 2009 and in the middle regions from 2010 to 2012. They moved to middle-southern regions in 2013 or 2014 and middle-western regions in 2015. The HFMD incidence from 2009 to 2015 in Hunan showed temporal and spatial clustering tendency, with the shifting trend of clustered areas toward south and west.

Analysis of contact rates and force of infection of Hand-foot-mouth disease in Chongqing, China

Hand-foot-mouth disease (HFMD) is primarily caused by enterovirus 71 and coxsackieviruses A16, and usually transmitted among children under five years old. HFMD has been a significant public health challenge in China. In 2015, there were 1767931 cases and 114 deaths reported in China. To understand the transmission of the disease, we examined the age-specific force of infection (FOI) and the transmission rate of HFMD in Chongqing using data from May 2008 to December 2011. Chongqing is the only municipality in the southwest part of China. It has the largest population density compared with other cities in the area, and its has a typical seasonality pattern of HFMD that was found in the southeastern part of China. The FOI of HFMD for Chongqing might be different between age groups, because we had an observation that the FOI of HFMD was identical among age groups before the 2008 outbreak, but was heterogeneity after the outbreak in Fuyang, Anhui Province. Regard to the transmission rate, we studied whether it changed during the year and studied the possible connection of changing in transmission rate with school closure and with holidays. Data of HFMD reported cases were obtained from the Data-center of China Public Health Science; demography data and meteorological data were obtained from the National Bureau of Statistics of China. We used catalytic model to estimate the age-specific FOI of HFMD for Chongqing, and used Time Series Susceptible Infectious Recovered (TSIR) model to estimate the time varied transmission rate of HFMD. In the TSIR model, the serial interval was assumed to be two weeks based on the fact that the incubation period of HFMD was 3–5 days and the infectious period was about 7–10 days. We calculated the proportion of HFMD incidence for each age group. Our results show that: the incidence of HFMD in Chongqing had two peaks, one in spring and one in winter; proportion of cases among children under six years old were 93%, with the largest fraction of cases among 2–3 years old; the FOIs in different age groups were different, FOI of 3–4 years old age group was the highest, and FOI of 35–39 years old was relatively higher than that of other adults; transmission rate among individuals changed during the year; transmission rate increased during summer and winter vocations, meaning that in China the transmission rate of HFMD in community was higher than the transmission rate in school. Control measures of HFMD should focus on young children, especially 3–4 years old, in community during summer and winter vocations.

Visualized Exploratory Spatiotemporal Analysis of Hand-Foot-Mouth Disease in Southern China.

ObjectivesIn epidemiological research, major studies have focused on theoretical models; however, few methods of visual analysis have been used to display the patterns of disease distribution.DesignFor this study, a method combining the space-time cube (STC) with space-time scan statistics (STSS) was used to analyze the pattern of incidence of hand-foot-mouth disease (HFMD) in Guangdong Province from May 2008 to March 2009. In this research, STC was used to display the spatiotemporal pattern of incidence of HFMD, and STSS were used to detect the local aggregations of the disease.SettingThe hand-foot-mouth disease data were obtained from Guangdong Province from May 2008 to March 2009, with a total of 68,130 cases.ResultsThe STC analysis revealed a differential pattern of HFMD incidence among different months and cities and also showed that the population density and average precipitation are correlated with the incidence of HFMD. The STSS analysis revealed that the most likely aggregation includes the Shenzhen, Foshan and Dongguan populations, which are the most developed regions in Guangdong Province.Conclusion Both STC and STSS are efficient tools for the exploratory data analysis of disease transmission. STC clearly displays the spatiotemporal patterns of disease. Using the maximum likelihood ratio, the STSS model precisely locates the most likely aggregation.

HAND-FOOT-MOUTH DISEASE AND CLIMATIC FACTORS IN DAK LAK PROVINCE FROM 2012 TO 2013

Introduction: Hand-foot-mouth-disease (HFMD) is an emerging infectious disease caused by enterovirus. Based on the surveillance data of HFMD and climatic parameters, this study aims to describe the distribution of HFMD in Dak Lak in 2012-2013 and explore the influence of climatic factors on HFMD cases. Methodology: Case series and ecologic studies were used. HFMD case was defined based on MOH’s guidelines. Poisson regression was used to examine the association between the incidence of HFMD and climatic factors. Results: There were 6913 cases of HFMD in Dak Lak in 2012-2013. Mean age (SD) was 24 (17) months. The incidence of HFMD (per 100,000) was 224 in male, 165 in female, 227 in Kinh people, 119 in ethnic minority people. HFMD occurred in all districts and scattered throughout the year, but the highest incidence was in September, October and November (accounting for 43.3%). The climatic variables were related to HFMD cases. Each 1°C rising in temperature corresponded to an increased of 6.3% (RR=1.063, 95%CI=1.037-1.089) in the monthly number of HFMD cases. Similarly, an increase of each 1% in relative humidity, 50mm in rainfall or 5 hour of sunlight corresponded to an increase of 9,8% (RR=1.098, 95% CI=1.087-1.110); 1.7% (RR=1.017, 95% CI=1.005-1.029); 3.4% (RR=1.034, 95% CI=1.029-1.040) in the monthly number of HFMD cases respectively. Conclusions: HFMD occurred all the year round, peaked from September through November. The disease occurred mainly in children under 5 years of age (96%), more common in boys than in girls (ratio 1.4), in Kinh than ethnic minority people (ratio 1.9). There were HFMD cases in all districts of the province. Climatic factors (temperature, humidity, precipitation, sunshine hours) had a significant influence on occurrence and transmission of HFMD. Keywords: Hand-foot-mouth disease (HFMD), climatic factors

Epidemiological analysis of Hand-Foot-Mouth disease in Renqiu city from 2010 to 2012

Objective To analyze the condition and characteristics of hand-foot-mouth disease （ HFMD） from 2010 to 2012 in Renqiu city.Methods Surveillance and detecetion of HFMD was collected according to Renqiu city system for diseases control and prevention .The pathogen of HFMD severe case was deteceted .Results 12 293 cases including 735 severe cases were recorded in Renqiu city from 2010 to 2012,The highest of the resident population was in 2012 and the lowest one was in 2010（r=0.47,P〈0.05）.The total morbidity presented the obvious seasonal char-acteristic,which reached the summit in June ,July,August.The population morbidity was the clustered children .The average incidence rate of severe cases was 5.98%.The incidence rate in 2012 and 2011 was higher than that in 2010 （r=0.43,0.39,all P〈0.05）.There was significant difference of the pathogens types in severe cases among three years with the pathogen of CoxA 16 in 2010,2011 and humantero virus 71 viruses in 2012.Conclusion The inci-dence of HFMD presents the increasing and seasonal characteristics with the prevalence in the scattered children and the pathogens of CoxA16 in 2010,2011,humantero virus 71 in 2012. Key words: Hand-foot-mouth disease; Epidemiologic Methods; Renqiu city

Validation of hepatitis B surface antigen (HBsAg) rapid test to screen HBV infection in rural Gambia

Background: During the last decades, outbreaks of hand-footmouthdisease (HFMD)havebeen reported formany times inChina. The prevention and control of it has become an issue. Presently, there are no specific treatments and specific antiviral drugs or vaccines available against non-polio enteroviruses causingHFMD. That means the risk of infection only can be reduced by good hygiene practices and early medical attention for children with severe symptoms. Therefore, early detection and response using mathematical statistics method during the epidemics will be helpful for policy-makers to generate preventive strategies. Methods & Materials: We proposed a multiple seasonal autoregressive integrated moving average model, to forecast the expected incidence from April 2013 to September 2013 using the retrospective incidence from January 2008 to December 2012 as training set, and incidence from January 2013 to March 2013 as validation set obtained from China Information System for Disease Control and Prevention (CISDCP). All the procedures were implemented via SAS9.2 system. Results: After one order of regular differencing and one order of seasonal differencing, the transformed series achieved stationary. The best fitted model was SARIMAwith the lowest value of Bayesian Information Criterions (BIC). Model parameters had significant differences (P 0.05) (Table 2). This indicated that the best fitted model extracted the useful information of the series. Predictions and observations were very close to each other and showed a good forecasting performance. Conclusion: The ARIMA model we proposed can be an effective way to forecast the incidence cases of HFMD. Detecting the outbreaks before they happened is the key point of the early detection and early warning, and that is also the main purpose of our study. The usefulness of forecasting expected incidence of HFMD performs not only in giving public-health officials a probable trend of the variability to be expected in the future, but also in detecting outbreaks and providing probability statements and guidance to policy makers.

Hand, Foot and Mouth disease in northeastern part of Romania in 2012

Hand-foot-mouth disease (HFMD) is an acute viral infection that occurs usually among children in summer. This paper reports a high incidence of HFMD in children and adults, occurred in summer-autumn 2012 in the northeastern part of Romania. We present a few cases with some atypical clinical manifestations.