Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019

Wuwei Wang; Mark W Rosenberg; Hongying Chen; Shengsheng Gong; Mengmeng Yang; Dacai Deng

doi:10.1371/journal.pone.0287539

Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019

PLoS One. 2023 Jun 23;18(6):e0287539. doi: 10.1371/journal.pone.0287539. eCollection 2023.

Authors

Wuwei Wang^{1

2

3}, Mark W Rosenberg³, Hongying Chen⁴, Shengsheng Gong², Mengmeng Yang², Dacai Deng¹

Affiliations

¹ Institute of China Rural Studies, Central China Normal University, Wuhan, Hubei, China.
² Institute of Sustainable Development & Department of Geography, Central China Normal University, Wuhan, Hubei, China.
³ Department of Geography and Planning, Queen's University, Kingston, Ontario, Canada.
⁴ Center for Disease Control and Prevention of Hubei Province, Wuhan, Hubei, China.

Abstract

Background: Hand, foot, and mouth disease (HFMD) is a public health issue in Hubei and studies of- spatiotemporal clustering at a fine scale are limited. The purpose of this research was to analyze the epidemiological characteristics, temporal variation characteristics, and spatiotemporal clustering of HFMD cases at the town level from 2009 to 2019 to improve public health outcomes.

Methods: Mathematical statistics, a seasonal index, wavelet analysis, and spatiotemporal scans were used to analyze epidemiological characteristics, time series trends, and spatiotemporal clusters of HFMD in Hubei.

Results: EV-A71 (Enterovirus A71) and CVA16 (Coxsackievirus A16) constitute the two primary pathogens of the HFMD epidemic in Hubei, among which EV-A71 is the dominant pathogen, especially in 2016. In terms of age distribution, a major peak occurred at 0-5 years and a very small increase appeared at 25-35 years, with the former having a higher incidence among males than females and the latter having the opposite difference between males and females. The number/rate of HFMD cases exhibited a considerable increase followed by a moderate decline from 2009 to 2019, with the first large peak in April-July and a smaller peak in November-December. HFMD in Hubei exhibited the characteristics of a 270-day cycle with multiscale nesting, which was similar to the periodicity of HFMD cases caused by EV-A71 (9 months). Cities with a higher incidence of HFMD formed a part of an "A-shaped urban skeleton". Subdistricts had the highest incidence of HFMD, followed by towns and villages. The spatiotemporal scan results showed one most likely cluster and 22 secondary clusters, which was consistent with the geographic location of railways and rivers in Hubei.

Conclusions: These findings may be helpful in the prevention and control of HFMD transmission and in implementing effective measures in Hubei Province.

Copyright: © 2023 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child, Preschool
China / epidemiology
Enterovirus A, Human*
Enterovirus Infections* / epidemiology
Enterovirus*
Female
Hand, Foot and Mouth Disease* / epidemiology
Humans
Infant
Infant, Newborn
Male

Grants and funding

This research was supported by National Natural Science Foundation of China (41171408) and Fundamental Research Funds for the Central Universities (Excellent Doctoral Dissertation Cultivation Program) (2020YBZZ003). The list of funded personnel can be found at http://gs.ccnu.edu.cn/info/1087/6546.htm. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.