Key result
HFMD in Qingdao City exhibited significant spatial-temporal clustering primarily in urban and urban-rural fringe areas between May and October, with an average annual incidence of 123.16 per 100,000.
Why the study?
Qingdao City has suffered from a serious hand, foot, and mouth disease epidemic, creating a need to describe its epidemiological characteristics and investigate spatial-temporal distribution at the town level.
Observational (n=69,646)
Effect estimate: Moran's I 0.19 to 0.31
p-value: p=<0.001
HFMD in Qingdao City from 2013-2018 showed significant spatial-temporal clustering in urban and urban-rural fringe areas between May and October, driven primarily by non-EV71/non-CA16 enteroviruses.
Urban HFMD clusters warrant targeted local surveillance; leaves open causal drivers for prospective studies.
BACKGROUND: Hand, foot, and mouth disease (HFMD) has become one of the most important infectious diseases recent years. Qingdao City has suffered from serious HFMD epidemic. This study aimed to describe epidemiological characteristics and investigate spatial-temporal distribution at town level in Qingdao City. METHOD: The surveillance data of HFMD during 2013-2018 were collected from the National Notifiable Disease Surveillance System. The global Moran's I statistic was used to detect the spatial autocorrelation of HFMD cases by ArcGis 10.0 software. Purely spatial and spatial-temporal analysis was used to detect epidemic clusters by SatScanTM v9.6 software. RESULTS: The annual average incidence of HFMD cases in Qingdao City from 2013 to 2018 was 123.16 per 100000, while the incidence rate of children≤5years old was 2879.80 per 100000. The majority (88.97%) of HFMD cases were aged within 0-5 years old and the males were 60.20%. Other enterovirus (EV), enteriovirus 71(EV71), and Coxsackievirus A16 (CA16) accounted for 48.75%, 30.91% and 20.34%. The seasonal peak was between May and October. HFMD had positive spatial autocorrelation at town level with global Moran's I from 0.19 to 0.31(P<0.001). Spatial-temporal cluster analysis detected six most likely clusters and three secondary clusters from 2013 to 2018. The most likely cluster was located in urban and urban-rural fringe areas. CONCLUSIONS: Urban and urban-rural fringe areas were the major locations of the clusters with other EV as the dominant pathogen between May and October. The findings suggested that the prevention and control of HFMD in Qingdao City should be focus on these high-risk periods and locations which had important public health significance for the allocation of public health resources.
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Kou et al. (2020) conducted an observational in Hand, foot, and mouth disease (HFMD) (n=69,646). Spatial-temporal clustering and epidemiological factors was evaluated on Spatial autocorrelation of HFMD cases at town level (Moran's I 0.19 to 0.31, p=<0.001). HFMD in Qingdao City exhibited significant spatial-temporal clustering primarily in urban and urban-rural fringe areas between May and October, with an average annual incidence of 123.16 per 100,000.
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