Hand, Foot and Mouth Disease in Hong Kong: A Time-Series Analysis on Its Relationship with Weather

Abstract

BackgroundHand, 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.MethodsA 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.ResultsThere 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.ConclusionsThe 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.

Associations between Meteorological Factors and Aseptic Meningitis in Six Metropolitan Provinces of the Republic of Korea

“…Solar radiation had a positive relationship with AM cases from lags 4 to 12. A recent study in Hong Kong also reported a positive effect of solar radiation on HFMD [39], which could be related to virus survival in the external environment that is influenced by variation in ultraviolet radiation, though the inactivation dose requirements vary by EV strains [11]. We found that IOD and ENSO had opposite effects on AM.…”

Spatiotemporal risk mapping of hand, foot and mouth disease and its association with meteorological variables in children under 5 years

“…Worldwide, HFMD epidemics have been reported in many counties and regions, including Singapore, Malaysia, Hong Kong and Japan [4][5][6][7]. The majority of new cases have been reported in mainland China, with at least 6·5 million paediatric cases of HFMD recorded in 2008-2012, of which more than 2000 died [8].…”

The utility of LASSO-based models for real time forecasts of endemic infectious diseases: A cross country comparison

“…Long term predictions were not accurate, even when we include multiple climatic variables as candidate features. We believe this reflects the difficulty in using weather data relating to current conditions to predict disease levels in several months-in contrast, most other analyses use climate data from near the time point being forecast [28,57], which is typically not available in real time. Hence the utility of predictive analytics for infectious disease policy making is mostly for immediate response over the next few weeks rather than months.…”

“…A further limitation is that, for simplicity, only weather information from the capitals were used in the study, but for countries like Japan, Thailand and Taiwan, there are great variation between climatic conditions in the North and the South. Prediction accuracy might improve if [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] incidence and weather information can be collected at a finer resolution. We suspect that even the accuracy of short term forecasts may be reduced should new epidemiological conditions replace those that the model was trained on.…”

“…Existing approaches to real-time forecasting include generalized linear regression, seasonal autoregressive integrated moving average (SARIMA) model or a simpler ARIMA form of it, phenomenological models like the logistic growth model and Richards model, and mechanistic models like the SIR models [19][20][21][22][23][24]. Often such approaches involve the challenge of integrating environmental factors including temperature, humidity and rainfall, which may influence pathogen transmission directly or affect the vector activities (for vector borne diseases), especially in temperate regions [25][26][27][28][29]. For instance, influenza virus is more transmissible in low temperature and low humidity conditions [30,31], while the primary vector of dengue, the yellow fever mosquito Aedes aegypti, favors higher temperature [32,33].…”