What does this research mean for the field?

Severe hand foot and mouth disease incidence in Shandong Province declined from 121.70 to 15.81 cases per 100,000 during the COVID-19 pandemic, with significant associations found with temperature and humidity. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to analyze the clustering patterns of severe hand foot and mouth disease (HFMD) in children and assess the influence of meteorological factors and COVID-19 on incidence.

January 10, 2026BMC Public Health0 citationsOpen Access

West-to-East transmission clusters and meteorological associations for severe hand foot and mouth disease in Shandong Province: a geospatial and GAM analysis

XXXiaoying XuShandong University JWJianxing WangShandong Center for Disease Control and Prevention HSHuifeng SunShandong Center for Disease Control and Prevention

Key Result

Severe hand foot and mouth disease incidence declined from 121.70 to 15.81/100,000 during COVID-19, with significant associations found with temperature and humidity.

Key Points

This research aims to analyze the clustering patterns of severe hand foot and mouth disease (HFMD) in children and assess the influence of meteorological factors and COVID-19 on incidence.
Conducted spatial autocorrelation analysis using Moran’s I to identify high-risk zones.
Utilized SaTScan for spatiotemporal cluster detection in HFMD cases.
Applied generalized additive models (GAM) to evaluate associations between meteorological factors and HFMD incidence.
Visualized geographic patterns using QGIS.
Identified significant spatial clustering of severe HFMD (Moran’s I = 0.219–0.415; p ≤ 0.05).
Annual incidence of severe HFMD declined from 121.70 to 15.81 cases per 100,000 during COVID-19, with a resurgence to 46.63 in 2023.
Temperature and humidity showed strong associations with HFMD incidence, with near-linear effects noted through GAM.

Structured PICO

Population

763,191 children aged ≤ 5 years with hand foot and mouth disease (HFMD) (17,212 severe cases, 2.32%) in Shandong Province, China, during 2013–2023.

Outcome

Spatiotemporal clustering patterns of severe HFMD and associations between meteorological factors (temperature, humidity, precipitation) and severe HFMD incidence

Severe HFMD epidemiology in Shandong is jointly influenced by meteorological factors and spatiotemporal dynamics, with west-to-east transmission patterns.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

To analyze spatiotemporal clustering patterns of severe hand foot and mouth disease (HFMD) in children aged ≤ 5 years, quantify the associations between meteorological factors and severe HFMD incidence, and evaluate incidence shifts associated with the COVID-19 pandemic in Shandong Province, China, during 2013–2023. Spatial autocorrelation analysis (Moran’s I) and spatiotemporal cluster detection (SaTScan) identified high-risk zones. Generalized additive models (GAM) assessed nonlinear associations between meteorological factors (temperature, humidity, precipitation) and severe HFMD incidence. QGIS visualized geographic patterns. Among 763,191 HFMD cases (17,212 severe, 2.32%), annual incidence declined from 121.70/100,000 (2014) to 15.81/100,000 (2022) during COVID-19, with partial resurgence in 2023 (46.63/100,000). Severe cases exhibited significant spatial clustering (Moran’s I = 0.219–0.415; p ≤ 0.05) with westward-to-eastward high-risk cluster migration. Seasonal peaks (April–September) showed 62%–79% reductions post-2021 ( p 20 mm/week, EDF = 1.24, p = 0.045), and persistent seasonality (EDF = 4.02, p < 0.001). Severe HFMD epidemiology in Shandong is jointly influenced by meteorological factors (nonlinear humidity effects) and spatiotemporal dynamics, with west-to-east transmission patterns and post-pandemic behavioral-environmental interactions. Targeted vaccination and climate-adaptive surveillance during April–September peaks in identified clusters are critical for mitigation.

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