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. 2019 Jun 13;19(1):521.
doi: 10.1186/s12879-019-4153-6.

The complex transmission seasonality of hand, foot, and mouth disease and its driving factors

Affiliations

The complex transmission seasonality of hand, foot, and mouth disease and its driving factors

Jijun Zhao et al. BMC Infect Dis. .

Abstract

Background: The transmission rate seasonality is an important index for transmission dynamics in many childhood infections, and has been widely studied in industrialized countries. However, it has been neglected in the study of pathogens in China.

Methods: To understand the transmission dynamics of hand, foot and mouth disease (HFMD), we examined the transmission rate seasonality of HFMD in three provinces, Henan, Anhui and Chongqing, in China, using a dynamical stochastic SIR model. We investigated potential driving factors, including school terms, the Chinese Spring Festival period, meteorological factors and population flux for their effects on the HFMD transmission seasonality using multiple regression models.

Results: The transmission rate of HFMD had complex seasonality with one large major peak in March and one small peak in autumn. School terms, the Chinese Spring Festival period, population flux and meteorological factors had combined effects on the HFMD transmission seasonality in mainland China. The school terms reflects the seasonal contact rate in Children, while the population flux and the Chinese Spring Festival period reflect the seasonal contact rate in population. They drove HFMD transmission rate seasonality in different time periods of the year in China. Contact rate seasonality in population dominated effects on HFMD transmission in February and March. The dramatic increase in transmission rate during February coincides with the Chinese Spring Festival period and high population flux in this month. The contact rate seasonality in children dominated effects on the transmission in the other months of the year in Chongqing. Meteorological factors can not solely explain the seasonality in HFMD transmission in mainland China; however, they may have combined effects with school terms and the highway passenger traffic on the transmission rate in Anhui during the fall semester.

Conclusion: The transmission rate of HFMD in three provinces in China had complex seasonality. The Chinese Spring Festival period, population flux and (or) school terms explained the majority of the transmission rate seasonality of HFMD, and they drove HFMD transmission rate seasonality in different time periods of the year. The Chinese Spring Festival period dominantly caused the dramatic increase of the HFMD transmission rate during February.

Keywords: Chinese spring festival; Hand foot and mouth disease; Population flux; Transmission rate.

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Conflict of interest statement

We have no competing interests.

Figures

Fig. 1
Fig. 1
Locations and reported cases of Anhui, Henan and Chongqing in the map of mainland China. a) Locations of Anhui, Henan and Chongqing. Regions in dark grey are provinces that have severe HFMD outbreaks every year. b) Time series of reported HFMD cases in Anhui, Henan and Chongqing from May 2008 to December 2011
Fig. 2
Fig. 2
Transmission rates and potential influential factors for HFMD in Anhui, Henan and Chongqing. The MLE transmission rates of HFMD for a) Anhui, b) Henan and c) Chongqing. The band area of light blue corresponds to school vacations. R0 estimated for Anhui, Henan and Chongqing are consistent with other studies [1, 18, 27]. Blue lines in d), e) and f) are the averaged seasonality of highway passenger traffic from year 2010 to year 2013, and black lines are seasonality of highway passenger traffic for every year from year 2010 to year 2013. g) to r) time series of temperature, relative humidity, rainfall and sunshine hours in Anhui, Henan and Chongqing. Blue lines are the average of climatic factors from year 2008 to year 2011, and black lines are time series of climatic factors for every year from 2008 to 2011

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