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Edwards AJ, King MF, López-García M, Peckham D, Noakes CJ. Assessing the effects of transient weather conditions on airborne transmission risk in naturally ventilated hospitals. J Hosp Infect 2024; 148:1-10. [PMID: 38447806 DOI: 10.1016/j.jhin.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Many UK hospitals rely heavily on natural ventilation as their main source of airflow in patient wards. This method of ventilation can have cost and energy benefits, but it may lead to unpredictable flow patterns between indoor spaces, potentially leading to the unexpected transport of infectious material to other connecting zones. However, the effects of weather conditions on airborne transmission are often overlooked. METHODS A multi-zone CONTAM model of a naturally ventilated hospital respiratory ward, incorporating time-varying weather, was proposed. Coupling this with an airborne infection model, this study assessed the variable risk in interconnected spaces, focusing particularly on occupancy, disease and ventilation scenarios based on a UK respiratory ward. RESULTS The results suggest that natural ventilation with varying weather conditions can cause irregularities in the ventilation rates and interzonal flow rates of connected zones, leading to infrequent but high peaks in the concentration of airborne pathogens in particular rooms. This transient behaviour increases the risk of airborne infection, particularly through movement of pathogens between rooms, and highlights that large outbreaks may be more likely under certain conditions. This study demonstrated how ventilation rates achieved by natural ventilation are likely to fall below the recommended guidance, and that the implementation of supplemental mechanical ventilation can increase ventilation rates and reduce the variability in infection risks. CONCLUSION This model emphasises the need for consideration of transient external conditions when assessing the risk of transmission of airborne infection in indoor environments.
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Affiliation(s)
- A J Edwards
- EPSRC Centre for Doctoral Training in Fluid Dynamics, University of Leeds, Leeds, UK.
| | - M-F King
- School of Civil Engineering, University of Leeds, Leeds, UK
| | | | - D Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C J Noakes
- School of Civil Engineering, University of Leeds, Leeds, UK
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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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Zhu H, Chen S, Liang R, Feng Y, Joldosh A, Xie Z, Chen G, Li L, Chen K, Fang Y, Ou J. Study of the influence of meteorological factors on HFMD and prediction based on the LSTM algorithm in Fuzhou, China. BMC Infect Dis 2023; 23:299. [PMID: 37147566 PMCID: PMC10161995 DOI: 10.1186/s12879-023-08184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND This study adopted complete meteorological indicators, including eight items, to explore their impact on hand, foot, and mouth disease (HFMD) in Fuzhou, and predict the incidence of HFMD through the long short-term memory (LSTM) neural network algorithm of artificial intelligence. METHOD A distributed lag nonlinear model (DLNM) was used to analyse the influence of meteorological factors on HFMD in Fuzhou from 2010 to 2021. Then, the numbers of HFMD cases in 2019, 2020 and 2021 were predicted using the LSTM model through multifactor single-step and multistep rolling methods. The root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to evaluate the accuracy of the model predictions. RESULTS Overall, the effect of daily precipitation on HFMD was not significant. Low (4 hPa) and high (≥ 21 hPa) daily air pressure difference (PRSD) and low (< 7 °C) and high (> 12 °C) daily air temperature difference (TEMD) were risk factors for HFMD. The RMSE, MAE, MAPE and SMAPE of using the weekly multifactor data to predict the cases of HFMD on the following day, from 2019 to 2021, were lower than those of using the daily multifactor data to predict the cases of HFMD on the following day. In particular, the RMSE, MAE, MAPE and SMAPE of using weekly multifactor data to predict the following week's daily average cases of HFMD were much lower, and similar results were also found in urban and rural areas, which indicating that this approach was more accurate. CONCLUSION This study's LSTM models combined with meteorological factors (excluding PRE) can be used to accurately predict HFMD in Fuzhou, especially the method of predicting the daily average cases of HFMD in the following week using weekly multifactor data.
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Affiliation(s)
- Hansong Zhu
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Si Chen
- Fujian Climate Center, Fuzhou, 350028, Fujian, China
| | - Rui Liang
- Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yulin Feng
- School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian, China
| | - Aynur Joldosh
- School of Public Health, Xiamen University, Xiamen, 361005, Fujian, China
| | - Zhonghang Xie
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Guangmin Chen
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Lingfang Li
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Kaizhi Chen
- College of Computer and Data Science, Fuzhou University, Fuzhou, 350108, Fujian, China.
| | - Yuanyuan Fang
- Department of Pediatric Surgery, Fujian Children's Hospital, Fuzhou, 350001, Fujian, China.
| | - Jianming Ou
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China.
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Sun J, Li Y, Yang Z, Fang Q, Chen B. Effect of enterovirus 71 vaccination on the epidemiological characteristics and etiology in hospitalized children with hand-foot-and-mouth disease: A retrospective study from a tertiary children's hospital. Medicine (Baltimore) 2022; 101:e30356. [PMID: 36123878 PMCID: PMC9478296 DOI: 10.1097/md.0000000000030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enterovirus 71 (EV71) vaccine for hand-foot-and-mouth disease (HFMD) prevention has been available for several years. However, as a new vaccine, the impact of EV71 vaccination on the epidemiology and etiology of HFMD is currently unclear. The purpose of this study was to compare and analyze the changes of epidemiological characteristics and etiology of HFMD patients after the introduction of EV71 vaccine. The data of hospitalized children with HFMD from 2014 to 2020 were collected from the case record department of a tertiary children hospital of Anhui Province. The changes of epidemiological characteristics, time distribution, disease severity and enterovirus serotypes in hospitalized children were analyzed. A total of 7373 cases of HFMD were reported during 2014 to 2020, including 634 (8.6%) severe cases. The number of cases reached the peak in 2016 (n = 1783) and decreased gradually after EV71 vaccination. The results of etiological test showed the positive rate was 80.5%, in which EV71 accounted for 1599 (21.7%) and CV-A16 accounted for 1028 (13.9%) respectively. The number of patients showed a bimodal distribution throughout the year, which were April to June and October to November. The age distribution changed significantly following the introduction of EV71 vaccine. The proportion of 1-year-old group of post-vaccination was significantly higher than that of pre-vaccination (61.9% vs 50.8%, P < .001). The proportion of HFMD caused by EV71 and severe cases decreased significantly after the vaccination (P < .001 for both). While the comparison of epidemiological characteristics and enterovirus serotypes between unvaccinated and vaccinated cases during 2017 to 2020 showed no significant difference. The dominant enterovirus serotypes of hospitalized HFMD changed significantly after the introduction of EV71 vaccine. The proportion of severe cases decreased significantly after the vaccination, but EV71 was still a major pathogen in patients with severe HFMD. More age-appropriate children are recommended to get vaccinated to establish stronger herd immunity in the population.
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Affiliation(s)
- Jing Sun
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Yuanyuan Li
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Zhi Yang
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Qingfeng Fang
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Biquan Chen
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
- *Correspondence: Biquan Chen, Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China (e-mail: )
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Zhong X, Wang H, Chen C, Zou X, Li T. Epidemiological Characteristics of Hand, Foot and Mouth Disease Reinfection in Guangzhou, Southern China from 2012 to 2017. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2078-2088. [PMID: 36743381 PMCID: PMC9884378 DOI: 10.18502/ijph.v51i9.10563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
Background Hand, foot and mouth disease (HFMD) reinfection is common because of the limited cross-protection from infections of different enterovirus. We aimed to investigate the epidemiological characteristics and its influential factors of HFMD reinfection in Guangzhou, China. Methods Data on HFMD patients aged ≤5 yr from 2012 to 2017 were extracted from surveillance system. Influential factors of reinfection were assessed using the logistic regression model. Results Of 369,054 HFMD patients, 11,321 patients (3.07%) were classified as reinfection. The reinfection rate in male was higher than in female (χ2=60.11, P<0.001). The reinfection rate in patients ≤1 yr was 3.86%, which showed a downward trend with age (Z=37.37, P trend<0.001). The highest reinfection rate was observed in the scattered children (3.38%), followed by nursery care children and others (χ2=514.75, P<0.001). Besides, higher risk of reinfection was detected among those who were male, lower age group, rural residence and other enteroviruses infection compared with their respective counterparts. Seasonality was illustrated according to the number of reinfections peaked from April to July. Time intervals curves revealed the number of reinfections gradually increased after 13 months from the initial infection. Conclusion Male ≤4 yr, living rural area, especially those lived scattered and infected with other enteroviruses were more likely to be reinfection.
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Affiliation(s)
- Xuan Zhong
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China,School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Hui Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Chun Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Xiaoni Zou
- Guangdong Women and Children Hospital, Guangzhou 510010, China,Corresponding Authors: Emails: ;
| | - Tiegang Li
- Guangzhou Municipal Health Commission, Guangzhou 510062, China,Corresponding Authors: Emails: ;
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Zhang L, Yang Y, Lin Y, Chen H. Human Health, Environmental Quality and Governance Quality: Novel Findings and Implications From Human Health Perspective. Front Public Health 2022; 10:890741. [PMID: 35812483 PMCID: PMC9263448 DOI: 10.3389/fpubh.2022.890741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/20/2022] [Indexed: 12/21/2022] Open
Abstract
Human health and wellbeing are intimately linked to the state of the environment. The current study emphasizes the role of environmental quality, government policies, and human health. This paper provides a detailed literature review of existing findings regarding our key variables of interest. The results argue that the implications of poor government policies and environmental pollution for rising economic development have led to poor environmental quality and health issues for humans. Based on earlier investigations, the present study reviewed the state-of-the-art review and determined innovative insights for outdoor and indoor environment difficulties. This study provides a detailed review of human health, environmental quality, and governance quality. In addition, the study conducts an empirical analysis using the annual data of low-income countries from 1996 to 2020. Government actions and health systems must be modified immediately to address these rising concerns successfully. The report offers policy recommendations for addressing health, governance, and environmental change mitigation issues, all of which are directly or indirectly related to the study. This article presents an overview of environmental change's health impacts and explores how health hazards may be reduced or eliminated through effective adaptation strategies.
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Affiliation(s)
- Liqin Zhang
- School of Economics, Fujian Normal University, Fuzhou, China
| | - Yuping Yang
- School of Economics, Fujian Normal University, Fuzhou, China
| | - Yesong Lin
- Fuzhou Lianjiang Ecological Environment Bureau, Fuzhou, China
| | - Huangxin Chen
- School of Economics, Fujian Normal University, Fuzhou, China
- *Correspondence: Huangxin Chen
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Ren FR, Abodurezhake Y, Cui Z, Zhang M, Wang YY, Zhang XR, Lu YQ. Effects of Meteorological Factors and Atmospheric Pollution on Hand, Foot, and Mouth Disease in Urumqi Region. Front Public Health 2022; 10:913169. [PMID: 35812470 PMCID: PMC9257078 DOI: 10.3389/fpubh.2022.913169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a febrile rash infection caused by enteroviruses, spreading mainly via the respiratory tract and close contact. In the past two decades, HFMD has been prevalent mainly in Asia, including China and South Korea, causing a huge disease burden and putting the lives and health of children at risk. Therefore, a further study of the factors influencing HFMD incidences has far-reaching implications. In existing studies, the environmental factors affecting such incidences are mainly divided into two categories: meteorological and air. Among these studies, the former are the majority of studies on HFMD. Some scholars have studied both factors at the same, but the number is not large and the findings are quite different. Methods We collect monthly cases of HFMD in children, meteorological factors and atmospheric pollution in Urumqi from 2014 to 2020. Trend plots are used to understand the approximate trends between meteorological factors, atmospheric pollution and the number of HFMD cases. The association between meteorological factors, atmospheric pollution and the incidence of HFMD in the Urumqi region of northwest China is then investigated using multiple regression models. Results A total of 16,168 cases in children are included in this study. According to trend plots, the incidence of HFMD shows a clear seasonal pattern, with O3 (ug/m3) and temperature (°C) showing approximately the same trend as the number of HFMD cases, while AQI, PM2.5 (ug/m3), PM10 (ug/m3) and NO2 (ug/m3) all show approximately opposite trends to the number of HFMD cases. Based on multiple regression results, O3 (P = 0.001) and average station pressure (P = 0.037) are significantly and negatively associated with HFMD incidences, while SO2 (P = 0.102), average dew point temperature (P = 0.072), hail (P = 0.077), and thunder (P = 0.14) have weak significant relationships with them.
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Affiliation(s)
- Fang-rong Ren
- College of Economics and Management, Nanjing Forestry University, Nanjing, China
| | | | - Zhe Cui
- Economics and Management School, Nantong University, Nantong, China
| | - Miao Zhang
- Economics and Management School, Nantong University, Nantong, China
| | - Yu-yu Wang
- Economics and Management School, Nantong University, Nantong, China
| | - Xue-rong Zhang
- Economics and Management School, Nantong University, Nantong, China
| | - Yao-qin Lu
- Department of Infectious Disease Control, Urumqi Center for Disease Control and Prevention, Ürümqi, China
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Gopalkrishna V, Ganorkar N. Epidemiological and molecular characteristics of circulating CVA16, CVA6 strains and genotype distribution in hand, foot and mouth disease cases in 2017 to 2018 from Western India. J Med Virol 2021; 93:3572-3580. [PMID: 32833231 DOI: 10.1002/jmv.26454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022]
Abstract
Hand, Foot, and Mouth disease (HFMD) is a mild exanthematous and febrile disease occurs in children aged ≤10 years old. The present study highlights clinical, epidemiological characteristics, distribution of enterovirus (EV) types, and sub genotypes in HFMD cases reported during 2017 to 2018 in Western India. A total of 93 clinical samples collected from 68 HFMD cases were included. The presence of EV-RNA was determined by 5'UTR based nested reverse transcription polymerase chain reaction followed by molecular typing, sub genotyping by VP1/2A junction or VP1, full VP1 gene amplification, and phylogenetic analysis. The study reports 80.64% (75/93) EV positivity and 94.66% (71/75) typing rate, with a predominant circulation of CVA16 and CVA6 strains. Sequence analysis revealed the presence of coxsackievirus (CV)A16 (57.7%), CVA6 (40.8%), and Echo1 (1.4%) strains. EV infections were predominantly observed in children aged 1 to 3 years old (43.9%). Although cases were reported throughout the year, peaked in July (15.8%) and August (24.6%) months and persisted till September (19.3%). All the CVA16 and CVA6 positive strains were genotyped using full VP1 gene amplification. All CVA16 Indian strains (n = 41) were clustered with rarely reported B1c sub genotype and CVA6 strains (n = 29) with E2 sub-lineage. The study highlights the genetic characteristics of circulating CVA16, CVA6, and Echo1 strains in HFMD cases from Western India. The emergence of CVA16 B1c genotype and sub-lineage E2 of CVA6 strains and their constant circulation further demands systemic surveillance studies on HFMD from different parts of India to facilitate the rapid diagnosis of CVA16 and CVA6 strains using the molecular and serological based approach and for intervention strategies.
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Affiliation(s)
- Varanasi Gopalkrishna
- Enteric Viruses Group, Indian Council of Medical Research (ICMR), National Institute of Virology, Pune, India
| | - Nital Ganorkar
- Enteric Viruses Group, Indian Council of Medical Research (ICMR), National Institute of Virology, Pune, India
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Huang R, Wei J, Li Z, Gao Z, Mahe M, Cao W. Spatial-temporal mapping and risk factors for hand foot and mouth disease in northwestern inland China. PLoS Negl Trop Dis 2021; 15:e0009210. [PMID: 33760827 PMCID: PMC8021183 DOI: 10.1371/journal.pntd.0009210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/05/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hand foot and mouth disease (HFMD) is becoming one of the common human infectious diseases in China. Previous studies have described HFMD in tropical or coastal areas of Asia-Pacific countries. However, limited studies have thoroughly studied the epidemiology and potential risk factors for HFMD in inland areas with complex environmental conditions. Methodology/Principal findings Using the data from 2009 to 2018 on reported cases of Xinjiang Uighur Autonomous Region, we characterized the epidemic features of HFMD. Panel negative binomial model was used to identify climate, geographical and demographic determinants for HFMD incidence. A total of 70856 HFMD cases (average annual incidence: 305 per million persons) were reported in Xinjiang during the 10-year study period, of which 10393 (14.7%) were laboratory-confirmed and 98 (0.1%) were severe. HFMD peaked in summer every year during the study period, and incidence in 2012, 2015, 2016 and 2018 had minor peaks in autumn. After adjusting the school or holiday month, multiple factors were found to affect HFMD epidemiology: urban area being major land cover type (incidence risk ratio, IRR 2.08; 95% CI 1.50, 2.89), higher gross domestic product per capita (IRR 1.14; 95% CI 1.11, 1.16), rise in monthly average temperature (IRR 1.65; 95% CI 1.61, 1.69) and monthly accumulative precipitation (IRR 1.20; 95% CI 1.16, 1.24) predicted increase in the incidence of HFMD; farmland being major land cover type (IRR 0.72; 95% CI 0.64, 0.81), an increase of percentage of the minority (IRR 0.91; 95% CI 0.89, 0.93) and population density (IRR 0.98; 95% CI 0.98, 0.99) were related to a decrease in the incidence of HFMD. Conclusions/Significance In conclusion, the epidemic status of HFMD in Xinjiang is characterized by low morbidity and fatality. Multiple factors have significant influences on the occurrence and transmission of HFMD in Xinjiang. Hand foot and mouth disease (HFMD) is one of the common human infectious disease threating Asia-Pacific countries. To explore the epidemiology and environmental risk factors for HFMD in inland China, we utilized 10-year HFMD surveillance data in Xinjiang Uighur Autonomous Region and combined multiple spatial-temporal statistical analyses. We identified spatial-temporal clusters of HFMD incidence and found that multiple factors could affect HFMD incidence: urban area being major land cover type, higher gross domestic product per capita, rise in monthly average temperature and monthly accumulative precipitation predicted increase in the incidence of HFMD; farmland being major land cover type, an increase of percentage of the minority and population density were related to a decrease in the incidence of HFMD. Our findings facilitate the understanding of HFMD epidemiology and risk factors in different geographic regions, which are crucial for conducting prevention and control strategies of HFMD.
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Affiliation(s)
- Ruifang Huang
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Urumqi, P. R. China
| | - Jiate Wei
- Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Zhenwei Li
- Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
| | - Zhenguo Gao
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Urumqi, P. R. China
| | - Muti Mahe
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Urumqi, P. R. China
| | - Wuchun Cao
- Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, P. R. China
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
- * E-mail:
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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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Ma Y, Zhang Y, Cheng B, Feng F, Jiao H, Zhao X, Ma B, Yu Z. A review of the impact of outdoor and indoor environmental factors on human health in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:42335-42345. [PMID: 32833174 DOI: 10.1007/s11356-020-10452-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/09/2020] [Indexed: 06/11/2023]
Abstract
The Intergovernmental Panel on Climate Change (IPCC) reported that global climate change has led to the increased occurrence of extreme weather events. In the context of global climate change, more evidence indicates that abnormal meteorological conditions could increase the risk of epidemiological mortality and morbidity. In this study, using a systematic review, we evaluated a total of 175 studies (including 158 studies on outdoor environment and 17 studies on indoor environment) to summarize the impact of outdoor and indoor environment on human health in China using the database of PubMed, Web of Science, the Cochrane Library, and Embase. In particular, we focused on studies about cardiovascular and respiratory mortality and morbidity, the prevalence of digestive system diseases, infectious diseases, and preterm birth. Most of the studies we reviewed were conducted in three of the metropolises of China, including Beijing, Guangzhou, and Shanghai. For the outdoor environment, we summarized the effects of climate change-related phenomena on health, including ambient air temperature, diurnal temperature range (DTR), temperature extremes, and so on. Studies on the associations between temperature and human health accounted for 79.7% of the total studies reviewed. We also screened out 19 articles to explore the effect of air temperature on cardiovascular diseases in different cities in the final meta-analysis. Besides, modern lifestyle involves a large amount of time spent indoors; therefore, indoor environment also plays an important role in human health. Nevertheless, studies on the impact of indoor environment on human health are rarely reported in China. According to the limited reports, adverse indoor environment could impose a high health risk on children.
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Affiliation(s)
- Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bowen Cheng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Fengliu Feng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Haoran Jiao
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Xiaoyan Zhao
- Neurology Department, General Hospital of the Chinese People's Liberation Army, Beijing, 100000, China
| | - Bingji Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Zhiang Yu
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
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12
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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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Han Y, Chen Z, Zheng K, Li X, Kong J, Duan X, Xiao X, Guo B, Luan R, Long L. Epidemiology of Hand, Foot, and Mouth Disease Before and After the Introduction of Enterovirus 71 Vaccines in Chengdu, China, 2009-2018. Pediatr Infect Dis J 2020; 39:969-978. [PMID: 32433221 DOI: 10.1097/inf.0000000000002745] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) has posed a serious threat to children's health. Three inactivated monovalent enterovirus 71 (EV71) vaccines are proved to be highly efficacious in phase III clinical trials and are now available in China. METHODS We analyzed the citywide surveillance data on HFMD cases in Chengdu during 2009-2018, and estimated cumulative first-dose EV71 vaccination coverage among children eligible to EV71 vaccination after August 2016 in Chengdu. Time series susceptible-infected-recovered model was developed to analyze basic reproduction number and herd immunity threshold of HFMD. Overall and serotype-specific HFMD incidences and severity risks were compared before and after the EV71 vaccination. RESULTS Among 3 laboratory-identified serotype categories, i.e. EV71, coxsackievirus A16 (CV-A16), and other enteroviruses, the major serotype attributed to HFMD has been changing across years. The cumulative first-dose EV71 vaccination coverage rate was estimated as 60.8% during the study period in Chengdu. By contrast, herd immunity threshold for EV71-related HFMD was 94.0%. After introduction of EV71 vaccines, the overall incidence of HFMD increased 60.8%, mainly driven by 173.7% and 11.8% increased in HFMD caused by other enteroviruses and CV-A16, respectively, which offset a significant reduction in the incidence of HFMD caused by EV71. The overall case-severity risk decreased from 1.4% to 0.3%, with significantly declined presented in all serotype categories. CONCLUSIONS The incidence and severity of EV71-related HFMD decreased following implementation of EV71 vaccination. Developing multivalent vaccines and strengthening laboratory-based surveillance could further decline burden of HFMD.
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Affiliation(s)
- Yutong Han
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Zhenhua Chen
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Ke Zheng
- Department of Immunization Planning, Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China
| | - Xianzhi Li
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Jinwang Kong
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiaoxia Duan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Bing Guo
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Rongsheng Luan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Lu Long
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
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14
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Xie J, Yang XH, Hu SQ, Zhan WL, Zhang CB, Liu H, Zhao HY, Chai HY, Chen KY, Du QY, Liu P, Yin AH, Luo MY. Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China. BMC Infect Dis 2020; 20:271. [PMID: 32264839 PMCID: PMC7137261 DOI: 10.1186/s12879-020-04992-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a common infectious disease occurring in children under 5 years of age worldwide, and Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA-16) are identified as the predominant pathogens. In recent years, Coxsackievirus A6 (CVA-6) and Coxsackievirus A10 (CVA-10) have played more and more important role in a series of HFMD outbreaks. This study aimed to understand the epidemic characteristics associated with HFMD outbreak in Guangzhou, 2018. Methods The clinical and laboratory data of 1220 enterovirus-associated HFMD patients in 2018 were analysed in this study. Molecular diagnostic methods were performed to identify its serotypes. Phylogenetic analyses were depicted based on the complete VP1 gene. Results There were 21 enterovirus serotypes detected in Guangzhou in 2018. Three serotypes of enterovirus, CVA-6 (364/1220, 29.8%), CVA-10 (305/1220, 25.0%), and CVA-16 (397/1220, 32.5%), were identified as the causative pathogens and accounted for 87.3% among all 1220 HFMD patients. In different seasons, CVA-6 was the predominant pathogen of HFMD during autumn, and CVA-10 as well as CVA-16 were more prevalent in summer. Patients infected by CVA-6, CVA-10 or CVA-16 showed similar clinical features and laboratory characteristics, and the ratios of severe HFMD were 5.8, 5.9, and 1.5% in the three serotypes. Phylogenetic analyses of VP1 sequences showed that the CVA-6, CVA-10, and CVA-16 sequences belonged to the sub-genogroup E2, genogroup E, and genogroup B1, respectively. Conclusions CVA-6, CVA-10, and CVA-16 were the predominant and co-circulated serotypes in Guangzhou China, 2018, which should be the new target for prevention and control of HFMD. Our findings provide useful information for diagnosis, treatment, and prevention of HFMD.
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Affiliation(s)
- Jia Xie
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China
| | - Xiao-Han Yang
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Si-Qi Hu
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China
| | - Wen-Li Zhan
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Chang-Bin Zhang
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Hong Liu
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Hong-Yu Zhao
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Hui-Ying Chai
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Ke-Yi Chen
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Qian-Yi Du
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Pan Liu
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Ai-Hua Yin
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China
| | - Ming-Yong Luo
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, 511442, People's Republic of China. .,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, 511442, People's Republic of China.
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15
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Meteorological factors associated with hand, foot and mouth disease in a Central Highlands province in Viet Nam: an ecological study. Western Pac Surveill Response J 2020; 10:18-23. [PMID: 32133207 PMCID: PMC7043093 DOI: 10.5365/wpsar.2017.8.1.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is a public health problem in Viet Nam, and studies have reported seasonal fluctuation in the occurrence of HFMD. This study sought to describe the occurrence of HFMD and its associated meteorological factors in Dak Lak province, Viet Nam. Methods Monthly data on HFMD cases were collected from all commune health stations in Dak Lak province from 2012 through 2013. An HFMD case was defined as a brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Average temperature, maximum temperature, minimum temperature, humidity, rainfall, evaporation, sunshine duration and wind speed were recorded monthly at five local meteorological stations throughout Dak Lak.Data were aggregated at the district level, and the association between these meteorological factors and HFMD cases were examined by Poisson regression. Results In 2012 through 2013, there were 7128 HFMD patients in Dak Lak. The number of HFMD cases increased during the rainy season. An increased risk of HFMD was associated with higher average temperature (risk ratio and 95% confidence interval: 1.06; 1.03-1.08 per 1 °C increase), higher rainfall (1.19; 1.14-1.24 per 200 mm increase) and longer sunshine duration (1.14; 1.07-1.22 per 60 hours increase). The risk of HFMD was inversely associated with wind speed (0.77; 0.73-0.81 per 1 m/s increase). Conclusion This study suggests that there is a significant association between HFMD occurrence and climate. Temperature, rainfall, wind speed and sunshine duration could be used as meteorological predictors of HFMD occurrence in Viet Nam's Central Highlands region. Intensified surveillance for HFMD during the rainy season is recommended.
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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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17
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Wang H, Di B, Zhang T, Lu Y, Chen C, Wang D, Li T, Zhang Z, Yang Z. Association of meteorological factors with infectious diarrhea incidence in Guangzhou, southern China: A time-series study (2006-2017). THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 672:7-15. [PMID: 30954825 DOI: 10.1016/j.scitotenv.2019.03.330] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Infectious diarrhea (ID) has exerted a severe disease burden on the world. The seasonal ID patterns suggest that meteorological factors (MFs) may influence ID incidence. The aim of this study was to evaluate the effect of MFs on ID, and to provide scientific evidence to the relevant health authorities for disease control and prevention. METHODS Data from ID cases and daily MFs (including mean temperature, diurnal temperature range, relative humidity, precipitation, atmospheric pressure, and wind velocity) in Guangzhou, Southern China from 2006 to 2017 were collected. Using a distributed lag non-linear model approach, we assessed the relationship between MFs and ID incidence. RESULTS Compared with the lowest ID risk values, low mean temperature, relative humidity, and precipitation were associated with an increased risk for ID, while higher diurnal temperature range and atmospheric pressure were also associated with increased risk. Maximum atmospheric pressure and minimum relative humidity had larger cumulative effects within 21 lag days, yielding relative risks of 133.11 (95% CI: 61.29-289.09) and 18.17 (14.42-22.89), respectively. The cumulative effect within 21 lag days of minimum temperature was higher than that from maximum temperature in all sub-populations. The cumulative effects of minimum temperature for men, teenagers, and young adults (10-29 years) were higher than those for other populations. CONCLUSIONS MFs should be considered when developing prevention and surveillance programs for ID. Special attention should be paid to vulnerable populations, such as teenagers and young adults.
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Affiliation(s)
- Hui Wang
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Biao Di
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - TieJun Zhang
- Department of Nuclear Medicine, The first Affiliated Hospital of Baotou Medical College, Baotou 014010, China
| | - Yin Lu
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Chun Chen
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Dahu Wang
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Tiegang Li
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
| | - Zhoubin Zhang
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
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18
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Zhong R, Wu Y, Cai Y, Wang R, Zheng J, Lin D, Wu H, Li Y. Forecasting hand, foot, and mouth disease in Shenzhen based on daily level clinical data and multiple environmental factors. Biosci Trends 2019; 12:450-455. [PMID: 30473551 DOI: 10.5582/bst.2018.01126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is caused by a group of enteroviruses. It infects millions of children in the Southeast Asian area. An accurate forecasting of outbreaks of HFMD could facilitate public health officials to suggest public health actions earlier. Many researchers tried to develop an early warning system for HFMD to lower the damage caused by a HFMD outbreak. The research data based on daily level could help figure out the relationship between HFMD and environmental factors, but nevertheless is difficult to collect. In this study, we collected the daily clinical data from the Shenzhen Health Information Center and multiple environmental factors to analyze the outbreaks of HFMD. Considering the incubation period of HFMD, we fed the previous 60 days' HFMD rates, 7 days' temperature factors and 7 days' air-quality factors into the tree model, XGBoost. The following conclusions were drawn in this study: i) Compared with the model only using the previous HFMD rate and temperature factors, the addition of the air-quality factors could make the model better, improving MAE nearly 16.7%. ii) By analyzing the Pearson correlation, we found that the temperature showed a positive correlation and the air quality showed a negative correlation for the HFMD outbreaks. Improving the air quality, especially decreasing PM2.5 and PM10 could decrease the risk of HFMD outbreaks.
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Affiliation(s)
- Ren Zhong
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention
| | - Yunpeng Cai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Ruxin Wang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | | | | | - Hongyan Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
| | - Ye Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
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19
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Xu C, Zhang X, Xiao G. Spatiotemporal decomposition and risk determinants of hand, foot and mouth disease in Henan, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:509-516. [PMID: 30550914 DOI: 10.1016/j.scitotenv.2018.12.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Abstract
Hand, foot and mouth disease (HFMD) remains an increasing public health concern. The spatiotemporal variation of HFMD can be represented from multiple-perspectives, and it may be driven by different dominant factors. In this study, the HFMD cases in children under the age of five years in each county in Henan province, China, from 2009 to 2013 were assessed to explore the integrative spatiotemporal patterns of HFMD and investigate their driving factors. The empirical orthogonal function was applied to identify representative spatiotemporal patterns. Then, GeoDetector was used to quantify the determinant powers of driving factors to the disease. The results indicated that the most prominent spatiotemporal pattern explained 56.21% of the total variance, presented in big cities, e.g. capital city and municipal districts. The dominant factors of this pattern were per capita gross domestic product and relative humidity, with determinant powers of 62% and 42%, respectively. The secondary spatiotemporal pattern explained 10.52% of the total variance, presented in the counties around big cities. The dominant factors for this pattern were the ratio of urban to rural population and precipitation, with determinant powers of 26% and 41%, respectively. These findings unveiled the key spatiotemporal features and their determinants related to the disease; this will be helpful in establishing accurate spatiotemporal preventing of HFMD.
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Affiliation(s)
- Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiangxue Zhang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; The School of Earth Science and Resources, Chang'an University, Xi'an 710054, China
| | - Gexin Xiao
- China National Center for Food Safety Risk Assessment, Beijing 100022, China.
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20
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Coates SJ, Davis MDP, Andersen LK. Temperature and humidity affect the incidence of hand, foot, and mouth disease: a systematic review of the literature - a report from the International Society of Dermatology Climate Change Committee. Int J Dermatol 2018; 58:388-399. [PMID: 30187452 DOI: 10.1111/ijd.14188] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is an enterovirus-mediated condition that predominantly affects children under 5 years of age. The tendency for outbreaks to peak in warmer summer months suggests a relationship between HFMD and weather patterns. We reviewed the English-language literature for articles describing a relationship between meteorological variables and HFMD. Seventy-two studies meeting criteria were identified. A positive, statistically significant relationship was identified between HFMD cases and both temperature (61 of 67 studies, or 91.0%, reported a positive relationship) [CI 81.8-95.8%, P = 0.0001] and relative humidity (41 of 54 studies, or 75.9%) [CI 63.1-85.4%, P = 0.0001]. No significant relationship was identified between HFMD and precipitation, wind speed, and/or sunshine. Most countries reported a single peak of disease each year (most commonly early Summer), but subtropical and tropical climate zones were significantly more likely to experience a bimodal distribution of cases throughout the year (two peaks a year; most commonly late spring/early summer, with a smaller peak in autumn). The rising global incidence of HFMD, particularly in Pacific Asia, may be related to climate change. Weather forecasting might be used effectively in the future to indicate the risk of HFMD outbreaks and the need for targeted public health interventions.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, The University of California San Francisco, San Francisco, CA, USA
| | - Mark D P Davis
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Louise K Andersen
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus, Denmark
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Cheng Q, Bai L, Zhang Y, Zhang H, Wang S, Xie M, Zhao D, Su H. Ambient temperature, humidity and hand, foot, and mouth disease: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 625:828-836. [PMID: 29306826 DOI: 10.1016/j.scitotenv.2018.01.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/12/2017] [Accepted: 01/01/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND The relationship between ambient temperature, humidity and hand, foot, and mouth disease (HFMD) has been highlighted in East and Southeast Asia, which showed multiple different results. Therefore, our goal is to conduct a meta-analysis to further clarify this relationship and to quantify the size of these effects as well as the susceptible populations. METHODS PubMed, Web of science, and Cochrane library were searched up to November 22, 2017 for articles analyzing the relationships between ambient temperature, humidity and incidence of HFMD. We assessed sources of heterogeneity by study design (temperature measure and exposed time resolution), population vulnerability (national income level and regional climate) and evaluated pooled effect estimates for the subgroups identified in the heterogeneity analysis. RESULTS We identified 11 studies with 19 estimates of the relationship between ambient temperature, humidity and incidence of HFMD. It was found that per 1°C increase in the temperature and per 1% increase in the relative humidity were both significantly associated with increased incidence of HFMD (temperature: IRR, 1.05; 95% CI, 1.02-1.08; relative humidity: IRR, 1.01; 95% CI, 1.00-1.02). Subgroup analysis showed that people living in subtropical and middle income areas had a higher risk of incidence of HFMD. CONCLUSIONS Ambient temperature and humidity may increase the incidence of HFMD in Asia-Pacific regions. Further studies are needed to clarify the relationship between ambient temperature, humidity and incidence of HFMD in various settings with distinct climate, socioeconomic, and demographic features.
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Affiliation(s)
- Qiang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Lijun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Yanwu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Heng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shusi Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Mingyu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Desheng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
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Liu S, Chen J, Wang J, Wu Z, Wu W, Xu Z, Hu W, Xu F, Tong S, Shen H. Predicting the outbreak of hand, foot, and mouth disease in Nanjing, China: a time-series model based on weather variability. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:565-574. [PMID: 29086082 DOI: 10.1007/s00484-017-1465-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 06/07/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a significant public health issue in China and an accurate prediction of epidemic can improve the effectiveness of HFMD control. This study aims to develop a weather-based forecasting model for HFMD using the information on climatic variables and HFMD surveillance in Nanjing, China. Daily data on HFMD cases and meteorological variables between 2010 and 2015 were acquired from the Nanjing Center for Disease Control and Prevention, and China Meteorological Data Sharing Service System, respectively. A multivariate seasonal autoregressive integrated moving average (SARIMA) model was developed and validated by dividing HFMD infection data into two datasets: the data from 2010 to 2013 were used to construct a model and those from 2014 to 2015 were used to validate it. Moreover, we used weekly prediction for the data between 1 January 2014 and 31 December 2015 and leave-1-week-out prediction was used to validate the performance of model prediction. SARIMA (2,0,0)52 associated with the average temperature at lag of 1 week appeared to be the best model (R 2 = 0.936, BIC = 8.465), which also showed non-significant autocorrelations in the residuals of the model. In the validation of the constructed model, the predicted values matched the observed values reasonably well between 2014 and 2015. There was a high agreement rate between the predicted values and the observed values (sensitivity 80%, specificity 96.63%). This study suggests that the SARIMA model with average temperature could be used as an important tool for early detection and prediction of HFMD outbreaks in Nanjing, China.
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Affiliation(s)
- Sijun Liu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Jiaping Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Zhuchao Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Weihua Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia.
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.
| | - Fei Xu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, 210003, China.
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
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Wu X, Hu S, Kwaku AB, Li Q, Luo K, Zhou Y, Tan H. Spatio-temporal clustering analysis and its determinants of hand, foot and mouth disease in Hunan, China, 2009-2015. BMC Infect Dis 2017; 17:645. [PMID: 28946852 PMCID: PMC5613322 DOI: 10.1186/s12879-017-2742-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is one of the highest reported infectious diseases with several outbreaks across the world. This study aimed at describing epidemiological characteristics, investigating spatio-temporal clustering changes, and identifying determinant factors in different clustering areas of HFMD. Methods Descriptive statistics was used to evaluate the epidemic characteristics of HFMD from 2009 to 2015. Spatial autocorrelation and spatio-temporal cluster analysis were used to explore the spatial temporal patterns. An autologistic regression model was employed to explore determinants of HFMD clustering. Results The incidence rates of HFMD ranged from 54.31/10 million to 318.06/10 million between 2009 and 2015 in Hunan. Cases were mainly prevalent in children aged 5 years and even younger, with an average male-to-female sex ratio of 1.66, and two epidemic periods in each year. Clustering areas gathered in the northern regions in 2009 and in the central regions from 2010 to 2012. They moved to central-southern regions in 2013 and 2014 and central-western regions in 2015. The significant risk factors of HFMD clusters were rainfall (OR = 2.187), temperature (OR = 4.329) and humidity (OR = 2.070). The protect factor was wind speed (OR = 0.258). Conclusions The HFMD incidence from 2009 to 2015 in Hunan showed a new spatiotemporal clustering tendency, with the shifting trend of clustering areas toward south and west. Meteorological factors showed a strong association with HFMD clustering, which may assist in predicting future spatial-temporal clusters. Electronic supplementary material The online version of this article (10.1186/s12879-017-2742-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinrui Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Shixiong Hu
- Hunan Center for Disease Control and Prevention, Changsha, Hunan, 410078, People's Republic of China
| | - Abuaku Benjamin Kwaku
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China.,Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, PO Box LG581, Legon, Accra, Ghana
| | - Qi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Kaiwei Luo
- Hunan Center for Disease Control and Prevention, Changsha, Hunan, 410078, People's Republic of China
| | - Ying Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China.
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Nguyen HX, Chu C, Nguyen HLT, Nguyen HT, Do CM, Rutherford S, Phung D. Temporal and spatial analysis of hand, foot, and mouth disease in relation to climate factors: A study in the Mekong Delta region, Vietnam. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:766-772. [PMID: 28063653 DOI: 10.1016/j.scitotenv.2017.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/31/2016] [Accepted: 01/01/2017] [Indexed: 04/15/2023]
Abstract
This study examined the temporal and spatial patterns of hand, foot, and mouth disease (HFMD) in the Mekong Delta region in Vietnam. A time-series analysis was used to examine the temporal patterns of HFMD in relation to climate factors while a retrospective space-time scan was used to detect the high-risk space-time clusters of this disease. A 1°C increase in average temperature was associated with 5.6% increase in HFMD rate at lag 5days (95% CI 0.3-10.9). A 1% increase in humidity had equal influence of 1.7% increases on HFMD rate at both lag 3days and 6days (95% CI 0.7-2.7 and 95% CI 0.8-2.6, respectively). An increase in 1 unit of rainfall was associated with a 0.5% increase of HFMD rate on the lag 1 and 6days (95% CI 0.2-0.9 and 95% CI 0.1-0.8, respectively). The predictive model indicated that the peak of HFMD was from October to December - the rainy season in the Mekong Delta region. Most high-risk clusters were located in areas with high population density and close to transport routes. The findings suggest that HFMD is influenced by climate factors and is likely to increase in the future due to climate change related weather events.
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Affiliation(s)
- Huong Xuan Nguyen
- Centre for Environment and Population Health (CEPH), Griffith University, Queensland, Australia
| | - Cordia Chu
- Centre for Environment and Population Health (CEPH), Griffith University, Queensland, Australia
| | | | - Ha Thanh Nguyen
- Health Environment Management Agency, Ministry of Health, Vietnam
| | - Cuong Manh Do
- Health Environment Management Agency, Ministry of Health, Vietnam
| | - Shannon Rutherford
- Centre for Environment and Population Health (CEPH), Griffith University, Queensland, Australia
| | - Dung Phung
- Centre for Environment and Population Health (CEPH), Griffith University, Queensland, Australia.
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Xiao X, Gasparrini A, Huang J, Liao Q, Liu F, Yin F, Yu H, Li X. The exposure-response relationship between temperature and childhood hand, foot and mouth disease: A multicity study from mainland China. ENVIRONMENT INTERNATIONAL 2017; 100:102-109. [PMID: 28069250 DOI: 10.1016/j.envint.2016.11.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 05/04/2023]
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is a rising public health issue in the Asia-Pacific region. Numerous studies have tried to quantify the relationship between meteorological variables and HFMD but with inconsistent results, in particular for temperature. We aimed to characterize the relationship between temperature and HFMD in various locations and to investigate the potential heterogeneity. METHODS We retrieved the daily series of childhood HFMD counts (aged 0-12 years) and meteorological variables for each of 143 cities in mainland China in the period 2009-2014. We fitted a common distributed lag nonlinear model allowing for over dispersion to each of the cities to obtain the city-specific estimates of temperature-HFMD relationship. Then we pooled the city-specific estimates through multivariate meta-regression with city-level characteristics as potential effect modifiers. RESULTS We found that the overall pooled temperature-HFMD relationship was shown as an approximately inverted V shape curve, peaking at the 91th percentile of temperature with a risk ratio of 1.30 (95% CI: 1.23-1.37) compared to its 50th percentile. We found that 68.5% of the variations of city-specific estimates was attributable to heterogeneity. We identified rainfall and altitude as the two main effect modifiers. CONCLUSIONS We found a nonlinear relationship between temperature and HFMD. The temperature-HFMD relationship varies depending on geographic and climatic conditions. The findings can help us deepen the understanding of weather-HFMD relationship and provide evidences for related public health decisions.
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Affiliation(s)
- Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Jiao Huang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China; Department of Epidemiology and Statistics & the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei 430030, PR China.
| | - Qiaohong Liao
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China.
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Fei Yin
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China.
| | - Hongjie Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China; Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China.
| | - Xiaosong Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China.
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Guo C, Yang J, Guo Y, Ou QQ, Shen SQ, Ou CQ, Liu QY. Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: a multi-city time-series analysis. BMC Infect Dis 2016; 16:524. [PMID: 27682137 PMCID: PMC5041518 DOI: 10.1186/s12879-016-1846-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors. Methods Based on daily time-series data in eight major cities in Guangdong, China during 2009–2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors. Results There were a total of 400,408 pediatric HFMD cases (children aged 0–14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30–1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00–1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city’s latitude and longitude with an explained heterogeneity of 32 %. Conclusions Daily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1846-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cui Guo
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jun Yang
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, QLD, 4006, Australia
| | - Qiao-Qun Ou
- Department of Pediatrics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510180, China
| | - Shuang-Quan Shen
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Qi-Yong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
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Wang P, Goggins WB, Chan EYY. Hand, Foot and Mouth Disease in Hong Kong: A Time-Series Analysis on Its Relationship with Weather. PLoS One 2016; 11:e0161006. [PMID: 27532865 PMCID: PMC4988669 DOI: 10.1371/journal.pone.0161006] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is an emerging enterovirus-induced infectious disease for which the environmental risk factors promoting disease circulation remain inconclusive. This study aims to quantify the association of daily weather variation with hospitalizations for HFMD in Hong Kong, a subtropical city in China. Methods A time series of daily counts of HFMD public hospital admissions from 2008 through 2011 in Hong Kong was regressed on daily mean temperature, relative humidity, wind speed, solar radiation and total rainfall, using a combination of negative binomial generalized additive models and distributed lag non-linear models, adjusting for trend, season, and day of week. Results There was a positive association between temperature and HFMD, with increasing trends from 8 to 20°C and above 25°C with a plateau in between. A hockey-stick relationship of relative humidity with HFMD was found, with markedly increasing risks over 80%. Moderate rainfall and stronger wind and solar radiation were also found to be associated with more admissions. Conclusions The present study provides quantitative evidence that short-term meteorological variations could be used as early indicators for potential HFMD outbreaks. Climate change is likely to lead to a substantial increase in severe HFMD cases in this subtropical city in the absence of further interventions.
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Affiliation(s)
- Pin Wang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - William B. Goggins
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
| | - Emily Y. Y. Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Kim BI, Ki H, Park S, Cho E, Chun BC. Effect of Climatic Factors on Hand, Foot, and Mouth Disease in South Korea, 2010-2013. PLoS One 2016; 11:e0157500. [PMID: 27285850 PMCID: PMC4902224 DOI: 10.1371/journal.pone.0157500] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/31/2016] [Indexed: 11/23/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) causes characteristic blisters and sores mainly in infants and children, and has been monitored in South Korea through sentinel surveillance since 2009. We described the patterns of HFMD occurrence and analyzed the effect of climatic factors on national HFMD incidence. Weekly clinically diagnosed HFMD case rates (per 1,000 outpatients) in sentinel sites and weekly climatic factors, such as average temperature, relative humidity, duration of sunshine, precipitation, and wind speed from 2010 to 2013, were used in this study. A generalized additive model with smoothing splines and climatic variables with time lags of up to 2 weeks were considered in the modeling process. To account for long-term trends and seasonality, we controlled for each year and their corresponding weeks. The autocorrelation issue was also adjusted by using autocorrelation variables. At an average temperature below 18°C, the HFMD rate increased by 10.3% for every 1°C rise in average temperature (95% confidence interval (CI): 8.4, 12.3%). We also saw a 6.6% increase in HFMD rate (95% CI: 3.6, 9.7%) with every 1% increase in relative humidity under 65%, with a 1.5% decrease in HFMD rate observed (95% CI: 0.4, 2.7%) with each 1% humidity increase above 65%. Modeling results have shown that average temperature and relative humidity are related to HFMD rate. Additional research on the environmental risk factors of HFMD transmission is required to understand the underlying mechanism between climatic factors and HFMD incidence.
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Affiliation(s)
- Bryan Inho Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea
- Department of Epidemiology and Medical Informatics, School of Public Health, Korea University, Seoul, Republic of Korea
| | - Hyunok Ki
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea
| | - Sunhee Park
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea
| | - Eunhi Cho
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea
| | - Byung Chul Chun
- Department of Epidemiology and Medical Informatics, School of Public Health, Korea University, Seoul, Republic of Korea
- * E-mail:
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Yang Y, Geng X, Liu X, Wang W, Zhang J. Association between the incidence of varicella and meteorological conditions in Jinan, Eastern China, 2012-2014. BMC Infect Dis 2016; 16:179. [PMID: 27102884 PMCID: PMC4840874 DOI: 10.1186/s12879-016-1507-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Varicella remains an important public health issue in China. In this study we explored the effect of weather conditions on the incidence of varicella in the temperate city of Jinan, Eastern China during 2012-2014 to inform public health prevention and control measures. METHODS Data on reported cases of varicella were obtained from National Notifiable Disease Report System. Meteorological data for the same time period were obtained from the Jinan Meteorological Bureau. A negative binomial regression model was used to assess the relationships between meteorological variables and the incidence of varicella. Given collinearity between average temperature and atmospheric pressure, separate models were constructed: one including average temperature without atmospheric pressure, the other including atmospheric pressure but without average temperature. Both models included relative humidity, wind velocity, rainfall, sunshine, and year as independent variables. RESULTS Annual incidence rates of varicella were 44.47, 53.69, and 46.81 per 100,000 for 2012, 2013, and 2014, respectively. Each increase of 100 Pa (hPa) in atmospheric pressure was estimated to be associated with an increase in weekly incidence of 3.35 % (95 % CI = 2.94-3.67 %), while a 1 °C rise in temperature was associated with a decrease of 3.44 % (95 % CI = -3.73-3.15 %) in the weekly incidence of varicella. Similarly, a 1 % rise in relative humidity corresponded to a decrease of 0.50 % or 1.00 %, a 1 h rise in sunshine corresponded to an increase of 1.10 % or 0.50 %, and a 1 mm rise in rainfall corresponded to an increase of 0.20 % or 0.30 %, in the weekly incidence of varicella cases, depending on the variable considered in the model. CONCLUSION Our findings show that weather factors have a significant influence on the incidence of varicella. Meteorological conditions should be considered as important predictors of varicella incidence in Jinan, Eastern China.
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Affiliation(s)
- Yunqing Yang
- />Faculty of Public Health, Shandong University, Shandong Province, 250100 P. R. China
| | - Xingyi Geng
- />Jinan Center for Disease Control and Prevention, Shandong Province, 250021 P. R. China
| | - Xiaoxue Liu
- />Jinan Center for Disease Control and Prevention, Shandong Province, 250021 P. R. China
| | - Weiru Wang
- />Jinan Center for Disease Control and Prevention, Shandong Province, 250021 P. R. China
| | - Ji Zhang
- />Jinan Center for Disease Control and Prevention, Shandong Province, 250021 P. R. China
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Meteorological factors affect the hand, foot, and mouth disease epidemic in Qingdao, China, 2007-2014. Epidemiol Infect 2016; 144:2354-62. [PMID: 27018924 DOI: 10.1017/s0950268816000601] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) has caused public health concerns worldwide. We aimed to investigate the effect of meteorological factors on the HFMD epidemic in Qingdao, a port city in China. A total of 78641 cases were reported in Qingdao between January 2007 and December 2014. Of those, 71084 (90·39%) occurred in children aged 0-5 years, with an incidence of 1691·2/100000. The incidence increased from early spring, peaked between spring and summer, and decreased in late summer. Aetiological agents in all severe cases and selected mild cases were characterized by examining throat swabs. Except for enterovirus 71 (EV71) and coxsackievirus A16 (CA16), other EVs caused >50% of the HFMD cases between 2011 and 2014. EV71 was more frequent in the off-peak months than in the peak months and prone to causing more severe cases compared to CA16 (χ 2 = 46·3, P < 0·001). CA10 caused more severe HFMD than did CA6 (χ 2 = 20·49, P < 0·001) and all non-CA10 EVs (χ 2 = 41·01, P < 0·001). Community-derived HFMD cases accounted for 65·11%. Spearman rank correlation analysis showed that HFMD incidence in children aged 0-5 years was positively correlated with atmospheric temperature (r s = 0·77, P < 0·001), relative humidity (r s = 0·507, P < 0·001), and precipitation (r s = 0·328, P < 0·001). Climate changes and CA10 surveillance in communities should be integrated into the current prophylactic programme.
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Assessing the impact of humidex on HFMD in Guangdong Province and its variability across social-economic status and age groups. Sci Rep 2016; 6:18965. [PMID: 26743684 PMCID: PMC4705518 DOI: 10.1038/srep18965] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022] Open
Abstract
Humidex is a meteorological index that combines the impacts of temperature and humidity, and is directly comparable with dry temperature in degrees Celsius. However, to date, no research has focused on the effect of humidex on hand, foot and mouth disease (HFMD). The current study was designed to address this research need. Case-based HFMD surveillance data and daily meteorological data collected between 2010 and 2012 was obtained from the China CDC and the National Meteorological Information Center, respectively. Distributed lag nonlinear models were applied to assess the impact of humidex on HFMD among children under 15 years oldin Guangdong, and its variability across social-economic status and age groups. We found that relative risk (RR) largely increased with humidex. Lag-specific and cumulative humidex-RR curves for children from the Pearl-River Delta Region as well as older children were more likely to show two-peak distribution patterns. One RR peak occurred at a humidex of between 15 and 20, and the other occurred between 30 and 35. This study provides a comprehensive picture of the impact of humidex on HFMD incidence in Guangdong Province. Results from the present study should be important in the development of area-and-age-targeted control programs.
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Xu J, Zhao D, Su H, Xie M, Cheng J, Wang X, Li K, Yang H, Wen L, Wang B. Impact of temperature variability on childhood hand, foot and mouth disease in Huainan, China. Public Health 2015; 134:86-94. [PMID: 26708474 DOI: 10.1016/j.puhe.2015.10.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 09/29/2015] [Accepted: 10/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The short-term temperature variation has been shown to be significantly associated with human health. However, little is known about whether temperature change between neighbouring days (TCN) and diurnal temperature range (DTR) have any effect on childhood hand, foot and mouth disease (HFMD). This study aims to explore whether temperature variability has any effect on childhood HFMD. STUDY DESIGN Ecological study. METHODS The association between meteorological variables and HFMD cases in Huainan, China, from January 1st 2012 to December 31st 2014 was analysed using Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) after controlling for long-term trend and seasonality, mean temperature and relative humidity. RESULTS An adverse effect of TCN on childhood HFMD was observed, and the impact of TCN was the greatest at five days lag, with a 10% (95% CI: 4%-15%) increase of daily number of HFMD cases per 3 °C (10th percentile) decrease of TCN. Male children, children aged 0-5 years, scattered children and children in high-risk areas appeared to be more vulnerable to the TCN effect than others. However, there was no significant association between DTR and childhood HFMD. CONCLUSIONS Our findings indicate that TCN drops may increase the incidence of childhood HFMD in Huainan, highlighting the importance of protecting children from forthcoming TCN drops, particularly for those who are male, young, scattered and from high-risk areas.
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Affiliation(s)
- J Xu
- Department of Clinical Laboratory, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - D Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - H Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - M Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - J Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - X Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - K Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - H Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - L Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - B Wang
- Department of Clinical Laboratory, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, 230032, China.
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Zhuang ZC, Kou ZQ, Bai YJ, Cong X, Wang LH, Li C, Zhao L, Yu XJ, Wang ZY, Wen HL. Epidemiological Research on Hand, Foot, and Mouth Disease in Mainland China. Viruses 2015; 7:6400-11. [PMID: 26690202 PMCID: PMC4690870 DOI: 10.3390/v7122947] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 01/23/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD), which has led to millions of attacks and several outbreaks across the world and become more predominant in Asia-Pacific Region, especially in Mainland China, is caused by several Human Enteroviruses including new enterovirus, coxsakievirus and echovirus. In recent years, much research has focused on the epidemiological characteristics of HFMD. In this article, multiple characteristics of HFMD such as basic epidemiology, etiology and molecular epidemiology; influencing factors; detection; and surveillance are reviewed, as these can be help protect high risks groups, prevalence prediction and policy making for disease prevention.
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Affiliation(s)
- Zhi-Chao Zhuang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Zeng-Qiang Kou
- Shandong Center for Disease Control and Prevention, Jinan 250014, China.
| | - Yong-Juan Bai
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xiang Cong
- Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Li-Hong Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Chun Li
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Li Zhao
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xue-Jie Yu
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
- Center for Biodefense and Emerging Infectious Diseases, Departments of Pathology and Microbiology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555-0609, USA.
| | - Zhi-Yu Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Hong-Ling Wen
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
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Xu M, Yu W, Tong S, Jia L, Liang F, Pan X. Non-Linear Association between Exposure to Ambient Temperature and Children's Hand-Foot-and-Mouth Disease in Beijing, China. PLoS One 2015; 10:e0126171. [PMID: 26010147 PMCID: PMC4444089 DOI: 10.1371/journal.pone.0126171] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) was listed as a notifiable communicable disease in 2008 and is an emerging public health problem in China, especially for children. However, few data are available on the risk assessment of the potential reasons for HFMD in Beijing. This study examined the association of temperature with the incidence of children's HFMD in Beijing at the daily scale for the first time. METHODS A newly developed case-crossover design with a distributed lag nonlinear model (DLNM) was used to assess the delayed and cumulative associations of daily temperature with gender- and age-specific HFMD in Beijing, China, during 2010-2012. Relative humidity, day of the week, public holiday, season and long-term trends were controlled in the model. RESULTS Among the total of 113,475 cases, the ratio between males and females was 1.52:1. HFMD was more prevalent in May-July. The temperature-HFMD relationships were non-linear in most age groups except for children aged 6-15 years, with a peak at 25.0~27.5°C. The high-temperature risks were greater, appeared earlier and lasted longer than the low-temperature risks. The relative risks for female children and those aged 6-15 years were higher than those among other groups. CONCLUSION Rising temperatures increased the incidence of children's HFMD, with the largest association at 25.0~27.5°C. Females and children aged 6-15 years were more vulnerable to changes in temperature with regard to the transmission of HFMD than males and other age groups, respectively. Further studies are warranted to confirm these findings in other populations.
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Affiliation(s)
- Meimei Xu
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China
| | - Weiwei Yu
- Epidemiology and Biostatistics Discipline, School of Population Health, University of Queensland, Brisbane, QLD 4006, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059, Australia
| | - Lei Jia
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Fengchao Liang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China
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Yang H, Wu J, Cheng J, Wang X, Wen L, Li K, Su H. Is high relative humidity associated with childhood hand, foot, and mouth disease in rural and urban areas? Public Health 2015; 142:201-207. [PMID: 25936976 DOI: 10.1016/j.puhe.2015.03.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/12/2015] [Accepted: 03/14/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the relationship between relative humidity and childhood hand, foot and mouth disease (HFMD) in Hefei, China, and to explore whether the effect is different between urban and rural areas. STUDY DESIGN Retrospective ecological study. METHODS A Poisson generalized linear model combined with a distributed lag non-linear model was used to examine the relationship between relative humidity and childhood HFMD in a temperate Chinese city during 2010-2012. RESULTS The effect of relative humidity on childhood HFMD increased above a humidity of 84%, with a 0.34% (95% CI: 0.23%-0.45%) increase of childhood HFMD per 1% increment of relative humidity. Notably, urban children, male children, and children aged 0-4 years appeared to be more vulnerable to the effect of relative humidity on HFMD. CONCLUSIONS This article study indicates that high relative humidity may trigger childhood HFMD in a temperate area, Hefei, particularly for those who are young and from urban areas.
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Affiliation(s)
- H Yang
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China
| | - J Wu
- Hefei Center for Disease Control and Prevention, Hefei, China
| | - J Cheng
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China
| | - X Wang
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China
| | - L Wen
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China
| | - K Li
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China
| | - H Su
- Department of Epidemiology and Health Statistic, School of Public Health, Anhui Medical University, Hefei, China.
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Song Y, Wang F, Wang B, Tao S, Zhang H, Liu S, Ramirez O, Zeng Q. Time series analyses of hand, foot and mouth disease integrating weather variables. PLoS One 2015; 10:e0117296. [PMID: 25729897 PMCID: PMC4346267 DOI: 10.1371/journal.pone.0117296] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/20/2014] [Indexed: 01/08/2023] Open
Abstract
Background The past decade witnessed an increment in the incidence of hand foot mouth disease (HFMD) in the Pacific Asian region; specifically, in Guangzhou China. This emphasized the requirement of an early warning system designed to allow the medical community to better prepare for outbreaks and thus minimize the number of fatalities. Methods Samples from 1,556 inpatients (hospitalized) and 11,004 outpatients (non-admitted) diagnosed with HFMD were collected in this study from January 2009 to October 2013. Seasonal Autoregressive Integrated Moving Average (SARIMA) model was applied to establish high predictive model for inpatients and outpatient as well as three viral serotypes (EV71, Pan-EV and CA16). To integrate climate variables in the data analyses, data from eight climate variables were simultaneously obtained during this period. Significant climate variable identified by correlation analyses was executed to improve time series modeling as external repressors. Results Among inpatients with HFMD, 248 (15.9%) were affected by EV71, 137 (8.8%) were affected by Pan-EV+, and 436 (28.0%) were affected by CA16. Optimal Univariate SARIMA model was identified: (2,0,3)(1,0,0)52 for inpatients, (0,1,0)(0,0,2)52 for outpatients as well as three serotypes (EV71, (1,0,1)(0,0,1)52; CA16, (1,0,1)(0,0,0)52; Pan-EV, (1,0,1)(0,0,0)52). Using climate as our independent variable, precipitation (PP) was first identified to be associated with inpatients (r = 0.211, P = 0.001), CA16-serotype (r = 0.171, P = 0.007) and outpatients (r = 0.214, P = 0.01) in partial correlation analyses, and was then shown a significant lag in cross-autocorrelation analyses. However, inclusion of PP [lag -3 week] as external repressor showed a moderate impact on the predictive performance of the SARIMA model described here-in. Conclusion Climate patterns and HFMD incidences have been shown to be strongly correlated. The SARIMA model developed here can be a helpful tool in developing an early warning system for HFMD.
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Affiliation(s)
- Yuanbin Song
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Wang
- Dept. of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Bin Wang
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shaohua Tao
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huiping Zhang
- Dept. of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Sai Liu
- Dept. of Psychology, Yale University, New Haven, CT, United States of America
| | - Oscar Ramirez
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America
- * E-mail: (OR); (QZ)
| | - Qiyi Zeng
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
- * E-mail: (OR); (QZ)
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Phylogenetic analysis of the VP1 gene of Enterovirus 71 in Guangzhou during the high occurrence period of 2008. Virus Genes 2014; 48:538-42. [DOI: 10.1007/s11262-014-1046-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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