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. 2020 Mar 9;14(3):e0008070.
doi: 10.1371/journal.pntd.0008070. eCollection 2020 Mar.

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

Yi Hu  1   2   3 , Lili Xu  4 , Hao Pan  5 , Xun Shi  6 , Yue Chen  7 , Henry Lynn  1   2   3 , Shenghua Mao  5 , Huayi Zhang  4 , Hailan Cao  4 , Jun Zhang  1   2   3 , Jing Zhang  1   2   3 , Shuang Xiao  1   2   3 , Jian Hu  1   2   3 , Xiande Li  8 , Shenjun Yao  9   10 , Zhijie Zhang  1   2   3 , Genming Zhao  1   2
Affiliations

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

Yi Hu et al. PLoS Negl Trop Dis. .

Abstract

Hand, foot, and mouth disease (HFMD) has become a major public health issue in China. The disease incidence varies substantially over time and across space. To understand the heterogeneity of HFMD transmission, we compare the spatiotemporal dynamics of HFMD in Qinghai and Shanghai by conducting combined analysis of epidemiological, wavelet time series, and mathematical methods to county-level data from 2009 to 2016. We observe hierarchical epidemic waves in Qinghai, emanating from Huangzhong and in Shanghai from Fengxian. Besides population, we also find that the traveling waves are significantly associated with socio-economic and geographical factors. The population mobility also varies between the two regions: long-distance movement in Qinghai and between-neighbor commuting in Shanghai. Our findings provide important evidence for characterizing the heterogeneity of HFMD transmission and for the design and implementation of interventions, such as deploying optimal vaccine and changing local driving factors in the transmission center, to prevent or limit disease spread in these areas.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
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).
Fig 2
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).
Fig 3
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).
Fig 4
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).
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