Jia Rui1, Kaiwei Luo2, Qiuping Chen3,4, Dexing Zhang5, Qinglong Zhao6, Yanhong Zhang7, Xiongjie Zhai8, Zeyu Zhao1, Siyu Zhang2, Yuxue Liao9, Shixiong Hu2, Lidong Gao2, Zhao Lei1, Mingzhai Wang10, Yao Wang1, Xingchun Liu1, Shanshan Yu1, Fang Xie1, Jia Li1, Ruoyun Liu1, Yi-Chen Chiang1, Benhua Zhao1, Yanhua Su1, Xu-Sheng Zhang11, Tianmu Chen1. 1. State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People's Republic of China. 2. Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, People's Republic of China. 3. Université de Montpellier, Montpellier, France; CIRAD, Intertryp, Montpellier, France; IES, Université de Montpellier-CNRS, Montpellier, France. 4. Medical Insurance Office, Xiang'an Hospital of Xiamen University, Xiamen City, Fujian Province, People's Republic of China. 5. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China. 6. Jilin Provincial Center for Disease Control and Prevention, Changchun City, Jilin Province, People's Republic of China. 7. Yunxiao County Center for Disease Control, Zhangzhou City, Fujian Province, People's Republic of China. 8. Longde County Center for Disease Control, Guyuan City, the Ningxia Hui Autonomous Region, People's Republic of China. 9. Shenzhen Centers for Disease Control and Prevention, Shenzhen City, Guangdong Province, People's Republic of China. 10. Xiamen City Center for Disease Control and Prevention, Shenzhen City, Fujian Province, People's Republic of China. 11. Public Health England, London, United Kingdom.
Abstract
BACKGROUND: Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model. METHODS: This study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, "epidemic acceleration week (EAW)" and "recommended warning week (RWW)", were calculated to show the early warning time. RESULTS: The mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R2 > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions. CONCLUSIONS: The disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.
BACKGROUND: Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model. METHODS: This study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, "epidemic acceleration week (EAW)" and "recommended warning week (RWW)", were calculated to show the early warning time. RESULTS: The mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R2 > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions. CONCLUSIONS: The disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.