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. 2013 Dec 23;11(1):312-36.
doi: 10.3390/ijerph110100312.

Spatio-temporal distribution and hotspots of Hand, Foot and Mouth Disease (HFMD) in northern Thailand

Ratchaphon Samphutthanon  1 , Nitin Kumar Tripathi, Sarawut Ninsawat, Raphael Duboz
Affiliations

Spatio-temporal distribution and hotspots of Hand, Foot and Mouth Disease (HFMD) in northern Thailand

Ratchaphon Samphutthanon et al. Int J Environ Res Public Health. .

Abstract

Hand, Foot and Mouth Disease (HFMD) is an emerging viral disease, and at present, there are no antiviral drugs or vaccines available to control it. Outbreaks have persisted for the past 10 years, particularly in northern Thailand. This study aimed to elucidate the phenomenon of HFMD outbreaks from 2003 to 2012 using general statistics and spatial-temporal analysis employing a GIS-based method. The spatial analysis examined data at the village level to create a map representing the distribution pattern, mean center, standard deviation ellipse and hotspots for each outbreak. A temporal analysis was used to analyze the correlation between monthly case data and meteorological factors. The results indicate that the disease can occur at any time of the year, but appears to peak in the rainy and cold seasons. The distribution of outbreaks exhibited a clustered pattern. Most mean centers and standard deviation ellipses occurred in similar areas. The linear directional mean values of the outbreaks were oriented toward the south. When separated by season, it was found that there was a significant correlation with the direction of the southwest monsoon at the same time. An autocorrelation analysis revealed that hotspots tended to increase even when patient cases subsided. In particular, a new hotspot was found in the recent year in Mae Hong Son province.

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Figures

Figure 1
Figure 1
HFMD outbreaks in number of patients per million inhabitants at the regional level, annually from 2003 to 2012 and the 10 year average.
Figure 2
Figure 2
Study area: Upper northern region of Thailand.
Figure 3
Figure 3
(a) Bar charts of the HFMD infection rate for each year by province, shown as average case counts for 2003–2012 per 100,000 inhabitants. (b) Yearly Ranking of HFMD cases per capita.
Figure 4
Figure 4
Monthly HFMD cases from 2003 to 2012.
Figure 5
Figure 5
HFMD case counts per month from 2003 to 2012 related to climatic factors.
Figure 6
Figure 6
Annual HFMD incidence rates (2003–2012) and population density of the provinces in the study area in Northern Thailand.
Figure 7
Figure 7
(a) HFMD Mean Center and Standard Deviation Ellipse and (b) Linear Directional Mean from 2003 to 2012.
Figure 8
Figure 8
HFMD hotspot development from 2003 to 2012.
Figure 9
Figure 9
Moran’s I scatter plot matrix and LISA cluster map of HFMD for 2012.
Figure 10
Figure 10
Number of affected villages, number of cases and number of hotspots in the upper north of Thailand during 2003–2012.
Figure 11
Figure 11
Spatio-temporal ring map: The inner ring shows the spatial distribution of hotspots and morbidity; the outer ring shows the temporal distribution.
Figure 12
Figure 12
Linear directional mean for each season and the annual monsoon direction in Thailand.
See this image and copyright information in PMC

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