Spatial-temporal variation and risk factor analysis of hand, foot, and mouth disease in children under 5 years old in Guangxi, China

Factors related to the mortality risk of severe hand, foot, and mouth diseases (HFMD): a 5-year hospital-based survey in Guangxi, Southern China

BACKGROUND

To understand the factors influencing clinical outcomes of severe hand, foot, and mouth diseases (HFMD), and to provide scientific evidence for reducing the mortality risk of severe HFMD.

METHODS

From 2014 to 2018, children diagnosed with severe HFMD cases in Guangxi, China, were enrolled in this hospital-based study. The epidemiological data obtained through face-to-face interviews with the parents and guardians. Univariate and multivariate logistics regression models were used to analyze the factors influencing the clinical outcomes of severe HFMD. The impact of the EV-A71 vaccination on inpatient mortality was analyzed by a comparison approach.

RESULTS

A total of 1565 severe HFMD cases were enrolled in this survey, including 1474 (94.19%) survival cases and 91 (5.81%) death cases. The multivariate logistic analysis demonstrated that HFMD history of playmates in the last three months, first visit to the village hospital, time from the first visit to admission less than two days, no correct diagnosis for HFMD at the first visit, and having no rash symptoms were the independent risk factors for severe HFMD cases (all p < 0.05). While EV-A71 vaccination was a protective factor (p < 0.05). The EV-A71 vaccination group versus the non-vaccination group showed 2.23% of death in the vaccination group and 7.24% of death in the non-vaccination group. The EV-A71 vaccination protected 70.80% of the death of severe HFMD cases, with an effective index of 4.79.

CONCLUSIONS

The mortality risk of severe HFMD in Guangxi was related to playmates had HFMD history in last 3 months, hospital grade, EV-A71 vaccination, patients visit hospital previously, and rash symptom. EV-A71 vaccination can significantly reduce mortality among severe HFMD. The findings are of great significance for the effective prevention and control of HFMD in Guangxi, southern China.

Short-term effects of indoor and outdoor air pollution on the lung cancer morbidity in Henan Province, Central China

Lung cancer is one of the most common cancer types and a major cause of death. The relationship between lung cancer morbidity and exposure to air pollutants is of particular concern. However, the relationship and difference in lung cancer morbidity between indoor and outdoor air pollution effects remain unclear. In this paper, the aim was to comprehensively investigate the spatial relationships between the lung cancer morbidity and indoor-outdoor air pollution in Henan based on the standard deviation ellipse, spatial autocorrelation analysis and GeoDetector. The results indicated that (1) the spatial distribution of lung cancer morbidity was related to the geomorphology, while high-morbidity areas were concentrated in the plains and basins of Central, Eastern and Southern Henan. (2) Among the selected outdoor air pollutants, PM_2.5, NO₂, SO₂, O₃ and CO were significantly correlated with the lung cancer morbidity. The degree of indoor air pollution was measured by the use of heating energy, and the proportions of coal-heating households, households with coal/biomass stoves and households with heated kangs were highly decisive in regard to the lung cancer morbidity. (3) The interaction between two factors was more notable than a single factor in explaining the lung cancer morbidity. Moreover, the interaction type was mainly nonlinear enhancement, and the proportion of households with coal/biomass stoves imposed the strongest interaction effect on the other factors.

Effects of Meteorological Factors and Atmospheric Pollution on Hand, Foot, and Mouth Disease in Urumqi Region

Background

Hand, foot, and mouth disease (HFMD) is a febrile rash infection caused by enteroviruses, spreading mainly via the respiratory tract and close contact. In the past two decades, HFMD has been prevalent mainly in Asia, including China and South Korea, causing a huge disease burden and putting the lives and health of children at risk. Therefore, a further study of the factors influencing HFMD incidences has far-reaching implications. In existing studies, the environmental factors affecting such incidences are mainly divided into two categories: meteorological and air. Among these studies, the former are the majority of studies on HFMD. Some scholars have studied both factors at the same, but the number is not large and the findings are quite different.

Methods

We collect monthly cases of HFMD in children, meteorological factors and atmospheric pollution in Urumqi from 2014 to 2020. Trend plots are used to understand the approximate trends between meteorological factors, atmospheric pollution and the number of HFMD cases. The association between meteorological factors, atmospheric pollution and the incidence of HFMD in the Urumqi region of northwest China is then investigated using multiple regression models.

Results

A total of 16,168 cases in children are included in this study. According to trend plots, the incidence of HFMD shows a clear seasonal pattern, with O3 (ug/m3) and temperature (°C) showing approximately the same trend as the number of HFMD cases, while AQI, PM2.5 (ug/m3), PM10 (ug/m3) and NO2 (ug/m3) all show approximately opposite trends to the number of HFMD cases. Based on multiple regression results, O3 (P = 0.001) and average station pressure (P = 0.037) are significantly and negatively associated with HFMD incidences, while SO2 (P = 0.102), average dew point temperature (P = 0.072), hail (P = 0.077), and thunder (P = 0.14) have weak significant relationships with them.

Epidemiological characteristics and spatial epidemiology of hand-foot-mouth disease in Hunan Province, China, from 2008 to 2019

OBJECTIVES

To investigate the epidemic situation of hand-foot-mouth disease (HFMD) in Hunan Province, China, from 2008 to 2019, as well as its spatial autocorrelation characteristics and spatial-temporal clustering, and to provide a reference for the prevention and control of HFMD in Hunan Province.

METHODS

Spatial autocorrelation and spatial-temporal clustering analyses were used to analyze the monitoring data of HFMD in Hunan Province from 2008 to 2019.

RESULTS

The epidemic situation of HFMD in Hunan Province from 2008 to 2019 showed obvious seasonal distribution, with a low incidence rate in January to March and a high incidence rate in April to July. As for population distribution, children aged 0-5 years had the highest number of HFMD cases and accounted for 95.89% (1 460 391/1 522 910) of all cases, with a mean annual incidence rate of 2 197.784/100 000, and scattered children had the highest number of cases and accounted for 82.59% (1 257 739/1 522 910) of all cases. The global spatial autocorrelation analysis showed that the onset of HFMD in Hunan Province showed a significant clustering distribution, and the local spatial autocorrelation analysis showed that the high clustering areas of HFMD were mainly the districts and counties of Changsha, Zhuzhou, and Yueyang cities. Time-space scanning showed that clustering time was mainly April to July; the cases were clustered in the northeast of Hunan Province from 2008 to 2010 and in the central part of Hunan Province from 2011 to 2019.

CONCLUSIONS

The high incidence rate of HFMD is observed in April to July in Hunan Province. Children under 5 years of age are at a high risk of this disease. Spatial-temporal clustering is observed for the epidemic of HFMD, mainly clustered in the northeastern and central areas of Hunan Province. It is suggested that the results may be used as guidance to determine the key areas for HFMD prevention and control in Hunan Province and optimize the allocation of health resources.

Spatial-temporal heterogeneity and meteorological factors of hand-foot-and-mouth disease in Xinjiang, China from 2008 to 2016

The study aims to depict the temporal and spatial distributions of hand-foot-and-mouth disease (HFMD) in Xinjiang, China and reveal the relationships between the incidence of HFMD and meteorological factors in Xinjiang. With the national surveillance data of HFMD in Xinjiang and meteorological parameters in the study area from 2008 to 2016, in GeoDetector Model, we examined the effects of meteorological factors on the incidence of HFMD in Xinjiang, China, tested the spatial-temporal heterogeneity of HFMD risk, and explored the temporal-spatial patterns of HFMD through the spatial autocorrelation analysis. From 2008 to 2016, the HFMD distribution showed a distinct seasonal pattern and HFMD cases typically occurred from May to July and peaked in June in Xinjiang. Relative humidity, precipitation, barometric pressure and temperature had the more significant influences on the incidence of HFMD than other meteorological factors with the explanatory power of 0.30, 0.29, 0.29 and 0.21 (P<0.000). The interaction between any two meteorological factors had a nonlinear enhancement effect on the risk of HFMD. The relative risk in Northern Xinjiang was higher than that in Southern Xinjiang. Global spatial autocorrelation analysis results indicated a fluctuating trend over these years: the positive spatial dependency on the incidence of HFMD in 2008, 2010, 2012, 2014 and 2015, the negative spatial autocorrelation in 2009 and a random distribution pattern in 2011, 2013 and 2016. Our findings revealed the correlation between meteorological factors and the incidence of HFMD in Xinjiang. The correlation showed obvious spatiotemporal heterogeneity. The study provides the basis for the government to control HFMD based on meteorological information. The risk of HFMD can be predicted with appropriate meteorological factors for HFMD prevention and control.

Spatiotemporal characteristics and driving forces of terrorist attacks in Belt and Road regions

To achieve the strategic goals of the Belt and Road Initiative (BRI), it is necessary to deepen our understanding of terrorist attacks in BRI countries. First, we selected data for terrorist attacks in BRI regions from 1998 to 2017 from the Global Terrorism Database and analyzed their time distribution using trend analysis and wavelet analysis. Then, we used honeycomb hexagons to present the spatial distribution characteristics. Finally, based on the Fragile States Index, we used GeoDetector to analyze the driving forces of the terrorist attacks. The following conclusions were obtained: (1) During 1998–2017, the number of events was the highest on Mondays and the lowest on Fridays. In addition, the incidence of events was high between Monday and Thursday but was the lowest on Fridays and Saturdays. The number of events was the largest in January, May, July, and November and was the lowest in June and September; the incidence of terrorist attacks from April to May and July to August was high. (2) Terrorist attacks showed a 10-year cycle during the study period. Terrorist attacks in the last 10 years of the study period were broader in scope and higher in number compared with the previous 10 years. In addition, China, Russia, Saudi Arabia, and northeastern Europe saw many new terrorist attacks during the latter 10 years. (3) The number of terrorist attacks by bombing/explosion was the largest, followed by armed attack; assassination, kidnapping, and infrastructure attacks were the least frequent. The core areas of the terrorist attacks were Iraq, Israel, Afghanistan, Pakistan, and India. (4) The driving force analysis revealed that the indicators “security apparatus,” “human flight and brain drain,” and “external intervention” contributed the most to BRI terrorist attacks.

Spatiotemporal characteristics and driving forces of terrorist attacks in Belt and Road regions

To achieve the strategic goals of the Belt and Road Initiative (BRI), it is necessary to deepen our understanding of terrorist attacks in BRI countries. First, we selected data for terrorist attacks in BRI regions from 1998 to 2017 from the Global Terrorism Database and analyzed their time distribution using trend analysis and wavelet analysis. Then, we used honeycomb hexagons to present the spatial distribution characteristics. Finally, based on the Fragile States Index, we used GeoDetector to analyze the driving forces of the terrorist attacks. The following conclusions were obtained: (1) During 1998–2017, the number of events was the highest on Mondays and the lowest on Fridays. In addition, the incidence of events was high between Monday and Thursday but was the lowest on Fridays and Saturdays. The number of events was the largest in January, May, July, and November and was the lowest in June and September; the incidence of terrorist attacks from April to May and July to August was high. (2) Terrorist attacks showed a 10-year cycle during the study period. Terrorist attacks in the last 10 years of the study period were broader in scope and higher in number compared with the previous 10 years. In addition, China, Russia, Saudi Arabia, and northeastern Europe saw many new terrorist attacks during the latter 10 years. (3) The number of terrorist attacks by bombing/explosion was the largest, followed by armed attack; assassination, kidnapping, and infrastructure attacks were the least frequent. The core areas of the terrorist attacks were Iraq, Israel, Afghanistan, Pakistan, and India. (4) The driving force analysis revealed that the indicators “security apparatus,” “human flight and brain drain,” and “external intervention” contributed the most to BRI terrorist attacks.

Association of environmental factors and high HFMD occurrence in northern Thailand

Background

The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand.

Methods

A case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews.

Results

Two variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention.

Conclusions

The number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs.