School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Chongqing Center for Disease Control and Prevention, Chongqing, China.
Int J Biometeorol. 2017 Aug;61(8):1411-1419. doi: 10.1007/s00484-017-1318-0. Epub 2017 Feb 10.
Hand, foot, and mouth disease (HFMD) is an enterovirus-induced infectious disease, mainly affecting children under 5 years old. Outbreaks of HFMD in recent years indicate the disease interacts with both the weather and season. This study aimed to investigate the seasonal association between HFMD and weather variation in Chongqing, China. Generalized additive models and distributed lag non-linear models based on a maximum lag of 14 days, with negative binomial distribution assumed to account for overdispersion, were constructed to model the association between reporting HFMD cases from 2009 to 2014 and daily mean temperature, relative humidity, total rainfall and sun duration, adjusting for trend, season, and day of the week. The year-round temperature and relative humidity, rainfall in summer, and sun duration in winter were all significantly associated with HFMD. An inverted-U relationship was found between mean temperature and HFMD above 19 °C in summer, with a maximum morbidity at 27 °C, while the risk increased linearly with the temperature in winter. A hockey-stick association was found for relative humidity in summer with increasing risks over 60%. Heavy rainfall, relative to no rain, was found to be associated with reduced HFMD risk in summer and 2 h of sunshine could decrease the risk by 21% in winter. The present study showed meteorological variables were differentially associated with HFMD incidence in two seasons. Short-term weather variation surveillance and forecasting could be employed as an early indicator for potential HFMD outbreaks.
手足口病（HFMD）是一种由肠道病毒引起的传染病，主要影响 5 岁以下儿童。近年来手足口病的爆发表明，该疾病与天气和季节都有相互作用。本研究旨在探讨中国重庆手足口病与天气变化之间的季节性关联。采用广义加性模型和基于最大滞后 14 天的分布式滞后非线性模型，假设负二项分布以考虑过离散，建立模型以评估 2009 年至 2014 年报告的手足口病病例与每日平均气温、相对湿度、总降雨量和日照时间之间的关联，同时调整趋势、季节和星期几的影响。全年温度和相对湿度、夏季降雨量和冬季日照时间均与手足口病显著相关。夏季平均温度与手足口病之间存在倒 U 型关系，在 19°C 以上时发病率最高，达到 27°C，而冬季温度线性增加与发病率呈正相关。夏季相对湿度呈冰球棒型关联，超过 60%时风险增加。与无雨相比，夏季强降雨与手足口病风险降低有关，冬季 2 小时的日照可使风险降低 21%。本研究表明，气象变量在两个季节与手足口病发病率存在差异关联。短期天气变化监测和预测可作为潜在手足口病爆发的早期指标。
