Academic journal article Environmental Health Perspectives

Modeling the Present and Future Incidence of Pediatric Hand, Foot, and Mouth Disease Associated with Ambient Temperature in Mainland China

Academic journal article Environmental Health Perspectives

Modeling the Present and Future Incidence of Pediatric Hand, Foot, and Mouth Disease Associated with Ambient Temperature in Mainland China

Article excerpt

Introduction

Hand, foot, and mouth disease (HFMD) is a common illness that predominantly affects young children. It is caused by a group of enteroviruses and is readily transmitted through coughs or sneezes or through contact with infected feces or contaminated surfaces (WHO 2012). HFMD is the primary childhood infectious disease in China: In 2016, >2.4 million HFMD infections (including 195 deaths) were reported nationwide, accounting for 35.2% of all 39 categories of notifiable diseases (Class A, 2; Class B, 26; Class C, 11) (National Health and Family Planning Commission of the People's Republic of China 2017a). The majority of HFMD cases are characterized by mild and self-limiting symptoms lasting between seven and ten days, whereas others may develop severe complications affecting the central nervous and cardiopulmonary systems (WHO 2011).

Currently, there are no specific antiviral drugs or specific treatments for the disease. A vaccine against enterovirus type 71 (EV71), one of >20 viruses causing HFMD, was approved in 2016 in China (China CDC 2016). However, the protective efficacy, safety, and affordability of this vaccine at the population level remain unknown (China CDC 2016; Chang 2016). Moreover, the vaccine may be ineffective at preventing infections from other HFMD viruses. Hence, combined with its high prevalence and morbidity, HFMD constitutes a substantial component of the burden of disease among children in China and consequently has generated widespread public health concerns in recent years (WHO 2011,2012).

Epidemics of HFMD occur every year in China but exhibit spatiotemporal variation: The epidemic peaks in June in northern areas of the country but in May and October in some southern cities (China CDC 2015). This seasonality suggests a potential association between ambient temperature and HFMD incidence, with recent evidence indicating that it is nonlinear and lagged (Xu et al. 2015; Yin et al. 2016; Zhang et al. 2016). The use of different statistical models and exposure parameters makes it difficult to compare findings from previous studies of temperature and HFMD incidence in individual provinces or cities (Xu et al. 2015; Yin et al. 2016; Zhu et al. 2015), but these findings suggest that the association between temperature and HFMD may vary according to geographical location (Guo et al. 2016; Xiao et al. 2017). Thus, a national study using a unified statistical approach is needed to examine associations between temperature and HFMD throughout China.

Climate change has been regarded as the single largest global health issue of the 21st century (IPCC 2014). Compared with 1986-2005, the average temperature in China is projected to increase by 1.3[degrees]C to 5.2[degrees]C between 2081 and 2100 under a series of climate change scenarios, with the warming rate exhibiting spatial and seasonal differences (Tian et al. 2015). Given the association between temperature and the incidence of HFMD, we hypothesize that changes in temperature due to climate change will influence future trends in HFMD incidence. Information on possible changes in the incidence of HFMD as a consequence of climate change is needed to inform effective public health strategies to reduce the future impact of HFMD. Therefore, we conducted a study with the following aims: a) to quantify the association between temperature and HFMD across mainland China using nationally representative historical data covering the years 2009-2014; and b) to estimate the change in the incidence of HFMD associated with temperature change under different climate change scenarios by the 2090s.

Methods

Study Area

Located in East Asia along the coastline of the Pacific Ocean, China covers an area of approximately 9.6 million square kilometers, with a north-south width of 5,500 kilometers and a west-east width of 5,200 kilometers (National Bureau of statistics of the People's Republic of China 2000). …

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