Key result
Depletion of susceptibles was the most important driving factor for hand, foot and mouth disease transmission, explaining 19% of the variance in the effective reproduction number, whereas meteorological factors and school holidays had limited impact.
Observational
HFMD transmission in Hong Kong is moderate and primarily associated with the depletion of susceptible individuals rather than meteorological factors or school holidays.
Depletion of susceptibles primarily drives HFMD transmissibility; leaves open the role of weather or holidays for targeted control strategies.
Hand-foot-and-mouth disease (HFMD) is a common childhood disease with substantial disease burden in Asia. Mixed results were reported on the associations between HFMD incidence and meteorological factors or school holidays, while limited studies focused on their association on transmissibility. We aimed to measure the transmissibility of HFMD and to examine its potential driving factors in Hong Kong. A likelihood-based procedure was used to estimate time-dependent effective reproduction number (Rt) based on weekly number of HFMD-associated hospitalizations from 2010 to 2014. The associations of between-year effects, depletion of susceptibles, absolute humidity and school holidays with Rt were examined using linear regression. Rt usually started increasing between early spring and summer and peaked in April to May at around 1.1-1.2, followed by a slight rebound in autumn. Depletion of susceptibles and between-years effects explained most of the variances (19 and 13% respectively) in Rt. We found a negative association between depletion of susceptibles and Rt (coefficients ranged from -0.14 to -0.03 for different years), but the estimated effects of absolute humidity and school holidays were insignificant. Overall, HFMD transmission was moderate in Hong Kong and was mainly associated with depletion of susceptibles. Limited impact was suggested from meteorological factors and school holidays.
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Yang et al. (2016) conducted an observational in Hand, foot and mouth disease (HFMD). Depletion of susceptibles, absolute humidity, and school holidays was evaluated on Variance in the effective reproduction number (Rt) explained by potential driving factors. Depletion of susceptibles was the most important driving factor for hand, foot and mouth disease transmission, explaining 19% of the variance in the effective reproduction number, whereas meteorological factors and school holidays had limited impact.
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