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Sun J, Zhang W, Yao G, Gu J, Wu W, Wang D, Du Z, Hao Y. Assessing the modification impact of vaccination on the relationship of the Discomfort Index with hand, foot, and mouth disease in Guizhou: A multicounty study. PLoS Negl Trop Dis 2024; 18:e0012008. [PMID: 38949988 PMCID: PMC11216560 DOI: 10.1371/journal.pntd.0012008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 06/02/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the combined effect of temperature and humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination. METHODS Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China's HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk. RESULTS The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties. CONCLUSIONS Although the EV71 vaccine policy has been implemented, it hasn't effectively controlled the overall risk of HFMD. There's been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.
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Affiliation(s)
- Jie Sun
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Institute for the Control of Infectious Diseases, Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Guanghai Yao
- Institute for the Control of Infectious Diseases, Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Wu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Dan Wang
- Institute for the Control of Infectious Diseases, Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Guangzhou Joint Research Center for Disease Surveillance and Risk Assessment, Sun Yat-sen University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Peking University, Beijing, China
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Li D, Liu Y, Zhang W, Shi T, Zhao X, Zhao X, Zheng H, Li R, Wang T, Ren X. The association between the scarlet fever and meteorological factors, air pollutants and their interactions in children in northwest China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02722-5. [PMID: 38884798 DOI: 10.1007/s00484-024-02722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
Scarlet fever (SF) is an acute respiratory transmitted disease that primarily affects children. The influence of meteorological factors and air pollutants on SF in children has been proved, but the relevant evidence in Northwest China is still lacking. Based on the weekly reported cases of SF in children in Lanzhou, northwest China, from 2014 to 2018, we used geographical detectors, distributed lag nonlinear models (DLNM), and bivariate response models to explore the influence of meteorological factors and air pollutants with SF. It was found that ozone (O3), carbon monoxide (CO), sulfur dioxide (SO2), temperature, pressure, water vapor pressure and wind speed were significantly correlated with SF based on geographical detectors. With the median as reference, the influence of high temperature, low pressure and high pressure on SF has a risk effect (relative risk (RR) > 1), and under extreme conditions, the dangerous effect was still significant. High O3 had the strongest effect at a 6-week delay, with an RR of 5.43 (95%CI: 1.74,16.96). The risk effect of high SO2 was strongest in the week of exposure, and the maximum risk effect was 1.37 (95%CI: 1.08,1.73). The interactions showed synergistic effects between high temperatures and O3, high pressure and high SO2, high nitrogen dioxide (NO2) and high particulate matter with diameter of less than 10 μm (PM10), respectively. In conclusion, high temperature, pressure, high O3 and SO2 were the most important factors affecting the occurrence of SF in children, which will provide theoretical support for follow-up research and disease prevention policy formulation.
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Affiliation(s)
- Donghua Li
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Yanchen Liu
- Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen Hospital, Nanshan District, Shenzhen city, 518000, Guangdong Province, China
| | - Wei Zhang
- Lanzhou Center for Disease Control and Prevention, Chengguan District, Lanzhou City, 733000, Gansu Province, China
| | - Tianshan Shi
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Xiangkai Zhao
- School of Public Health, Zhengzhou University, Zhongyuan District, Zhengzhou City, 450001, Henan Province, China
| | - Xin Zhao
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Hongmiao Zheng
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Rui Li
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Tingrong Wang
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China
| | - Xiaowei Ren
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
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Cao H, Xu R, Liang Y, Li Q, Jiang W, Jin Y, Wang W, Yuan J. Effects of extreme meteorological factors and high air pollutant concentrations on the incidence of hand, foot and mouth disease in Jining, China. PeerJ 2024; 12:e17163. [PMID: 38766480 PMCID: PMC11102053 DOI: 10.7717/peerj.17163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 05/22/2024] Open
Abstract
Background The evidence on the effects of extreme meteorological conditions and high air pollution levels on incidence of hand, foot and mouth disease (HFMD) is limited. Moreover, results of the available studies are inconsistent. Further investigations are imperative to elucidate the specific issue. Methods Data on the daily cases of HFMD, meteorological factors and air pollution were obtained from 2017 to 2022 in Jining City. We employed distributed lag nonlinear model (DLNM) incorporated with Poisson regression to explore the impacts of extreme meteorological conditions and air pollution on HFMD incidence. Results We found that there were nonlinear relationships between temperature, wind speed, PM2.5, SO2, O3 and HFMD. The cumulative risk of extreme high temperature was higher at the 95th percentile (P95th) than at the 90th percentile(P90th), and the RR values for both reached their maximum at 10-day lag (P95th RR = 1.880 (1.261-2.804), P90th RR = 1.787 (1.244-2.569)), the hazardous effect of extreme low temperatures on HFMD is faster than that of extreme high temperatures. The cumulative effect of extreme low wind speeds reached its maximum at 14-day lag (P95th RR = 1.702 (1.389-2.085), P90th RR = 1.498(1.283-1.750)). The cumulative effect of PM2.5 concentration at the P90th was largest at 14-day lag (RR = 1.637 (1.069-2.506)), and the cumulative effect at the P95th was largest at 10-day lag (RR = 1.569 (1.021-2.411)). High SO2 concentration at the P95th at 14-day lag was associated with higher risk for HFMD (RR: 1.425 (1.001-2.030)). Conclusion Our findings suggest that high temperature, low wind speed, and high concentrations of PM2.5 and SO2 are associated with an increased risk of HFMD. This study not only adds insights to the understanding of the impact of extreme meteorological conditions and high levels of air pollutants on HFMD incidence but also holds practical significance for the development and enhancement of an early warning system for HFMD.
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Affiliation(s)
- Haoyue Cao
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Rongrong Xu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Yongmei Liang
- Business Management Department, Jining Center For Disease Control And Prevention, Jining, Shandong, China
| | - Qinglin Li
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Wenguo Jiang
- Infectious Disease Prevention and Control Department, Jining Center For Disease Control And Prevention, Jining, Shandong, China
| | - Yudi Jin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjun Wang
- Weifang Nursing Vocational College, Weifang, Shandong, China
| | - Juxiang Yuan
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, China
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Zain A, Sadarangani SP, Shek LPC, Vasoo S. Climate change and its impact on infectious diseases in Asia. Singapore Med J 2024; 65:211-219. [PMID: 38650059 PMCID: PMC11132621 DOI: 10.4103/singaporemedj.smj-2023-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/04/2024] [Indexed: 04/25/2024]
Abstract
ABSTRACT Climate change, particularly increasing temperature, changes in rainfall, extreme weather events and changes in vector ecology, impacts the transmission of many climate-sensitive infectious diseases. Asia is the world's most populous, rapidly evolving and diverse continent, and it is already experiencing the effects of climate change. Climate change intersects with population, sociodemographic and geographical factors, amplifying the public health impact of infectious diseases and potentially widening existing disparities. In this narrative review, we outline the evidence of the impact of climate change on infectious diseases of importance in Asia, including vector-borne diseases, food- and water-borne diseases, antimicrobial resistance and other infectious diseases. We also highlight the imperative need for strategic intersectoral collaboration at the national and global levels and for the health sector to implement adaptation and mitigation measures, including responsibility for its own greenhouse gas emissions.
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Affiliation(s)
- Amanda Zain
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Sapna P Sadarangani
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lynette Pei-Chi Shek
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Yu HW, Kuan CH, Tseng LW, Chen HY, Tsai MY, Chen YS. Investigation of the Correlation between Enterovirus Infection and the Climate Factor Complex Including the Ping-Year Factor and El Niño-Southern Oscillation in Taiwan. Viruses 2024; 16:471. [PMID: 38543836 PMCID: PMC10975746 DOI: 10.3390/v16030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 05/23/2024] Open
Abstract
Enterovirus infection and enterovirus infection with severe complications (EVSC) are critical issues in several aspects. However, there is no suitable predictive tool for these infections. A climate factor complex (CFC) containing several climate factors could provide more effective predictions. The ping-year factor (PYF) and El Niño-Southern Oscillation (ENSO) are possible CFCs. This study aimed to determine the relationship between these two CFCs and the incidence of enterovirus infection. Children aged 15 years and younger with enterovirus infection and/or EVSC were enrolled between 2007 and 2022. Each year was categorized into a ping-year or non-ping-year according to the PYF. Poisson regression was used to evaluate the associations between the PYF, ENSO, and the incidence of enterovirus infection. Compared to the ping-year group, the incidence rate of enterovirus infection, the incidence rate of EVSC, and the ratio of EVSC in the non-ping-year group were 1.24, 3.38, and 2.73 times higher, respectively (p < 0.001). For every one-unit increase in La Niña, the incidence rate of enterovirus infection decreased to 0.96 times (p < 0.001). Our study indicated that CFCs could be potential predictors for enterovirus infection, and the PYF was more suitable than ENSO. Further research is needed to improve the predictive model.
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Affiliation(s)
- Hsueh-Wen Yu
- Department of Chinese Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Gueishan Dist., Taoyuan City 333423, Taiwan; (H.-W.Y.); (C.-H.K.); (L.-W.T.)
- Taiwan Huangdi-Neijing Medical Practice Association (THMPA), Taoyuan City 330032, Taiwan
| | - Chia-Hsuan Kuan
- Department of Chinese Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Gueishan Dist., Taoyuan City 333423, Taiwan; (H.-W.Y.); (C.-H.K.); (L.-W.T.)
- Taiwan Huangdi-Neijing Medical Practice Association (THMPA), Taoyuan City 330032, Taiwan
| | - Liang-Wei Tseng
- Department of Chinese Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Gueishan Dist., Taoyuan City 333423, Taiwan; (H.-W.Y.); (C.-H.K.); (L.-W.T.)
- Taiwan Huangdi-Neijing Medical Practice Association (THMPA), Taoyuan City 330032, Taiwan
| | - Hsing-Yu Chen
- Department of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Gueishan Dist., Taoyuan City 333423, Taiwan;
| | - Meg-Yen Tsai
- Pingzhen Fengze Chinese Medicine Clinic, No. 65, Sec. 2, Yanping Rd., Pingzhen Dist., Taoyuan City 324005, Taiwan;
| | - Yu-Sheng Chen
- Department of Chinese Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Gueishan Dist., Taoyuan City 333423, Taiwan; (H.-W.Y.); (C.-H.K.); (L.-W.T.)
- Taiwan Huangdi-Neijing Medical Practice Association (THMPA), Taoyuan City 330032, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wen-Hwa 1st Rd., Gueishan Dist., Taoyuan City 333323, Taiwan
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Wang H, Li W, Shi L, Chen G, Tu Z. Modeling and analysis of the effect of optimal virus control on the spread of HFMD. Sci Rep 2024; 14:6387. [PMID: 38493254 PMCID: PMC10944539 DOI: 10.1038/s41598-024-56839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
A within-host and between-host hand, foot and mouth disease (HFMD) mathematical model is established and the affect of optimal control in its within-host part on HFMD transmission is studied. Through define two basic reproduction numbers, by using the fast-slow system analysis method of time scale, the global stabilities of the between-host (slow) system and within-host (fast) system are researched, respectively. An optimal control problem with drug-treatment control on coupled within-host and between-host HFMD model is formulated and analysed theoretically. Finally, the purposed optimal control measures are applied to the actual HFMD epidemic analysis in Zhejiang Province, China from April 1, 2021 to June 30, 2021. The numerical results show that the drug control strategies can reduce the virus load per capita and can effectively prevent large-scale outbreaks of HFMD.
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Affiliation(s)
- Hui Wang
- College of Nursing, Chongqing Three Gorges Medical College, Wanzhou, 404120, China.
| | - Weihua Li
- College of Nursing, Chongqing Three Gorges Medical College, Wanzhou, 404120, China
| | - Lei Shi
- School of Mathematics and Statistics, Guilin University of Technology, Guilin, 541004, China
| | - Gaofang Chen
- School of Mathematics and Statistics, Guilin University of Technology, Guilin, 541004, China
| | - Zhengwen Tu
- School of Mathematics and Statistics, Chongqing Three Gorges University, Wanzhou, 404100, China
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Wei Y, Ma Y, Zhang T, Luo X, Yin F, Shui T. Spatiotemporal patterns and risk mapping of provincial hand, foot, and mouth disease in mainland China, 2014-2017. Front Public Health 2024; 12:1291361. [PMID: 38344231 PMCID: PMC10853440 DOI: 10.3389/fpubh.2024.1291361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) has remained a serious public health threat since its first outbreak in China. Analyzing the province-level spatiotemporal distribution of HFMD and mapping the relative risk in mainland China will help determine high-risk provinces and periods of infection outbreaks for use in formulating new priority areas for prevention and control of this disease. Furthermore, our study examined the effect of air pollution on HFMD nationwide, which few studies have done thus far. Methods Data were collected on the number of provincial monthly HFMD infections, air pollution, meteorological variables, and socioeconomic variables from 2014 to 2017 in mainland China. We used spatial autocorrelation to determine the aggregate distribution of HFMD incidence. Spatiotemporal patterns of HFMD were analyzed, risk maps were developed using the Bayesian spatiotemporal model, and the impact of potential influencing factors on HFMD was assessed. Results In our study, from 2014 to 2017, the HFMD annual incidence rate in all provinces of mainland China ranged from 138.80 to 203.15 per 100,000 people, with an average annual incidence rate of 165.86. The temporal risk of HFMD for 31 Chinese provinces exhibited cyclical and seasonal characteristics. The southern and eastern provinces had the highest spatial relative risk (RR > 3) from 2014 to 2017. The HFMD incidence risk in provinces (Hunan, Hubei, and Chongqing) located in central China increased over time. Among the meteorological variables, except for the mean two-minute wind speed (RR 0.6878; 95% CI 0.5841, 0.8042), all other variables were risk factors for HFMD. High GDP per capita (RR 0.9922; 95% CI 0.9841, 0.9999) was a protective factor against HFMD. The higher the birth rate was (RR 1.0657; 95% CI 1.0185, 1.1150), the higher the risk of HFMD. Health workers per 1,000 people (RR 1.2010; 95% CI 1.0443, 1.3771) was positively correlated with HFMD. Conclusions From 2014 to 2017, the central provinces (Hunan, Hubei, and Chongqing) gradually became high-risk regions for HFMD. The spatiotemporal pattern of HFMD risk may be partially attributed to meteorological and socioeconomic factors. The prevalence of HFMD in the central provinces requires attention, as prevention control efforts should be strengthened there.
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Affiliation(s)
- Yuxin Wei
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xuelian Luo
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, China
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Luo C, Ma Y, Lu K, Li Y, Liu Y, Zhang T, Yin F, Shui T. How multiple air pollutants affect hand, foot, and mouth disease incidence in children: assessing effect modification by geographical context in multicity of Sichuan, southwest China. BMC Public Health 2024; 24:263. [PMID: 38263020 PMCID: PMC10804470 DOI: 10.1186/s12889-023-17484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Several studies have suggested a significant association of hand, foot, and mouth disease (HFMD) with ambient air pollutants. Existing studies have characterized the role of air pollutants on HFMD using only risk ratio measures while ignoring the attributable burden. And whether the geographical context (i.e., diverse topographic features) could modulate the relationships is unclear. METHODS Daily reported childhood HFMD counts, ambient air pollution, and meteorological data during 2015-2017 were collected for each of 21 cities in Sichuan Province. A multistage analysis was carried out in different populations based on geographical context to assess effect modification by topographic conditions. We first constructed a distributed lag nonlinear model (DLNM) for each city to describe the relationships with risk ratio measures. Then, we applied a multivariate meta-regression to estimate the pooled effects of multiple air pollutants on HFMD from the exposure and lagged dimensions. Finally, attributable risks measures were calculated to quantify HFMD burden by air pollution. RESULTS Based on 207554 HFMD cases in Sichuan Province, significant associations of HFMD with ambient air pollutants were observed mainly at relatively high exposure ranges. The effects of ambient air pollutants on HFMD are most pronounced on lag0 or around lag7, with relative risks gradually approaching the reference line thereafter. The attributable risks of O3 were much greater than those of other air pollutants, particularly in basin and mountain regions. CONCLUSIONS This study revealed significant pooled relationships between multiple air pollutants and HFMD incidence from both exposure and lag dimensions. However, the specific effects, including RRs and ARs, differ depending on the air pollution variable and geographical context. These findings provide local authorities with more evidence to determine key air pollutants and regions for devising and implementing targeted interventions.
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Affiliation(s)
- Caiying Luo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kai Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yaqiong Liu
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, China.
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Wang W, Li S, Zhang T, Yin F, Ma Y. Detecting the spatial clustering of exposure-response relationships with estimation error: a novel spatial scan statistic. Biometrics 2023; 79:3522-3532. [PMID: 36964947 DOI: 10.1111/biom.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/25/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Detecting the spatial clustering of the exposure-response relationship (ERR) between environmental risk factors and health-related outcomes plays important roles in disease control and prevention, such as identifying highly sensitive regions, exploring the causes of heterogeneous ERRs, and designing region-specific health intervention measures. However, few studies have focused on this issue. A possible reason is that the commonly used cluster-detecting tool, spatial scan statistics, cannot be used for multivariate spatial datasets with estimation error, such as the ERR, which is often defined by a vector with its covariance estimated by a regression model. Such spatial datasets have been produced in abundance in the last decade, which suggests the importance of developing a novel cluster-detecting tool applicable for multivariate datasets with estimation error. In this work, by extending the classic scan statistic, we developed a novel spatial scan statistic called the estimation-error-based scan statistic (EESS), which is applicable for both univariate and multivariate datasets with estimation error. Then, a two-stage analytic process was proposed to detect the spatial clustering of ERRs in practical studies. A published motivating example and a simulation study were used to validate the performance of EESS. The results show that the clusters detected by EESS can efficiently reflect the clustering heterogeneity and yield more accurate ERR estimates by adjusting for such heterogeneity.
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Affiliation(s)
- Wei Wang
- West China School of Public Health and West China Fourth hospital, Sichuan University, Chengdu, China
| | - Sheng Li
- West China School of Public Health and West China Fourth hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth hospital, Sichuan University, Chengdu, China
| | - Fei Yin
- West China School of Public Health and West China Fourth hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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10
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Yang L, Liu T, Tian D, Zhao H, Xia Y, Wang J, Li T, Li Q, Qi L. Non-linear association between daily mean temperature and children's hand foot and mouth disease in Chongqing, China. Sci Rep 2023; 13:20355. [PMID: 37990138 PMCID: PMC10663521 DOI: 10.1038/s41598-023-47858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023] Open
Abstract
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.
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Affiliation(s)
- Lin Yang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Tian Liu
- Jingzhou Center for Disease Control and Prevention, Hubei, 434000, China
| | - Dechao Tian
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Han Zhao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Yu Xia
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Ju Wang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Tingting Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China.
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Zhan ZY, Fang HY, Xu XY, Hu ZJ. Interactions of particulate matter with temperature, heat index and relative humidity on pediatric hand, foot, and mouth disease in a subtropical city. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 336:122385. [PMID: 37648054 DOI: 10.1016/j.envpol.2023.122385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
The associations of hand, foot, and mouth disease (HFMD) with meteorological variables and particulate matter (PM) remain controversial, and limited evidence is available on heat index (HI) and coarse particulate (PM10-2.5). Moreover, temperature and humidity are considered major risk factors but their interaction with PM remains unclear. We combined the distributed lag non-linear and quasi-Poisson models to estimate the non-linear and lagged associations of meteorological variables and PM with HFMD based on reported HFMD during 2015-2019 in Fuzhou, China. The multiplicative term of interaction was used to explore the relationship between HFMD and meteorological variables or PM at different levels of another variable. Stratified analyses were used to identify vulnerable subpopulations. We observed inverted-V-shaped relationships between HFMD and temperature and HI, and the W- and N-shaped for relative humidity (RH) and PM, respectively. Extreme high (i.e., the 95th percentile) temperature, HI and RH increased the HFMD with relative risks (RR) of 4.00 (95% confidence interval, 2.79-5.75), 2.20 (1.71-2.83) and 1.54 (1.35-1.75) referent to the minimum effect value of 10.3 °C, 69.4 and 54.8%, respectively. Higher concentrations of PM rapidly increased the HFMD. Infants under 2 years suffered more from temperature, HI and PM. There were synergistic effects between meteorological variables and PM on HFMD. For instance, the RRs of temperature (30 °C) and RH (40%) on HFMD increased from 3.68 (2.24-6.06) to 6.44 (4.29-9.66) and from 0.45 (0.14-1.47) to 2.15 (0.90-5.12) at low (<25%) and high (>75%) categories of PM2.5, respectively. While the RRs of 70 μg/m3 of PM10 and PM10-2.5 increased from 0.65 (0.32-1.31) to 2.93 (1.63-5.26) and from 0.86 (0.23-3.21) to 3.26 (1.23-8.62) at low and high categories of HI. These findings are essential for the development a prediction and warning systems and prevention and control strategies for HFMD.
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Affiliation(s)
- Zhi-Ying Zhan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Hai-Yin Fang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China; Fuzhou Center for Disease Control and Prevention, Fuzhou 350004, Fujian Province, China
| | - Xin-Ying Xu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Zhi-Jian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China.
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12
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Guo Z, Wang Y, Li Y, Zhou L. Impact of meteorological factors on the incidence of hand-foot-mouth disease in Yangzhou from 2017 to 2022: a time series study. Front Public Health 2023; 11:1278516. [PMID: 37881347 PMCID: PMC10597706 DOI: 10.3389/fpubh.2023.1278516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a significant public health issue in China, and numerous studies have indicated a close association between HFMD incidence and meteorological factors. This study aims to investigate the relationship between meteorological factors and HFMD in Yangzhou City, Jiangsu Province, China. Methods HFMD case reports and meteorological data from Yangzhou City between 2017 and 2022 were extracted from the National Notifiable Infectious Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) was employed to assess the exposure-response relationship between meteorological factors and HFMD. Subsequently, a distributed lag nonlinear model (DLNM) was used to explore the exposure-lag-effect of meteorological factors on HFMD. Results HFMD in Yangzhou City exhibits obvious seasonality and periodicity. There is an inverted "U" shaped relationship between average temperature and the risk of HFMD, with the maximum lag effect observed at a temperature of 25°C with lag 0 day (RR = 2.07, 95% CI: 1.74-2.47). As the duration of sunshine and relative humidity increase, the risk of HFMD continuously rises, with the maximum lag effect observed at a sunshine duration of 12.4 h with a lag of 14 days (RR = 2.10, 95% CI: 1.17-3.77), and a relative humidity of 28% with a lag of 14 days (RR = 1.21, 95% CI: 1.01-1.64). There is a "U" shaped relationship between average atmospheric pressure and the risk of HFMD, with the maximum effect observed at an atmospheric pressure of 989 hPa with no lag (RR = 1.45, 95% CI: 1.25-1.69). As precipitation increases, the risk of HFMD decreases, with the maximum effect observed at a precipitation of 151 mm with a lag of 14 days (RR = 1.45, 95% CI: 1.19-2.53). Conclusion Meteorological factors including average temperature, average atmospheric pressure, relative humidity, precipitation, and sunshine duration significantly influenced the risk of HFMD in Yangzhou City. Effective prevention measures for HFMD should be implemented, taking into account the local climate conditions.
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Affiliation(s)
- Zaijin Guo
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yin Wang
- Department of Acute Infectious Disease Control and Prevention, Yangzhou Centre for Disease Control and Prevention, Yangzhou, China
| | - Yunshui Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Luojing Zhou
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
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13
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Wang L, Xu C, Wang J, Qiao J, Wu N, Li L. Spatiotemporal associations between hand, foot and mouth disease and meteorological factors over multiple climate zones. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:1493-1504. [PMID: 37458818 DOI: 10.1007/s00484-023-02519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023]
Abstract
Prior studies of hand, foot, and mouth disease (HFMD) have often observed inconsistent results regarding meteorological factors. We propose the hypothesis that these meteorological associations vary in regions because of the heterogeneity of their geographical characteristics. We have tested this hypothesis by applying a geographical detector and Bayesian space-time hierarchy model to measure stratified spatiotemporal heterogeneity and local associations between meteorological factors and HFMD risk in five climate zones in China from January 2016 to December 2017. We found a significant spatial stratified heterogeneity in HFMD risk and climate zone explained 15% of the spatial stratified heterogeneity. Meanwhile, there was a significant temporal stratified heterogeneity of 14% as determined by meteorological factors. Average temperatures and relative humidity had a significant positive effect on HFMD in all climate zones, they were the most obvious in the southern temperate zone. In northern temperate, southern temperate, northern subtropics, middle subtropics and southern subtropics climate zone, a 1 °C rise in temperature was related to an increase of 3.99%, 13.76%, 4.38%, 3.99%, and 7.74% in HFMD, and a 1% increment in relative humidity was associated with a 1.51%, 5.40%, 2.21%, 3.44%, and 4.78% increase, respectively. These findings provide strong support for our hypotheses that HFMD incidence has a significant spatiotemporal stratified heterogeneity and different climate zones have distinct influences on the disease. These findings provide strong support for our hypotheses: HFMD incidence had significant spatiotemporal stratified heterogeneity and different climate zones had distinct influences on it. The study suggested that HFMD prevention and policy should be made according to meteorological variation in each climate zone.
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Affiliation(s)
- Li Wang
- College of Geography and Environmental Science, Henan University, Kaifeng, China
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Kaifeng, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Jiajun Qiao
- College of Geography and Environmental Science, Henan University, Kaifeng, China.
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Kaifeng, China.
| | - Nalin Wu
- College of Geography and Environmental Science, Henan University, Kaifeng, China
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Kaifeng, China
| | - Li Li
- Key Laboratory of Ecosystem Network Observation and Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
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14
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Geng X, Ma Y, Cai W, Zha Y, Zhang T, Zhang H, Yang C, Yin F, Shui T. Evaluation of models for multi-step forecasting of hand, foot and mouth disease using multi-input multi-output: A case study of Chengdu, China. PLoS Negl Trop Dis 2023; 17:e0011587. [PMID: 37683009 PMCID: PMC10511093 DOI: 10.1371/journal.pntd.0011587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/20/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is a public health concern that threatens the health of children. Accurately forecasting of HFMD cases multiple days ahead and early detection of peaks in the number of cases followed by timely response are essential for HFMD prevention and control. However, many studies mainly predict future one-day incidence, which reduces the flexibility of prevention and control. METHODS We collected the daily number of HFMD cases among children aged 0-14 years in Chengdu from 2011 to 2017, as well as meteorological and air pollutant data for the same period. The LSTM, Seq2Seq, Seq2Seq-Luong and Seq2Seq-Shih models were used to perform multi-step prediction of HFMD through multi-input multi-output. We evaluated the models in terms of overall prediction performance, the time delay and intensity of detection peaks. RESULTS From 2011 to 2017, HFMD in Chengdu showed seasonal trends that were consistent with temperature, air pressure, rainfall, relative humidity, and PM10. The Seq2Seq-Shih model achieved the best performance, with RMSE, sMAPE and PCC values of 13.943~22.192, 17.880~27.937, and 0.887~0.705 for the 2-day to 15-day predictions, respectively. Meanwhile, the Seq2Seq-Shih model is able to detect peaks in the next 15 days with a smaller time delay. CONCLUSIONS The deep learning Seq2Seq-Shih model achieves the best performance in overall and peak prediction, and is applicable to HFMD multi-step prediction based on environmental factors.
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Affiliation(s)
- Xiaoran Geng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wennian Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuanyi Zha
- Kunming Medical University, Kunming, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huadong Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Changhong Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, China
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15
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Song X, Guo X, Hu X, Zhang Y, Wei D, Hu Y, Jiang L, Zhang Y. Human exposure risk assessment for infectious diseases due to temperature and air pollution: an overview of reviews. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:88272-88280. [PMID: 37440140 DOI: 10.1007/s11356-023-28453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
Air pollution and global temperature change are expected to affect infectious diseases. Air pollution usually causes inflammatory response and disrupts immune defense system, while temperature mainly exacerbates the effect of vectors on humans. Yet to date overview of systematic reviews assessing the exposure risk of air pollutants and temperature on infectious diseases is unavailable. This article aims to fill this research gap. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature were searched. Systematic reviews and meta-analyses investigated the exposure risk of pollutants or temperature on infectious diseases were included. Two investigators screened literature, extracted data and performed the risk of bias assessments independently. A total of 23 articles met the inclusion criteria, which 3 (13%) were "low" quality and 20 (87%) were "critically low" quality. COVID-19 morbidity was associated with long-term exposure PM2.5 (RR = 1.056 per 1 [Formula: see text], 95% CI: 1.039-1.072) and NO2 (RR = 1.042 per 1 [Formula: see text], 95% CI: 1.017-1.068). In addition, for each 1 °C increase in temperature, the morbidity risk of dengue increased 13% (RR = 1.130 per 1 °C, 95% CI: 1.120-1.150), infectious diarrhea increased 8% (RR = 1.080 per 1 °C, 95% CI: 1.050-1.200), and hand, foot and mouth disease (HFMD) increased 5% (RR = 1.050 per 1 °C, 95% CI: 1.020-1.080). In conclusion, PM2.5 and NO2 increased the risk of COVID-19 and temperatures were associated with dengue, infectious diarrhoea and HFMD morbidity. Moreover, the exposure risk of temperature on COVID-19 was recommended to be further explored.
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Affiliation(s)
- Xuping Song
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
- McMaster Health Forum, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, L8S4L8, Canada
| | - Xinye Guo
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xiaopeng Hu
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yajie Zhang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Dandan Wei
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yue Hu
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | | | - Yan Zhang
- Gansu Province Hospital Rehabilitation Center, Lanzhou, 730000, Gansu, China.
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Cai W, Luo C, Geng X, Zha Y, Zhang T, Zhang H, Yang C, Yin F, Ma Y, Shui T. City-level meteorological conditions modify the relationships between exposure to multiple air pollutants and the risk of pediatric hand, foot, and mouth disease in the Sichuan Basin, China. Front Public Health 2023; 11:1140639. [PMID: 37601186 PMCID: PMC10433208 DOI: 10.3389/fpubh.2023.1140639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
Background Several studies have examined the effects of city-level meteorological conditions on the associations between meteorological factors and hand, foot, and mouth disease (HFMD) risk. However, evidence that city-level meteorological conditions modify air pollutant-HFMD associations is lacking. Methods For each of the 17 cities in the Sichuan Basin, we obtained estimates of the relationship between exposures to multiple air pollutants and childhood HFMD risk by using a unified distributed lag nonlinear model (DLNM). Multivariate meta-regression models were used to identify the effects of city-level meteorological conditions as effect modifiers. Finally, we conducted subgroup analyses of age and sex to explore whether the modification effects varied in different subgroups. Results The associations between PM2.5/CO/O3 and HFMD risk showed moderate or substantial heterogeneity among cities (I 2 statistics: 48.5%, 53.1%, and 61.1%). Temperature conditions significantly modified the PM2.5-HFMD association, while relative humidity and rainfall modified the O3-HFMD association. Low temperatures enhanced the protective effect of PM2.5 exposure against HFMD risk [PM2.5 <32.7 μg/m3 or PM2.5 >100 μg/m3, at the 99th percentile: relative risk (RR) = 0.14, 95% CI: 0.03-0.60]. Low relative humidity increased the adverse effect of O3 exposure on HFMD risk (O3 >128.7 μg/m3, at the 99th percentile: RR = 2.58, 95% CI: 1.48-4.50). However, high rainfall decreased the risk of HFMD due to O3 exposure (O3: 14.1-41.4 μg/m3). In addition, the modification effects of temperature and relative humidity differed in the female and 3-5 years-old subgroups. Conclusion Our findings revealed moderate or substantial heterogeneity in multiple air pollutant-HFMD relationships. Temperature, relative humidity, and rainfall modified the relationships between PM2.5 or O3 exposure and HFMD risk.
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Affiliation(s)
- Wennian Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Caiying Luo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaoran Geng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuanyi Zha
- Graduate School of Kunming Medical University, Kunming, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huadong Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Changhong Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, China
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Liu W, Wang R, Li Y, Zhao S, Chen Y, Zhao Y. The indirect impacts of nonpharmacological COVID-19 control measures on other infectious diseases in Yinchuan, Northwest China: a time series study. BMC Public Health 2023; 23:1089. [PMID: 37280569 DOI: 10.1186/s12889-023-15878-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Various nonpharmaceutical interventions (NPIs) against COVID-19 continue to have an impact on socioeconomic and population behaviour patterns. However, the effect of NPIs on notifiable infectious diseases remains inconclusive due to the variability of the disease spectrum, high-incidence endemic diseases and environmental factors across different geographical regions. Thus, it is of public health interest to explore the influence of NPIs on notifiable infectious diseases in Yinchuan, Northwest China. METHODS Based on data on notifiable infectious diseases (NIDs), air pollutants, meteorological data, and the number of health institutional personnel in Yinchuan, we first fitted dynamic regression time series models to the incidence of NIDs from 2013 to 2019 and then estimated the incidence for 2020. Then, we compared the projected time series data with the observed incidence of NIDs in 2020. We calculated the relative reduction in NIDs at different emergency response levels in 2020 to identify the impacts of NIPs on NIDs in Yinchuan. RESULTS A total of 15,711 cases of NIDs were reported in Yinchuan in 2020, which was 42.59% lower than the average annual number of cases from 2013 to 2019. Natural focal diseases and vector-borne infectious diseases showed an increasing trend, as the observed incidence in 2020 was 46.86% higher than the estimated cases. The observed number of cases changed in respiratory infectious diseases, intestinal infectious diseases and sexually transmitted or bloodborne diseases were 65.27%, 58.45% and 35.01% higher than the expected number, respectively. The NIDs with the highest reductions in each subgroup were hand, foot, and mouth disease (5854 cases), infectious diarrhoea (2157 cases) and scarlet fever (832 cases), respectively. In addition, it was also found that the expected relative reduction in NIDs in 2020 showed a decline across different emergency response levels, as the relative reduction dropped from 65.65% (95% CI: -65.86%, 80.84%) during the level 1 response to 52.72% (95% CI: 20.84%, 66.30%) during the level 3 response. CONCLUSIONS The widespread implementation of NPIs in 2020 may have had significant inhibitory effects on the incidence of respiratory infectious diseases, intestinal infectious diseases and sexually transmitted or bloodborne diseases. The relative reduction in NIDs during different emergency response levels in 2020 showed a declining trend as the response level changed from level 1 to level 3. These results can serve as essential guidance for policy-makers and stakeholders to take specific actions to control infectious diseases and protect vulnerable populations in the future.
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Affiliation(s)
- Weichen Liu
- School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, No. 1160, Shengli Street, Xingqing District, Yinchuan, 750004, Ningxia, China
| | - Ruonan Wang
- Key Laboratory of Environmental Factors and Chronic Disease Control, No. 1160, Shengli Street, Xingqing District, Yinchuan, 750004, Ningxia, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yan Li
- Center for Disease Control and Prevention of Yinchuan, Yinchuan, 750004, Ningxia, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- CUHK Shenzhen Research Institute, Shenzhen, China
| | - Yaogeng Chen
- School of Science, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yu Zhao
- School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
- Key Laboratory of Environmental Factors and Chronic Disease Control, No. 1160, Shengli Street, Xingqing District, Yinchuan, 750004, Ningxia, China.
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18
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Zhu P, Ji W, Li D, Li Z, Chen Y, Dai B, Han S, Chen S, Jin Y, Duan G. Current status of hand-foot-and-mouth disease. J Biomed Sci 2023; 30:15. [PMID: 36829162 PMCID: PMC9951172 DOI: 10.1186/s12929-023-00908-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. These symptoms typically resolve spontaneously within a few days without complications. Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. These findings reveal clinical, epidemiological, pathological, and etiological characteristics that are quite different from initial understandings of the illness. It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. At present, there is no specific pharmaceutical intervention for HFMD. An inactivated Enterovirus A71 (EV-A71) vaccine that has been approved by the China Food and Drug Administration (CFDA) has been shown to provide a high level of protection against EV-A71-related HFMD. However, the simultaneous circulation of multiple pathogens and the evolution of the molecular epidemiology of infectious agents make interventions based solely on a single agent comparatively inadequate. Enteroviruses are highly contagious and have a predilection for the nervous system, particularly in child populations, which contributes to the ongoing outbreak. Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.
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Affiliation(s)
- Peiyu Zhu
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Wangquan Ji
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Dong Li
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Zijie Li
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yu Chen
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Bowen Dai
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Shujie Han
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Shuaiyin Chen
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China. .,Academy of Medical Science, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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Meng L, Zhou C, Xu Y, Liu F, Zhou C, Yao M, Li X. The lagged effect and attributable risk of apparent temperature on hand, foot, and mouth disease in Changsha, China: a distributed lag non-linear model. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:11504-11515. [PMID: 36094702 DOI: 10.1007/s11356-022-22875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is the leading Category C infectious disease affecting millions of children in China every year. In the context of global climate change, the understanding and quantification of the impact of weather factors on human health are particularly critical to the development and implementation of climate change adaptation and mitigation strategies. The aim of this study was to quantify the attributable burden of a combined bioclimatic indicator (apparent temperature) on HFMD and to identify temperature-specific sensitive populations. A total of 123,622 HFMD cases were included in the study. The non-linear relationship between apparent temperature and the incidence of HFMD was approximately M-shaped, with hot weather being more likely to be attributable than cold conditions, of which moderately hot accounting for the majority of cases (21,441, 17.34%). Taking the median apparent temperature (19.2 °C) as reference, the cold effect showed a short acute effect with the highest risk on the day of lag 0 (RR = 1.086, 95% CI: 1.024 ~ 1.152), whereas the hot effect lasted longer with the greatest risk at a lag of 7 days (RR = 1.081, 95% CI: 1.059 ~ 1.104). Subgroup analysis revealed that males, children under 3 years old, and scattered children tended to be more vulnerable to HFMD in hot weather, while females, those aged 3 ~ 5 years, and nursery children were sensitive to cold conditions. This study suggests that high temperatures have a greater impact on HFMD than low temperatures as well as lasting longer, of particular concern being moderately high temperatures rather than extreme temperatures. Early intervention takes on greater importance during cold days, while the duration of HFMD intervention must be longer during hot days.
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Affiliation(s)
- Lijun Meng
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Chunliang Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, Hunan, China
| | - Yiqing Xu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, Hunan, China
| | - Fuqiang Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, Hunan, China
| | - Cui Zhou
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Meng Yao
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Xingli Li
- Department of Epidemiology and Health Statistics, Xiang Ya School of Public Health, Central South University, Changsha, 410078, Hunan, China.
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Huang J, Ma Y, Lv Q, Liu Y, Zhang T, Yin F, Shui T. Interactive effects of meteorological factors and air pollutants on hand, foot, and mouth disease in Chengdu, China: a time-series study. BMJ Open 2022; 12:e067127. [PMID: 36450433 PMCID: PMC9716848 DOI: 10.1136/bmjopen-2022-067127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Hand, foot, and mouth disease (HFMD) is a viral infectious disease that poses a substantial threat in the Asia-Pacific region. It is widely reported that meteorological factors are associated with HFMD. However, the relationships between air pollutants and HFMD are still controversial. In addition, the interactive effects between meteorological factors and air pollutants on HFMD remain unknown. To fill this research gap, we conducted a time-series study. DESIGN A time-series study. SETTING AND PARTICIPANTS Daily cases of HFMD as well as meteorological and air pollution data were collected in Chengdu from 2011 to 2017. A total of 184 610 HFMD cases under the age of 15 were included in our study. OUTCOME MEASURES Distributed lag nonlinear models were used to investigate the relationships between HFMD and environmental factors, including mean temperature, relative humidity, SO2, NO2, and PM10. Then, the relative excess risk due to interaction (RERI) and the proportion attributable to interaction were calculated to quantitatively evaluate the interactions between meteorological factors and air pollutants on HFMD. Bivariate response surface models were used to visually display the interactive effects. RESULTS The cumulative exposure-response curves of SO2 and NO2 were inverted 'V'-shaped and 'M'-shaped, respectively, and the risk of HFMD gradually decreased with increasing PM10 concentrations. We found that there were synergistic interactions between mean temperature and SO2, relative humidity and SO2, as well as relative humidity and PM10 on HFMD, with individual RERIs of 0.334 (95% CI 0.119 to 0.548), 0.428 (95% CI 0.214 to 0.642) and 0.501 (95% CI 0.262 to 0.741), respectively, indicating that the effects of SO2 and PM10 on HFMD were stronger under high temperature (>17.3°C) or high humidity (>80.0%) conditions. CONCLUSIONS There were interactive effects between meteorological factors and air pollutants on HFMD. Our findings could provide guidance for targeted and timely preventive and control measures for HFMD.
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Affiliation(s)
- Jiaqi Huang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Qiang Lv
- Department of Acute Infectious Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yaqiong Liu
- Department of Acute Infectious Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Fei Yin
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Department of Leprosy Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
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21
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Li M, Ma Y, Luo C, Lv Q, Liu Y, Zhang T, Yin F, Shui T. Modification effects of socioeconomic factors on associations between air pollutants and hand, foot, and mouth disease: A multicity time-series study based on heavily polluted areas in the basin area of Sichuan Province, China. PLoS Negl Trop Dis 2022; 16:e0010896. [PMID: 36413517 PMCID: PMC9681081 DOI: 10.1371/journal.pntd.0010896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a serious threat among children in China. Some studies have found that air pollution is associated with HFMD incidence, but the results showed heterogeneity. In this study, we aimed to explore the heterogeneity of associations between air pollutants and the number of HFMD cases and to identify significant socioeconomic effect modifiers. METHODS We collected daily surveillance data on HFMD cases in those aged less than 15 years, air pollution variables and meteorological variables from 2015 to 2017 in the basin area of Sichuan Province. We also collected socioeconomic indicator data. We conducted a two-stage multicity time-series analysis. In the first stage, we constructed a distributed lag nonlinear model (DLNM) to obtain cumulative exposure-response curves between each air pollutant and the numbers of HFMD cases for every city. In the second stage, we carried out a multivariable meta-regression to merge the estimations in the first stage and to identify significant socioeconomic effect modifiers. RESULTS We found that PM10, NO2 and O3 concentrations were associated with the number of HFMD cases. An inverted V-shaped association between PM10 and the number of HFMD cases was observed. The overall NO2-HFMD association was a hockey-stick shape. For the relationships of PM10, SO2, NO2, O3 and CO with HFMD counts, approximately 58.5%, 48.4%, 51.0%, 55.6% and 52.5% of the heterogeneity could be explained, respectively. The proportion of primary school students, population density, urbanization rate, number of licensed physicians and number of hospital beds explained part of the heterogeneity and modified the relationships. CONCLUSION Our study explored the heterogeneity of associations between air pollutants and HFMD counts. The proportion of primary school students, population density, urbanization rate, number of licensed physicians and number of hospital beds could modify the relationships. The results can serve as a reference for relevant public health decision making.
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Affiliation(s)
- Mengyao Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Caiying Luo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qiang Lv
- Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yaqiong Liu
- Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
- * E-mail: (FY); (TS)
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, People’s Republic of China
- * E-mail: (FY); (TS)
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22
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Qin T, Hao Y, Wu Y, Chen X, Zhang S, Wang M, Xiong W, He J. Association between averaged meteorological factors and tuberculosis risk: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2022; 212:113279. [PMID: 35561834 DOI: 10.1016/j.envres.2022.113279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
Inconsistencies were discovered in the findings regarding the effects of meteorological factors on tuberculosis (TB). This study conducted a systematic review of published studies on the relationship between TB and meteorological factors and used a meta-analysis to investigate the pooled effects in order to provide evidence for future research and policymakers. The literature search was completed by August 3rd, 2021, using three databases: PubMed, Web of Science and Embase. Relative risks (RRs) in included studies were extracted and all effect estimates were combined together using meta-analysis. Subgroup analyses were carried out based on the resolution of exposure time, regional climate, and national income level. A total of eight studies were included after screening for inclusion and exclusion criteria. Our results show that TB risk was positively correlated with precipitation (RR = 1.32, 95% CI: 1.14, 1.51), while temperature (RR = 1.15, 95% CI: 1.00, 1.32), humidity (RR = 1.05, 95% CI: 0.99, 1.10), air pressure (RR = 0.89, 95% CI: 0.69, 1.14) and sunshine duration (RR = 0.95, 95% CI: 0.80, 1.13) all had no statistically significant correlation. Subgroup analysis shows that quarterly measure resolution, low and middle Human Development Index (HDI) level and subtropical climate increase TB risk not only in precipitation, but also in temperature and humidity. Moreover, less heterogeneity was observed in "high and extremely high" HDI areas and subtropical areas than that in other subgroups (I2 = 0%). Precipitation, a subtropical climate, and a low HDI level are all positive influence factors to tuberculosis. Therefore, residents and public health managers should take precautionary measures ahead of time, especially in extreme weather conditions.
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Affiliation(s)
- Tianyu Qin
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yu Hao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - You Wu
- Key Laboratory of Health Cultivation of the Ministry of Education, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xinli Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shuwen Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Mengqi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Weifeng Xiong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Juan He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
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23
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Hand, Foot, and Mouth Disease: A Narrative Review. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:77-95. [PMID: 36284392 DOI: 10.2174/1570180820666221024095837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. OBJECTIVE This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. METHODS A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. RESULTS Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. CONCLUSION Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Hong Kong Institute of Integrative Medicine, and the Jockey Club School of Public Health and Primary Care, The Chinese University Hong Kong, Hong Kong
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Du Z, Zhang W, Yu S, Lin S, Hao Y. Assessing the impact of ambient temperature on the risk of hand, foot, and mouth disease in Guangdong, China: New insight from the disease severity and burden. PLoS Negl Trop Dis 2022; 16:e0010470. [PMID: 35737664 PMCID: PMC9223337 DOI: 10.1371/journal.pntd.0010470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background The association between the incidence of hand, foot, and mouth disease (HFMD) and ambient temperature has been well documented. Although the severity of symptoms is an important indicator of disease burden and varies significantly across cases, it usually was ignored in previous studies, potentially leading to biased estimates of the health impact of temperature. Methods We estimated the disability-adjusted life year (DALY) by considering the severity of symptoms for each HFMD case reported during 2010–2012 in Guangdong and used distributed lag-nonlinear models to estimate the association between the daily average temperature and daily DALY of HFMD cases at the city-level. We investigated the potential effect modifiers on the pathway between temperature and DALY and pooled city-specific estimates to a provincial association using a meta-regression. The overall impact of temperature was further evaluated by estimates of DALYs that could be attributed to HFMD. Results The overall cumulative effect of daily mean temperature on the DALY of HFMD showed an inverse-U shape, with the maximum effect estimated to be β = 0.0331 (95%CI: 0.0199–0.0463) DALY at 23.8°C. Overall, a total of 6.432 (95%CI: 3.942–8.885) DALYs (attributable fraction = 2.721%, 95%CI: 1.660–3.759%) could be attributed to temperature exposure. All the demographic subgroups had a similar trend as the main analysis, while the magnitude of the peak of the temperature impact tended to be higher among the males, those aged ≥3yrs or from the Pear-River Delta region. Additionally, the impact of temperature on DALY elevated significantly with the increasing population density, per capita GDP, and per capita green space in parks. Conclusions Temperature exposure was associated with increased burden of HFMD nonlinearly, with certain groups such as boys and those from areas with greater population density being more vulnerable. Hand, foot, and mouth disease (HFMD) is a contagious viral infection common in young children. Although the association between ambient temperature and the risk of HFMD has been well documented, existing studies were solely based on the reported number of cases, failing to differentiate cases of different severity. This study improves the estimation of disease burden by additionally accounting for the severity of symptoms. Our major findings included that (1) we identified an inverse-U shaped association between the ambient temperature and the daily DALY (i.e. an established indicator for disease burden) associated with HFMD, with 2.7% DALY could be attributed to the temperature exposure; (2) the peak impact of temperature on DALY was estimated to be β = 0.0331 (95%CI: 0.0199–0.0463) DALY and identified at 23.8°C; (3) the trends were generally consistent across different demographic and geographic subgroups, with the peak effect identified to be greater among the males, those aged ≥3yrs or from the Pear-River Delta region; (4) the impact of temperature on DALY elevated more apparently in areas with a greater population density, per capita GDP, or per capita green space in parks.
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Affiliation(s)
- Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Health Information Research, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Health Information Research, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, the State University of New York, Albany, New York, USA
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Health Information Research, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- * E-mail:
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25
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Li C, Zhu Y, She K, Jia Y, Liu T, Han C, Fang Q, Cheng C, Han L, Liu Y, Zhang Y, Li X. Modified effects of air pollutants on the relationship between temperature variability and hand, foot, and mouth disease in Zibo City, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:44573-44581. [PMID: 35133585 DOI: 10.1007/s11356-022-18817-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Hand, foot, and mouth disease (HFMD) poses a great disease burden in China. However, there are few studies on the relationship between temperature variability (TV) and HFMD. Moreover, whether air pollutions have modified effects on this relationship is still unknown. Therefore, this study aims to explore the modified effects of air pollutants on TV-HFMD association in Zibo City, China. Daily data of HFMD cases, meteorological factors, and air pollutants from 2015 to 2019 were collected for Zibo City. TV was estimated by calculating standard deviation of minimum and maximum temperatures over the exposure days. We used generalized additive model to estimate the association between TV and HFMD. The modified effects of air pollutants were assessed by comparing the estimated TV-HFMD associations between different air stratums. We found that TV increased the risk of HFMD. The effect was strongest at TV03 (4 days of exposure), when the incidence of HFMD increased by 3.6% [95% CI: 1.3-5.9%] for every 1℃ increases in TV. Males, children aged 0-4 years, were more sensitive to TV. We found that sulfur dioxide (SO2) enhanced TV's effects on all considered exposure days, while ozone (O3) reduced TV's effects on some exposure days in whole concerned population. However, we did not detect significant effect modification by particulate matter less than 10 microns in aerodynamic diameter (PM10). These findings are of significance in developing policies and public health practices to reduce the risks of HFMD by integrating changes in temperatures and air pollutants.
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Affiliation(s)
- Chunyu Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Yuchen Zhu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Kaili She
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Yan Jia
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Tingxuan Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Chuang Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Qidi Fang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Chuanlong Cheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Luyi Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Ying Zhang
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China.
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26
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Peng H, Chen Z, Cai L, Liao J, Zheng K, Li S, Ren X, Duan X, Tang X, Wang X, Long L, Yang C. Relationship between meteorological factors, air pollutants and hand, foot and mouth disease from 2014 to 2020. BMC Public Health 2022; 22:998. [PMID: 35581574 PMCID: PMC9112249 DOI: 10.1186/s12889-022-13365-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Meteorological factors and air pollutants have been reported to be associated with hand, foot, and mouth disease (HFMD) epidemics before the introduction of vaccine. However, there is limited evidence for studies with long-term dimensions. Methods We collected the daily HFMD counts, weather and air pollution data from 2014 to 2020 in Chengdu. Distributed lag non-linear models (DLNM) were used to assess the associations of meteorological factors and air pollutants on HFMD cases. Results From 2014–2020, high relative humidity and precipitation and extremely high and low levels of PM10, O3, SO2 and CO increased the risk of HFMD. In pre-vaccination period, extreme high and low temperatures, PM10 and NO2, low precipitation and high concentrations of PM2.5 and O3 significantly increase the risk of HFMD; In post-vaccination period, high relative humidity and low level of CO can significantly increase the incidence of HFMD; During the period of COVID-19, only low temperature will significantly increase the risk of HFMD; Low concentration of air pollutants has the greatest impact on the 6–14 age group, while the high concentration of air pollutants has the greatest impact on the 0–1 age group. Conclusions Our study suggest that high relative humidity and precipitation and extremely high and low levels of PM10, O3, SO2 and CO increased the risk of HFMD from 2014 to 2020. The results of this study provide a reference for local authorities to formulate intervention measures and establish an environment-based disease early warning system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13365-9.
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Affiliation(s)
- Hongxia Peng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Zhenhua Chen
- Department of Microbiology Laboratory, Chengdu Municipal Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lin Cai
- Department of Gastroenterology, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, Sichuan, China.,Non-Communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, Sichuan, China.,Non-Communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Ke Zheng
- Department of Immunization Planning, Chengdu Municipal Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Shuo Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xueling Ren
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xiaoxia Duan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xueqin Tang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xiao Wang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Lu Long
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China.
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Wang T, Wang J, Rao J, Han Y, Luo Z, Jia L, Chen L, Wang C, Zhang Y, Zhang J. Meta-analysis of the effects of ambient temperature and relative humidity on the risk of mumps. Sci Rep 2022; 12:6440. [PMID: 35440700 PMCID: PMC9017417 DOI: 10.1038/s41598-022-10138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
Many studies have shown that the relationship between ambient temperature, relative humidity and mumps has been highlighted. However, these studies showed inconsistent results. Therefore, the goal of our study is to conduct a meta-analysis to clarify this relationship and to quantify the size of these effects as well as the potential factors. Systematic literature researches on PubMed, Embase.com, Web of Science Core Collection, Cochrane library, Chinese BioMedical Literature Database (CBM) and China National Knowledge Infrastructure (CNKI) were performed up to February 7, 2022 for articles analyzing the relationships between ambient temperature, relative humidity and incidence of mumps. Eligibility assessment and data extraction were conducted independently by two researchers, and meta-analysis was performed to synthesize these data. We also assessed sources of heterogeneity by study region, regional climate, study population. Finally, a total of 14 studies were screened out from 1154 records and identified to estimate the relationship between ambient temperature, relative humidity and incidence of mumps. It was found that per 1 °C increase and decrease in the ambient temperature were significantly associated with increased incidence of mumps with RR of 1.0191 (95% CI: 1.0129–1.0252, I2 = 92.0%, Egger’s test P = 0.001, N = 13) for per 1 °C increase and 1.0244 (95% CI: 1.0130–1.0359, I2 = 86.6%, Egger’s test P = 0.077, N = 9) for per 1 °C decrease. As to relative humidity, only high effect of relative humidity was slightly significant (for per 1 unit increase with RR of 1.0088 (95% CI: 1.0027–1.0150), I2 = 72.6%, Egger’s test P = 0.159, N = 9). Subgroup analysis showed that regional climate with temperate areas may have a higher risk of incidence of mumps than areas with subtropical climate in cold effect of ambient temperature and low effect of relative humidity. In addition, meta-regression analysis showed that regional climate may affect the association between incidence of mumps and cold effect of ambient temperature. Our results suggest ambient temperature could affect the incidence of mumps significantly, of which both hot and cold effect of ambient temperature may increase the incidence of mumps. Further studies are still needed to clarify the relationship between the incidence of mumps and ambient temperature outside of east Asia, and many other meteorological factors. These results of ambient temperature are important for establishing preventive measures on mumps, especially in temperate areas. The policy-makers should pay more attention to ambient temperature changes and take protective measures in advance.
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Affiliation(s)
- Taiwu Wang
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Junjun Wang
- Nanjing Center for Disease Control and Prevention, Nanjing, 210002, China.,Chinese Field Epidemiology Training Program, Beijing, 100050, China
| | - Jixian Rao
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Yifang Han
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Zhenghan Luo
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Lingru Jia
- Wuxi Center of Joint Logistic Support Force, Wuxi, 214000, China
| | - Leru Chen
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Chunhui Wang
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing, 400038, China.
| | - Jinhai Zhang
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, 210002, China.
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Transmissibility of hand, foot, and mouth disease in 97 counties of China. Sci Rep 2022; 12:4103. [PMID: 35260706 PMCID: PMC8902910 DOI: 10.1038/s41598-022-07982-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a serious disease burden in the Asia–Pacific region, including China. This study calculated the transmissibility of HFMD at county levels in Jiangsu Province, China, analyzed the differences of transmissibility and explored the possible influencing factors of its transmissibility. We built a mathematical model for seasonal characteristics of HFMD, estimated the effective reproduction number (Reff), and compared the incidence rate and transmissibility in different counties using non-parametric tests, rapid cluster analysis and rank-sum ratio in 97 counties in Jiangsu Province from 2015 to 2020. The average daily incidence rate was between 0 and 4 per 100,000 people in Jiangsu Province from 2015–2020. The Quartile of Reff in Jiangsu Province from 2015 to 2020 was 1.54 (0.49, 2.50). Rugao District and Jianhu District had the highest transmissibility according to the rank-sum ratio. Reff generally decreased in 2017 and increased in 2018 in most counties, and the median level of Reff was the lowest in 2017 (P < 0.05). The transmissibility was different in 97 counties in Jiangsu Province. The reasons for the differences may be related to the climate, demographic characteristics, virus subtypes, vaccination, hygiene and other infectious diseases.
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Liu R, Cai J, Guo W, Guo W, Wang W, Yan L, Ma N, Zhang X, Zhang S. Effects of temperature and PM 2.5 on the incidence of hand, foot, and mouth in a heavily polluted area, Shijiazhuang, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:11801-11814. [PMID: 34550518 DOI: 10.1007/s11356-021-16397-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
The influence of weather and air pollution factors on hand, foot, and mouth disease (HFMD) has received widespread attention. However, most of the existing studies came from lightly polluted areas and the results were inconsistent. There was a lack of relevant evidence of heavily polluted areas. This study aims to quantify the relationship between weather factors and air pollution with HFMD in heavily polluted areas. We collected the daily number of hand, foot, and mouth disease in Shijiazhuang, China from 2014 to 2018, as well as meteorological and air pollutant data over the same period. The generalized linear model combined with the distributed lag model was used to study the effect of meteorological factors and air pollutants on the daily cases of HFMD and its hysteresis effect. We found that the dose-response relationship between temperature, PM2.5, and the risk of hand-foot-mouth disease was non-linear. Both low temperature and high temperature increased the risk of hand-foot-mouth disease. The cumulative effect of high temperature reached the maximum at 0-10 lag days, and the cumulative effect of low temperature reached the maximum at 0-3 lag days. The concentration of PM2.5 between 76 and 200 μg/m3 has a certain risk of the onset of hand, foot, and mouth disease, but the extreme PM2.5 concentration has a certain protective effect. In addition, low humidity, low wind speed, and low-O3 can increase the risk of HFMD. Risks of humidity and low concentration of O3 increased as lag days extended. In conclusion, our study found that climate factors and air pollutants exert varying degrees of impact on HFMD. Our research provided the scientific basis for establishing an early warning system so that medical staff and parents can take corresponding measures to prevent HFMD.
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Affiliation(s)
- Ran Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Jianning Cai
- The Department of Epidemic Treating and Preventing, Center for Disease Prevention and Control of Shijiazhuang City, Likang Road 3#, Shijiazhuang, 050011, China
| | - Weiheng Guo
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Wei Guo
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Wenjuan Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Lina Yan
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Ning Ma
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China.
| | - Shiyong Zhang
- The Department of Epidemic Treating and Preventing, Center for Disease Prevention and Control of Shijiazhuang City, Likang Road 3#, Shijiazhuang, 050011, China.
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Deng X, Chen Z, Zou Y, He Y, Chen S, Wang Q, Xing D, Zhang Y. The effect of daily mean temperature on hand, foot and mouth disease and the source of regional heterogeneity in Chongqing, China, 2010-2019. Environ Health Prev Med 2022; 27:47. [PMID: 36517013 PMCID: PMC9792571 DOI: 10.1265/ehpm.22-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is a serious infectious disease which has become a public health problem. A multi-regional study was conducted in this study to explore the relationship between temperature and HFMD in different regions and the source of heterogeneity, and further detect the effect modifiers such as socio-economic factors, medical and health factors and meteorological factors. METHODS The data on daily reported HFMD cases and meteorological data from 2010 to 2019 in Chongqing were collected. Thirty-eight districts and counties of Chongqing were divided into 6 regions. The distributed lag nonlinear model (DLNM) was applied to assess the effect of daily mean temperature on HFMD at region level with the pooled effect estimates from multivariate meta-regression model analysis. Stratified analyses by gender, age and children's type were also conducted. Potential modifiers were considered in meta regression to explore the source of heterogeneity. RESULTS There were nonlinear relationships with an inverted V-shape between temperature and HFMD. A maximum cumulative relative risk (CRR) of 1.22 (95% confidence interval (CI): 1.12-1.34) peaked at 23.8 °C, and the risk appeared immediately and lasted for the whole 14 days. Compared with other groups, warm temperature had a stronger effect on children aged 0-1 and scattered children, while cold temperature had a stronger effect on female, children aged 3-6 and childcare children with an M-shape. We found that socio-economic factors, medical health factors and meteorological factors were significantly associated with heterogeneity. Density of medical technical personnel, urbanization rate and density of health care institutions were the main modifiers for explaining heterogeneity of 26.10%, 24.90% and 24.86% respectively which were revealed by meta-analysis. CONCLUSIONS There was a significant nonlinear correlation between temperature and HFMD. Compared with other groups, children aged 0-1 and scattered children were more susceptible to warm temperature, while female, children aged 3-6 and childcare children were more susceptible to cold temperature. Socio-economic factors, medical health factors and meteorological factors may be the source of the heterogeneity. Therefore, local governments should consider different temperature-HFMD relationships between different regions and populations when formulating appropriate preventive measures.
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Affiliation(s)
- Xinyi Deng
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Zhiyi Chen
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Yang Zou
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Ying He
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Saijuan Chen
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Qiuting Wang
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Dianguo Xing
- Office of Health Emergency, Chongqing Municipal Health Commission, Chongqing, China
| | - Yan Zhang
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
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Awasthi A, Vishwakarma K, Pattnayak KC. Retrospection of heatwave and heat index. THEORETICAL AND APPLIED CLIMATOLOGY 2022; 147:589-604. [PMID: 34785831 PMCID: PMC8581126 DOI: 10.1007/s00704-021-03854-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/29/2021] [Indexed: 05/21/2023]
Abstract
The frequency and intensity of extreme events especially heat waves (HW) are growing all around the world which ultimately poses a serious threat to the health of individuals. To quantify the effects of extreme temperature, appropriate information, and the importance of HW and heat index (HI) are carefully discussed for different parts of the world. Varied definitions of the HW and HI formula proposed and used by different countries are carried out systematically continent-wise. Different studies highlighted the number of definitions of HW; however, mostly used Steadman's formulae, which was developed in the late 1970s, for the calculation of HI that uses surface air temperature and relative humidity as climatic fields. Since then, dramatic changes in climatic conditions have been observed as evident from the ERA5 datasets which need to be addressed; likewise, the definition of HW, which is modified by the researchers as per the geographic conditions. It is evident from the ERA5 data that the temperature has increased by 1-2 °C as compared to the 1980s. There is a threefold increase in the number of heatwave days over most of the continents in the last 40 years. This study will help the researcher community to understand the importance of HW and HI. Furthermore, it opens the scope to develop an equation based on the present scenario keeping in mind the basics of an index as considered by Steadman.
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Affiliation(s)
- Amit Awasthi
- Department of Applied Sciences, University of Petroleum & Energy Studies, Dehradun, 248007 Uttarakhand India
| | - Kirti Vishwakarma
- Department of Aerospace Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand India
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Zhang L, Jiang H, Wang K, Yuan Y, Fu Q, Jin X, Zhao N, Huang X, Wang S, Zhang T, Yao K, Chan TC, Xu W, Liu S. Long-term effects of weather condition and air pollution on acute hemorrhagic conjunctivitis in China: A nationalwide surveillance study in China. ENVIRONMENTAL RESEARCH 2021; 201:111616. [PMID: 34233156 DOI: 10.1016/j.envres.2021.111616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/14/2021] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Global climate change could have potential impact on enterovirus (EV)-induced infectious diseases. However, the environmental factors promoting acute hemorrhagic conjunctivitis (AHC) circulation remain inconclusive. This study aimed to quantify the relationship between the environment and AHC. METHODS We retrieved the monthly counts and incidence of AHC, meteorological variables and air quality in mainland China between 2013 and 2018. Exposure risks were evaluated by multivariate distributed lag nonlinear models. RESULTS A total of 219,599 AHC cases were reported in 31 provinces of China, predominantly in southern and central China, seasonally increased in summer. AHC incidence increased by 7% between 2013 and 2018, from 2.6873 to 2.7570 per 100,000 people. A moderate positive correlation was seen between AHC and monthly mean temperature, relative humidity (RH) and precipitation. Each unit increment was associated with a relative risk for AHC of 1.058 at 17°-32 °C at lag 0 months, 1.017 at 65-71% RH at lag 1.4 months, and 1.039 at 400-569 mm at lag 2.4 months. By contrast, a negative correlation was seen between monthly ambient NO2 and AHC. CONCLUSION Long-term exposure to higher mean temperature, RH and precipitation were associated with an increased risk of AHC. The general public, especially susceptible populations, should pay close attention to weather changes and take protective measures in advance to any AHC outbreak as the above situations occur.
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Affiliation(s)
- Li Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, China
| | - Hui Jiang
- Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China; Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Kehan Wang
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China
| | - Yuan Yuan
- Department of Geriatrics, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Qiuli Fu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, China
| | - Xiuming Jin
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, China
| | - Na Zhao
- Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, School of Ecology and Environment, Anhui Normal University, Wuhu, Anhui Province, 241002, China
| | - Xiaodan Huang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, China
| | - Supen Wang
- Anhui Provincial Key Laboratory of the Conservation and Exploitation of Biological Resources, College of Life Sciences, Anhui Normal University, Wuhu, Anhui Province, 241000, China
| | - Tao Zhang
- Nanjing Jiliang Information Technology Co., Ltd, Nanjing, Jiangsu Provice, 210002, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, China.
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, 115, Taiwan.
| | - Wangli Xu
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China.
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, 310051, China.
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Xu J, Yang M, Zhao Z, Wang M, Guo Z, Zhu Y, Rui J, Wang Y, Liu X, Lin S, Luo L, Su Y, Zhao B, Zhou Y, Frutos R, Chen T. Meteorological Factors and the Transmissibility of Hand, Foot, and Mouth Disease in Xiamen City, China. Front Med (Lausanne) 2021; 7:597375. [PMID: 33553200 PMCID: PMC7862718 DOI: 10.3389/fmed.2020.597375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background: As an emerging infectious disease, the prevention and control of hand, foot, and mouth disease (HFMD) poses a significant challenge to the development of public health in China. In this study, we aimed to explore the mechanism of the seasonal transmission characteristics of HFMD and to reveal the correlation and potential path between key meteorological factors and the transmissibility of HFMD. Methods: Combined with daily meteorological data such as average temperature, average relative humidity, average wind velocity, amount of precipitation, average air pressure, evaporation capacity, and sunshine duration, a database of HFMD incidence and meteorological factors was established. Spearman rank correlation was used to calculate the correlation between the various meteorological factors and the incidence of HFMD. The effective reproduction number (R eff ) of HFMD was used as an intermediate variable to further quantify the dynamic relationship between the average temperature and R eff . Results: A total of 43,659 cases of HFMD were reported in Xiamen from 2014 to 2018. There was a significantly positive correlation between the average temperature and the incidence of HFMD (r = 0.596, p < 0.001), and a significantly negative correlation between the average air pressure and the incidence of HFMD (r = -0.511, p < 0.001). There was no correlation between the average wind velocity (r = 0.045, p > 0.05) or amount of precipitation (r = 0.043, p > 0.05) and incidence. There was a temperature threshold for HFMD's transmissibility. Owing to the seasonal transmission characteristics of HFMD in Xiamen, the temperature threshold of HFMD's transmissibility was 13.4-18.4°C and 14.5-29.3°C in spring and summer and in autumn and winter, respectively. Conclusions: HFMD's transmissibility may be affected by the average temperature; the temperature threshold range of transmissibility in autumn and winter is slightly wider than that in spring and summer. Based on our findings, we suggest that the relevant epidemic prevention departments should pay close attention to temperature changes in Xiamen to formulate timely prevention strategies before the arrival of the high-risk period.
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Affiliation(s)
- Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Mingzhai Wang
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Zhinan Guo
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen City, China
| | - Roger Frutos
- Agricultural Research Centre for International Development, Intertryp, Montpellier, France
- Institut d'Electronique et des Systèmes, Université de Montpellier-Centre National de la Recherche Scientifique, Montpellier, France
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
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Pan Q, Liu F, Zhang J, Zhao X, Hu Y, Fan C, Yang F, Chang Z, Xiao X. Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China. Environ Health Prev Med 2021; 26:4. [PMID: 33419405 PMCID: PMC7792012 DOI: 10.1186/s12199-020-00927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. Methods We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. Results We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. Conclusion Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-020-00927-9.
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Affiliation(s)
- Qing Pan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China
| | - Juying Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yifan Hu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Chaonan Fan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fan Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China.
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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Gao Q, Liu Z, Xiang J, Tong M, Zhang Y, Wang S, Zhang Y, Lu L, Jiang B, Bi P. Forecast and early warning of hand, foot, and mouth disease based on meteorological factors: Evidence from a multicity study of 11 meteorological geographical divisions in mainland China. ENVIRONMENTAL RESEARCH 2021; 192:110301. [PMID: 33069698 DOI: 10.1016/j.envres.2020.110301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a significant public health issue in China. Early warning and forecasting are one of the most cost-effective ways for HFMD control and prevention. However, relevant research is limited, especially in China with a large population and diverse climatic characteristics. This study aims to identify local specific HFMD epidemic thresholds and construct a weather-based early warning model for HFMD control and prevention across China. METHODS Monthly notified HFMD cases and meteorological data for 22 cities selected from different climate zones from 2014 to 2018 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) based on meteorological factors was conducted to forecast HFMD epidemics. The receiver operator characteristic curve (ROC) was generated to determine the value of optimal warning threshold. RESULTS The developed model was solid in forecasting the epidemic of HFMD with all R square (R2) in the 22 cities above 85%, and mean absolute percentage error (MAPE) less than 1%. The warning thresholds varied by cities with the highest threshold observed in Shenzhen (n = 7195) and the lowest threshold in Liaoyang (n = 12). The areas under the curve (AUC) was greater than 0.9 for all regions, indicating a satisfied discriminating ability in epidemics detection. CONCLUSIONS The weather-based HFMD forecasting and early warning model we developed for different climate zones provides needed information on occurrence time and size of HFMD epidemics. An effective early warning system for HFMD could provide sufficient time for local authorities to implement timely interventions to minimize the HFMD morbidity and mortality.
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Affiliation(s)
- Qi Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Zhidong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia; School of Public Health, Fujian Medical University, Fuzhou, 350108, People's Republic of China
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Shuzi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Yiwen Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Liang Lu
- Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China; State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Hong ZM, Wang HH, Wang YJ, Wang WR. Spatiotemporal analysis of hand, foot and mouth disease data using time-lag geographically-weighted regression. GEOSPATIAL HEALTH 2020; 15. [PMID: 33461279 DOI: 10.4081/gh.2020.849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 08/19/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Zhi-Min Hong
- School of Sciences, Inner Mongolia University of Technology, Hohhot; Inner Mongolia Key Laboratory of Statistical Analysis Theory for Life Data and Neural Network Modeling, Inner Mongolia, Hohhot.
| | - Hu-Hu Wang
- School of Sciences, Inner Mongolia University of Technology, Hohhot; Institute for infectious disease and endemic disease control, Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot.
| | - Yan-Juan Wang
- School of Sciences, Inner Mongolia University of Technology, Hohhot.
| | - Wen-Rui Wang
- Institute for infectious disease and endemic disease control, Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot.
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Yi X, Chang Z, Zhao X, Ma Y, Liu F, Xiao X. The temporal characteristics of the lag-response relationship and related key time points between ambient temperature and hand, foot and mouth disease: A multicity study from mainland China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141679. [PMID: 32836135 DOI: 10.1016/j.scitotenv.2020.141679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/26/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous studies have thoroughly elucidated the exposure-response relationship between ambient temperature and hand, foot, and mouth disease (HFMD), whereas very little concern has been to the lag-response relationship and related key time points. OBJECTIVES We aimed to clarify the temporal characteristics of the lag-response relationship between ambient temperature and HFMD and how they may vary spatially. METHODS We retrieved the daily time series of meteorological variables and HFMD counts for 143 cities in mainland China between 2009 and 2014. We estimated the city-specific lag-response curve between ambient temperature and HFMD and related key time points by applying common distributed lag nonlinear models (DLNM) and Monte Carlo simulation methods. Then, we pooled the city-specific estimates by performing a meta-regression with the city-specific characteristics as meta-predictors to explain the potential spatial heterogeneity. RESULTS We found a robust lag pattern between temperature and HFMD for different levels of temperatures. The temporal change of risk obtained its maximum value on the current day but dropped sharply thereafter and then rebounded to a secondary peak, which implied the presence of a harvesting effect. By contrast, the estimation of key time points showed substantial heterogeneity, especially at high temperature (the I2 statistics ranged from 47% to 80%). With one unit increase in the geographic index, the secondary peak would arrive 0.37 (0.02, 0.71) days later. With one unit increase in the economic index and climatic index, the duration time of the lag-response curve would be lengthened by 0.36 (0.1, 0.62) and 0.92 (0.54, 1.29) days, respectively. CONCLUSION Our study examined the lag pattern and spatial heterogeneity of the lag-response relationship between temperature and HFMD. Those findings gave us new insights into the complex association and the related mechanisms between weather and HFMD and important information for weather-based disease early warning systems.
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Affiliation(s)
- Xiaowei Yi
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Li Y, Dou Q, Lu Y, Xiang H, Yu X, Liu S. Effects of ambient temperature and precipitation on the risk of dengue fever: A systematic review and updated meta-analysis. ENVIRONMENTAL RESEARCH 2020; 191:110043. [PMID: 32810500 DOI: 10.1016/j.envres.2020.110043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 05/16/2023]
Abstract
OBJECTIVES We systematically reviewed the published studies on the relationship between dengue fever and meteorological factors and applied a meta-analysis to explore the effects of ambient temperature and precipitation on dengue fever. METHODS We completed the literature search by the end of September 1st, 2019 using databases including Science Direct, PubMed, Web of Science, and Google Scholar. We extracted relative risks (RRs) in selected studies and converted all effect estimates to the RRs per 1 °C increase in temperature and 10 mm increase in precipitation, and combined all standardized RRs together using random-effect meta-analysis. RESULTS Our results show that dengue fever was significantly associated with both temperature and precipitation. Our subgroup analyses suggested that the effect of temperature on dengue fever was most pronounced in high-income subtropical areas. The pooled RR of dengue fever associated with the maximum temperature was much lower than the overall effect. CONCLUSIONS Temperature and precipitation are important risk factors for dengue fever. Future studies should focus on factors that can distort the effects of temperature and precipitation.
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Affiliation(s)
- Yanbing Li
- School of Health Sciences, Wuhan University, 115 Donghu Road, 430071, Wuhan, China
| | - Qiujun Dou
- School of Health Sciences, Wuhan University, 115 Donghu Road, 430071, Wuhan, China
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University Hawaii at Manoa, 1960 East West Rd, Biomed Bldg, D105, Honolulu, USA
| | - Hao Xiang
- School of Health Sciences, Wuhan University, 115 Donghu Road, 430071, Wuhan, China
| | - Xuejie Yu
- School of Health Sciences, Wuhan University, 115 Donghu Road, 430071, Wuhan, China
| | - Suyang Liu
- School of Health Sciences, Wuhan University, 115 Donghu Road, 430071, Wuhan, China.
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Association of Short-Term Exposure to Meteorological Factors and Risk of Hand, Foot, and Mouth Disease: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218017. [PMID: 33143315 PMCID: PMC7663009 DOI: 10.3390/ijerph17218017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
(1) Background: Inconsistencies were observed in studies on the relationship between short-term exposure to meteorological factors and the risk of hand, foot, and mouth disease (HFMD). This systematic review and meta-analysis was aimed to assess the overall effects of meteorological factors on the incidence of HFMD to help clarify these inconsistencies and serve as a piece of evidence for policy makers to determine relevant risk factors. (2) Methods: Articles published as of 24 October 2020, were searched in the four databases, namely, PubMed, Web of Science, Embase, and MEDLINE. We applied a meta-analysis to assess the impact of ambient temperature, relative humidity, rainfall, wind speed, and sunshine duration on the incidence of HFMD. We conducted subgroup analyses by exposure metrics, exposure time resolution, regional climate, national income level, gender, and age as a way to seek the source of heterogeneity. (3) Results: Screening by the given inclusion and exclusion criteria, a total of 28 studies were included in the analysis. We observed that the incidence of HFMD based on the single-day lag model is significantly associated with ambient temperature, relative humidity, rainfall, and wind speed. In the cumulative lag model, ambient temperature and relative humidity significantly increased the incidence of HFMD as well. Subgroup analysis showed that extremely high temperature and relative humidity significantly increased the risk of HFMD. Temperate regions, high-income countries, and children under five years old are major risk factors for HFMD. (4) Conclusions: Our results suggest that various meteorological factors can increase the incidence of HFMD. Therefore, the general public, especially susceptible populations, should pay close attention to weather changes and take protective measures in advance.
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Fan C, Liu F, Zhao X, Ma Y, Yang F, Chang Z, Xiao X. An alternative comprehensive index to quantify the interactive effect of temperature and relative humidity on hand, foot and mouth disease: A two-stage time series study including 143 cities in mainland China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 740:140106. [PMID: 32927545 DOI: 10.1016/j.scitotenv.2020.140106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/25/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Comprehensive indices have been used to quantify the interactive effect of temperature and humidity on hand, foot and mouth disease (HFMD). The majority of them reflect how weather feels to humans. In this study, we propose an alternative index aiming to reflect the impacts of weather on HFMD and compare its performance with that of previous indices. METHODS We proposed an index defined as the product of temperature and a weight parameter raised to the rescaled relative humidity, denoted by THIa. We then compared its model fit and heterogeneity with those of previous indices (including the humidex, heat index and temperature) by a multicity two-stage time series analysis. We first built a common distributed lag nonlinear model to estimate the associations between different indices and HFMD for each city separately. We then pooled the city-specific estimates and compared the average model fit (measured by the QAIC) and heterogeneity (measured by I2) among the different indices. RESULTS We included the time series of HFMD and meteorological variables from 143 cities in mainland China from 2009 to 2014. By varying the weight parameter of THIa, the results suggested that 100% relative humidity can amplify the effects of temperature on HFMD 1.6-fold compared to 50% relative humidity. By comparing different candidate indices, THIa performed the best in terms of the average of the model fits (QAIC = 9449.37), followed by humidex, heat index and temperature. In addition, the estimated exposure-response curves between THIa and HFMD were consistent across climate regions with minimum heterogeneity (I2 = 65.90), whereas the others varied across climate regions. CONCLUSIONS This study proposed an alternative comprehensive index to characterize the interactive effects of temperature and humidity on HFMD. In addition, the results also imply that previous human-based indices might not be sufficient to reflect the complicated associations between weather and HFMD.
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Affiliation(s)
- Chaonan Fan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fan Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Lu JY, Zhang ZB, He Q, Ma XW, Yang ZC. Association between climatic factors and varicella incidence in Guangzhou, Southern China, 2006-2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 728:138777. [PMID: 32330739 DOI: 10.1016/j.scitotenv.2020.138777] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyze the correlation between climatic factors and the incidence of varicella in Guangzhou, and improve the prevention measures about public health. METHODS Data for daily climatic variables and varicella incidence from 2006 to 2018 in Guangzhou were collected from the Guangzhou Meteorological Bureau and the National Notifiable Disease Report System. Distributed lag nonlinear models were applied to evaluate the association between climatic factors and varicella incidence. RESULTS The nonlinear effects of meteorological factors were observed. At lag day21,when the mean temperature was 31.8 °C, the relative risk was the highest as 1.11 (95% CI: 1.07-1.16). When the diurnal temperature range was 24.0 °C at lag day 20, the highest RR was 1.11 (95% CI: 1.05-1.17). For rainfall, the highest RR was 1.09 (95% CI: 1.01-1.19) at lag day 21,when the aggregate rainfall was 160 mm. When air pressure was 1028 hPa, the highest RR was 1.08 (95% CI: 1.04-1.13) at lag day 21. When wind speed was 0.7 m/s, the highest RR was 1.07 (95% CI: 1.04-1.11) at lag day 7. When the hours of sunshine were 9.0 h at lag day 21, the RR was highest as 1.04 (95% CI: 1.02-1.05). Aggregate rainfall, air pressure, and sunshine hours were positively correlated with the incidence of varicella, which was inconsistent with the wind velocity. Mean temperature showed a reverse U-shape curve relationship with varicella, while the diurnal temperature range showed a binomial distribution curve. The extreme effect of climatic factors on the varicella cases was statistically significant, apart from the extremely low effect of rainfall. CONCLUSION Our preliminary results offered fundamental knowledge which might be benefit to give an insight into epidemic trends of varicella and develop an early warning system. We could use our findings about influential factors to strengthen the intervention and prevention of varicella.
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Affiliation(s)
- Jian-Yun Lu
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Baiyun District Qi De Road in Guangzhou, Guangdong Province 510440, China
| | - Zhou-Bin Zhang
- Guangzhou Center for Disease Control and Prevention, Baiyun District Qi De Road in Guangzhou, Guangdong Province 510440, China
| | - Qing He
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Baiyun District Qi De Road in Guangzhou, Guangdong Province 510440, China
| | - Xiao-Wei Ma
- Department of Public Health Emergency Preparedness and Response, Guangzhou Center for Disease Control and Prevention, Baiyun District Qi De Road in Guangzhou, Guangdong Province 510440, China
| | - Zhi-Cong Yang
- Guangzhou Center for Disease Control and Prevention, Baiyun District Qi De Road in Guangzhou, Guangdong Province 510440, China.
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Chen L, Xu SJ, Yao XJ, Yang H, Zhang HL, Meng J, Zeng HR, Huang XH, Zhang RL, He YQ. Molecular epidemiology of enteroviruses associated with severe hand, foot and mouth disease in Shenzhen, China, 2014-2018. Arch Virol 2020; 165:2213-2227. [PMID: 32666145 PMCID: PMC7360124 DOI: 10.1007/s00705-020-04734-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
Abstract
In this study, we investigated the epidemiology and molecular characteristics of enteroviruses associated with severe hand, foot and mouth disease (HFMD) in Shenzhen, China, during 2014-2018. A total of 137 fecal specimens from patients with severe HFMD were collected. Enterovirus (EV) types were determined using real-time reverse transcription polymerase chain reaction (RT-PCR), RT nested PCR, and sequencing. Sequences were analyzed using bioinformatics programs. Of 137 specimens tested, 97 (70.8%), 12 (8.8%), and 10 (7.3%) were positive for EV-A71, coxsackievirus A6 (CVA6), and CVA16, respectively. Other pathogens detected included CVA2 (2.9%, 4/137), CVA10 (2.9%, 4/137), CVA5 (0.7%, 1/137), echovirus 6 (E6) (0.7%, 1/137) and E18 (0.7%, 1/137). The most frequent complication in patients with proven EV infections was myoclonic jerk, followed by aseptic encephalitis, tachypnea, and vomiting. The frequencies of vomiting and abnormal eye movements were higher in EV-A71-infected patients than that in CVA6-infected or CVA16-infected patients. Molecular phylogeny based on the complete VP1 gene revealed no association between the subgenotype of the virus and disease severity. Nevertheless, 12 significant mutations that were likely to be associated with virulence or the clinical phenotype were observed in the 5’UTR, 2Apro, 2C, 3A, 3Dpol and 3’UTR of CVA6. Eight significant mutations were observed in the 5’UTR, 2B, 3A, 3Dpol and 3’UTR of CVA16, and 10 significant mutations were observed in the 5’UTR, VP1, 3A and 3Cpro of CVA10. In conclusion, EV-A71 is still the main pathogen causing severe HFMD, although other EV types can also cause severe complications. Potential virulence or phenotype-associated sites were identified in the genomes of CVA6, CVA16, and CVA10.
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Affiliation(s)
- Long Chen
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China.
| | - Shao-Jian Xu
- District Key Laboratory for Infectious Disease Prevention and Control, Longhua District Center for Disease Control and Prevention, Shenzhen, 518109, China
| | - Xiang-Jie Yao
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Hai-Long Zhang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Jun Meng
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Han-Ri Zeng
- Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xu-He Huang
- Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Ren-Li Zhang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Ya-Qing He
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China.
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Hu P, Liu J, Gan L, Chen Y, Su K, Chen Y, Zhang D. Lack of effective home quarantine: The cause of the continuing prevalence of hand, foot, and mouth disease in China? J Infect Public Health 2020; 13:963-969. [DOI: 10.1016/j.jiph.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022] Open
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Hu Y, Liu F, Zhao X, Ma Y, Lan T, Yang F, Chang Z, Xiao X, Li Z. The modification effect of the diurnal temperature range on the exposure-response relationship between temperature and pediatric hand, foot and mouth disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 722:137921. [PMID: 32208268 DOI: 10.1016/j.scitotenv.2020.137921] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Growing evidence suggests that the diurnal temperature range (DTR) could modify the temperature-disease relationship for those environmentally-related infectious diseases. However, there is a lack of evidence on the hand, foot and mouth disease (HFMD). In this study, we thoroughly examined this hypothesis via a nationwide study. METHOD We collected the daily time series of HFMD cases and meteorological factors of 143 cities in mainland China from 2009 to 2014. For each city, we calculated the arithmetic average of the meteorological factors as a proxy for the climatic differences. We then performed two-stage time series analyses for four different climatic regions. Specifically, a distributed lag nonlinear model was applied to estimate the temperature-HFMD relationship for each city, and then a multivariate meta-regression was implemented to examine whether the DTR could explain the potential heterogeneity as an effect modifier. In addition, we compared the modification effect of the DTR with those of other climatic factors. RESULT We found a significant modification effect of DTR on the temperature-HFMD relationship in the moderate-temperature region. Besides, the modification effect was only observed at hot temperatures. Comparing the maximum temperature (32.2 °C) to the median temperature (11.9 °C), the risk ratio was 1.60 (1.33, 1.92) when DTR was in the 10th percentile (6.8 °C) and 0.81 (0.69, 0.96) when the DTR was in the 90th percentile (11.8 °C). By comparing DTR with other climatic variables, we found that the DTR had the best performance in improving the model fit (ΔQAIC= 10.1) and reducing the heterogeneity (ΔI2 = 3.1%) in the multivariate meta-regression. CONCLUSION Our findings verified that DTR can modify the temperature-HFMD relationship. Besides, our findings also implied that DTR could be used as a proxy variable to comprehensively reflect the modification effects of multiple climatic factors.
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Affiliation(s)
- Yifan Hu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tianjiao Lan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fan Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Zhongjie Li
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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Pearson D, Basu R, Wu XM, Ebisu K. Temperature and hand, foot and mouth disease in California: An exploratory analysis of emergency department visits by season, 2005-2013. ENVIRONMENTAL RESEARCH 2020; 185:109461. [PMID: 32278924 DOI: 10.1016/j.envres.2020.109461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND For the past decade, hand, foot and mouth disease (HFMD), caused by entero and coxsackie viruses, has been spreading in Asia, particularly among children, overloading healthcare settings and creating economic hardships for parents. Recent studies have found meteorological factors, such as temperature, are associated with HFMD in Asia. However, few studies have explored the relationship in the United States, although HFMD cases have steadily increased recently. As concerns of climate change grow, we explored the association between temperature and HFMD admissions to the Emergency Department (ED) in California. METHODS Weekly counts of HFMD for 16 California climate zones were collected from 2005 to 2013. We calculated weekly temperature for each climate zone using an inverse distance-weighting method. For each climate zone stratified by season, we conducted a time-series using Poisson regression models. We adjusted models for weekly averaged relative humidity, average number of HFMD cases in previous weeks and long-term temporal trends. Climate zone estimates were combined to obtain an overall seasonal estimate. We attempted stratified analyses by region, race/ethnicity, and sex to identify sensitive subpopulations. RESULTS Risk of ED visits for HFMD per 1 °F increase in mean temperature during the same week increased 2.00% (95% confidence intervals 1.15, 2.86%) and 2.35% (1.38, 3.33%) during the warm and cold seasons, respectively. The coastal region showed a higher, though not statistically different, association during the cold season [3.18% (1.99, 4.39)] than the warm season [1.64% (0.47, 2.82)]. CONCLUSIONS Our findings indicated an association between temperature and ED visits for HFMD, with variation by season and region. Thus, the causative pathogen's ability to persist in the atmosphere may vary by season. Furthermore, the mild and wet winter in the coastal region of California may contribute to different results than studies in Asia. With the onset of climate change, HFMD cases will likely grow in California, warranting further investigation on this relationship, including new populations at-risk.
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Affiliation(s)
- Dharshani Pearson
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, United States.
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, United States
| | - Xiangmei May Wu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, United States
| | - Keita Ebisu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, United States
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The role of meteorological factors on mumps incidence among children in Guangzhou, Southern China. PLoS One 2020; 15:e0232273. [PMID: 32348370 PMCID: PMC7190132 DOI: 10.1371/journal.pone.0232273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/10/2020] [Indexed: 01/19/2023] Open
Abstract
Mumps, a common childhood disease, has a high incidence in Guangzhou city, China. It has been proven that mumps is influenced by seasonality. However, the role of meteorological factors among children is yet to be fully ascertained. This study explored the association between meteorological factors and the incidence of mumps among children in Guangzhou. Distributed lag nonlinear models were used to evaluate the correlation between meteorological factors and the incidence of mumps among children from 2014–2018. The nonlinear lag effects of some meteorological factors were detected. Mean temperature, atmospheric pressure, and relative humidity were positively correlated with mumps incidence, contrary to that of wind speed. Extreme effects of temperature, wind speed, atmospheric pressure, and relative humidity on the incidence of mumps among children in Guangzhou were evaluated in a subgroup analysis according to gender and age. Our preliminary results offered fundamental information to better understand the epidemic trends of mumps among children to develop an early warning system, and strengthen the intervention and prevention of mumps.
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Bo Z, Ma Y, Chang Z, Zhang T, Liu F, Zhao X, Long L, Yi X, Xiao X, Li Z. The spatial heterogeneity of the associations between relative humidity and pediatric hand, foot and mouth disease: Evidence from a nation-wide multicity study from mainland China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 707:136103. [PMID: 31874401 DOI: 10.1016/j.scitotenv.2019.136103] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) remains a serious health threat to young children in East and Southeast Asia. The humidity is crucial for the survival of enterovirus, but the evidence of the humidity-HFMD association is inconsistent. In this study we investigated the spatial heterogeneity of humidity-HFMD associations and related effect modifiers. METHODS We retrieved the daily surveillance data of childhood HFMD counts and meteorological variables from 143 cities in mainland China between 2009 and 2014 and then adopted a three-stage time series analysis. We first fitted a common distributed lag nonlinear model (DLNM) for each of the 143 cities separately to obtain the city-specific estimates of humidity-HFMD association. Then, we pooled the city-specific estimates through multivariate meta-regression with city-level characteristics as potential effect modifiers to study the reasons for heterogeneity. Finally, we applied a region-specific analysis to verify our findings and to better visualize our results. RESULTS We found that the overall pooled humidity-HFMD relationship was shown as an approximately U-shaped curve with substantial spatial heterogeneity (I2 = 77.8%). Taking the reference relative humidity as 70%, the minimum relative risk (RR) was obtained at 45% with a value of 0.83 (0.79, 0.87), while the maximum RR was found to be at both 20% and over 85% separately with a value of 1.10 (1.05, 1.15). The spatial heterogeneity can be well explained by the climatic, social characteristics and terrains among cities. The modification effects can be roughly classified into two types, including change in the overall slope and the shape of the curve. CONCLUSIONS Due to substantial spatial heterogeneity, caution should be taken when interpreting the weather-HFMD association in a single-site study and to avoid generalizing its findings to another site. Our study also implied the existence of interactions among meteorological factors given that climatic factors can modify the weather-HFMD association.
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Affiliation(s)
- Zhenyan Bo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lu Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaowei Yi
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Zhongjie Li
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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He X, Dong S, Li L, Liu X, Wu Y, Zhang Z, Mei S. Using a Bayesian spatiotemporal model to identify the influencing factors and high-risk areas of hand, foot and mouth disease (HFMD) in Shenzhen. PLoS Negl Trop Dis 2020; 14:e0008085. [PMID: 32196496 PMCID: PMC7112242 DOI: 10.1371/journal.pntd.0008085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 04/01/2020] [Accepted: 01/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The epidemic of hand, foot, and mouth disease (HFMD) has become a severe public health problem in the world and has also brought a high economic and health burden. Furthermore, the prevalence of HFMD varies significantly among different locations. However, there have been few investigations of the effects of socioeconomic factors and air pollution factors on the incidence of HFMD. METHODS This study collected data on HFMD in Shenzhen, China, from 2012 to 2015. We selected eleven factors as potential risk factors for HFMD. A Bayesian spatiotemporal model was used to quantify the influence of the factors on HFMD and to identify the relative risks in different districts. RESULTS The risk factors of HFMD were the population, population density, concentration of SO2, and concentration of NO2. The relative risks (RRs) were 1.00473 (95% CI: 1.00059-1.00761), 1.00010 (95% CI: 1.00002-1.00016), 1.00215 (95% CI: 1.00170-1.00232) and 1.00058 (95% CI: 1.00028-1.00078), respectively. The protective factors against HFMD were the per capita GDP, the number of public kindergartens, the concentration of PM10, and the concentration of O3. The RRs were 0.98840 (95% CI: 0.98660-0.99026), 0.97686 (95% CI: 0.96946-0.98403), 0.99108 (95% CI: 0.98551-0.99840) and 0.99587 (95% CI: 0.99534-0.99610), respectively. The risk of incidence in Longgang district and Pingshan district decreased, while the risk of incidence in Baoan district increased. CONCLUSIONS Studies have confirmed that socioeconomic factors and air pollution factors have an impact on the incidence of HFMD in Shenzhen, China. The results will be of great practical significance to local authorities, which is conducive to accurate prevention and can be used to formulate HFMD early warning systems.
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Affiliation(s)
- Xiaoyi He
- Shantou University Medical College, Shantou, China
| | - Shengjie Dong
- Orthopedic Department, Yantaishan Hospital, Yantai, Shandong, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Xiaojian Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhen Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shujiang Mei
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Xu Z, Hu W, Jiao K, Ren C, Jiang B, Ma W. The effect of temperature on childhood hand, foot and mouth disease in Guangdong Province, China, 2010-2013: a multicity study. BMC Infect Dis 2019; 19:969. [PMID: 31718560 PMCID: PMC6852944 DOI: 10.1186/s12879-019-4594-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/24/2019] [Indexed: 12/30/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is a serious infectious disease, which has become a public health problem. Previous studies have shown that temperature may influence the incidence of HFMD, but most only focus on single city and the results are highly heterogeneous. Therefore, a multicity study was conducted to explore the association between temperature and HFMD in different cities and search for modifiers that influence the heterogeneity. Methods We collected daily cases of childhood HFMD (aged 0–5 years) and meteorological factors of 21 cities in Guangdong Province in the period of 2010–2013. Distributed lag non-linear model (DLNM) with quasi-Poisson was adopted to quantify the effects of temperature on HFMD in 21 cities. Then the effects of each city were pooled by multivariate meta-analysis to obtain the heterogeneity among 21 cities. Potential city-level factors were included in meta-regression to explore effect modifiers. Results A total of 1,048,574 childhood cases were included in this study. There was a great correlation between daily childhood HFMD cases and temperature in each city, which was non-linear and lagged. High heterogeneity was showed in the associations between temperature and HFMD in 21 cities. The pooled temperature-HFMD association was peaking at the 79th percentile of temperature with relative risk (RR) of 2.474(95% CI: 2.065–2.965) as compared to the median temperature. Latitude was the main modifier for reducing the heterogeneity to 69.28% revealed by meta-analysis. Conclusions There was a strong non-linear and lagged correlation between temperature and HFMD. Latitude was strongly associated with the relationship between temperature and HFMD. Meanwhile, it had an effect on modifying the relationship. These findings can conducive to local governments developing corresponding preventive measures.
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Affiliation(s)
- Zece Xu
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Wenqi Hu
- Qianfoshan Hospital of Shandong Province, 16766 Jingshi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Ci Ren
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.,Shandong University Climate Change and Health Center, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China. .,Shandong University Climate Change and Health Center, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.
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Yan S, Wei L, Duan Y, Li H, Liao Y, Lv Q, Zhu F, Wang Z, Lu W, Yin P, Cheng J, Jiang H. Short-Term Effects of Meteorological Factors and Air Pollutants on Hand, Foot and Mouth Disease among Children in Shenzhen, China, 2009-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193639. [PMID: 31569796 PMCID: PMC6801881 DOI: 10.3390/ijerph16193639] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A few studies have explored the association between meteorological factors and hand, foot, and mouth disease (HFMD) with inconsistent results. Besides, studies about the effects of air pollutants on HFMD are very limited. METHODS Daily HFMD cases among children aged 0-14 years in Shenzhen were collected from 2009 to 2017. A distributed lag nonlinear model (DLNM) model was fitted to simultaneously assess the nonlinear and lagged effects of meteorological factors and air pollutants on HFMD incidence, and to further examine the differences of the effect across different subgroups stratified by gender, age and childcare patterns. RESULTS The cumulative relative risk (cRR) (median as reference) of HFMD rose with the increase of daily temperature and leveled off at about 30 °C (cRR: 1.40, 95%CI: 1.29, 1.51). There was a facilitating effect on HFMD when relative humidity was 46.0% to 88.8% (cRR at 95th percentile: 1.18, 95%CI: 1.11, 1.27). Short daily sunshine duration (5th vs. 50th) promoted HFMD (cRR: 1.07, 95%CI: 1.02, 1.11). The positive correlation between rainfall and HFMD reversed when it exceeded 78.3 mm (cRR: 1.41, 95% CI: 1.22, 1.63). Ozone suppressed HFMD when it exceeded 104 µg /m3 (cRR at 99th percentile: 0.85, 95%CI: 0.76, 0.94). NO2 promoted HFMD among infants and the cRR peaked at lag 9 day (cRR: 1.47, 95%CI: 1.02, 2.13) (99th vs. 50th). Besides, children aged below one year, males and scattered children were more vulnerable to high temperature, high relative humidity, and short sunshine duration. CONCLUSIONS Temperature, relative humidity, sunshine duration, rainfall, ozone and NO2 were significantly associated with HFMD, and such effects varied with gender age and childcare patterns. These findings highlight the need for more prevention effort to the vulnerable populations and may be helpful for developing an early environment-based warning system for HFMD.
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Affiliation(s)
- Siyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Lan Wei
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Hongyan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Yi Liao
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Qiuying Lv
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Fang Zhu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Zhihui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Wanrong Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Hongwei Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
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