Transmission center and driving factors of hand, foot, and mouth disease in China: A combined analysis

Figures

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  Fig 1. a. Classification of HFMD based on treatment history and laboratory analysis. b, Location of Qinghai Province and Shanghai Municipality, China. c/d, Annual average incidence of HFMD in Qinghai/Shanghai. SH = Shanghai; QH = Qinghai. The map a, c, and d were created using ArcGIS software (version 10.4.1, ESRI Inc. Redlands, CA).

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  Fig 2. Temporal pattern and periodicity of HFMD. a/e. Weekly pattern of HFMD in Huangzhong (Qinghai) and Fengxian (Shanghai). b/f, Local wavelet power spectrum in Huangzhong and Fengxian. c/g, Global wavelet spectrum (red points represent periods with 95% statistical significance) in Huangzhong and Fengxian. d/h, Major epidemic component of the incidence series in Huangzhong (mainly annual) and Fengxian (mainly annual and semi-annual), reconstructed with wavelet spectral analysis from the components in their respective period. All the plots were created using R software (R Development Core Team 2013).

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  Fig 3. Phase difference, spatial synchrony, and phase coherence plots. a/e. Mean phase difference from Huangzhong and Fengxian (as a function of distance from the county). Within 70km of Huangzhong and 50 km of Fengxian, there is an increasing trend in the phase difference with increasing distance (rHZ = 0.456, rFX = 0.760). The error bars are standard deviation from mean phase difference. b/f, Phase difference from Huangzhong and Fengxian (as a function of population size for neighboring counties, within 70 km of Huangzhong and 50 km of Fengxian). There is a decreasing trend of phase difference with increasing population size (rHZ = -0.350, rFX = -0.611). The error bars are standard deviation from mean phase difference. c/g, Phase coherency curve (as a function of distance) of HFMD in Qinghai and Shanghai with 95% confidence limits. d/h, Spatial synchrony curve (as a function of distance) of HFMD with 95% confidence limits in Qinghai and Shanghai. All the plots were created using R software (R Development Core Team 2013).

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  Fig 4. Spatial SEIR fitting results of HFMD transmission. a/c. Posterior predictive distribution for HFMD in Huangzhong and Fengxian. b/d, Empirical adjusted reproductive number of HFMD for Huangzhang and Fengxian. e/f, network of outgoing/incoming infected individuals in Qinghai. HZ = Huangzhong; FX = Fengxian. The map e and f were created using R software (R Development Core Team 2013).