Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 23;18(6):e0287539.
doi: 10.1371/journal.pone.0287539. eCollection 2023.

Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019

Wuwei Wang  1   2   3 , Mark W Rosenberg  3 , Hongying Chen  4 , Shengsheng Gong  2 , Mengmeng Yang  2 , Dacai Deng  1
Affiliations

Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019

Wuwei Wang et al. PLoS One. .

Abstract

Background: Hand, foot, and mouth disease (HFMD) is a public health issue in Hubei and studies of- spatiotemporal clustering at a fine scale are limited. The purpose of this research was to analyze the epidemiological characteristics, temporal variation characteristics, and spatiotemporal clustering of HFMD cases at the town level from 2009 to 2019 to improve public health outcomes.

Methods: Mathematical statistics, a seasonal index, wavelet analysis, and spatiotemporal scans were used to analyze epidemiological characteristics, time series trends, and spatiotemporal clusters of HFMD in Hubei.

Results: EV-A71 (Enterovirus A71) and CVA16 (Coxsackievirus A16) constitute the two primary pathogens of the HFMD epidemic in Hubei, among which EV-A71 is the dominant pathogen, especially in 2016. In terms of age distribution, a major peak occurred at 0-5 years and a very small increase appeared at 25-35 years, with the former having a higher incidence among males than females and the latter having the opposite difference between males and females. The number/rate of HFMD cases exhibited a considerable increase followed by a moderate decline from 2009 to 2019, with the first large peak in April-July and a smaller peak in November-December. HFMD in Hubei exhibited the characteristics of a 270-day cycle with multiscale nesting, which was similar to the periodicity of HFMD cases caused by EV-A71 (9 months). Cities with a higher incidence of HFMD formed a part of an "A-shaped urban skeleton". Subdistricts had the highest incidence of HFMD, followed by towns and villages. The spatiotemporal scan results showed one most likely cluster and 22 secondary clusters, which was consistent with the geographic location of railways and rivers in Hubei.

Conclusions: These findings may be helpful in the prevention and control of HFMD transmission and in implementing effective measures in Hubei Province.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Temporal changes in the distribution of HFMD virus types in Hubei from 2010 to 2019.
Fig 2
Fig 2. HFMD incidence by age group in Hubei from 2009 to 2019.
Fig 3
Fig 3. HFMD incidence by age group in Hubei from 2009 to 2019.
(A) HFMD incidence in the 0–10 age group. (B) HFMD incidence in the 15–75 age group.
Fig 4
Fig 4. Annual variation in HFMD incidence in Hubei from 2009 to 2019.
Fig 5
Fig 5. Daily time-series data and wavelet analysis of HFMD in Hubei from 2009 to 2019.
(A) The real part of the wavelet coefficient of HFMD. Color is the power spectrum, strong to weak (red–blue gradient). (B) The wavelet variance of HFMD on daily scale. (C) The real part of the wavelet coefficient’s changing process on daily scale.
Fig 6
Fig 6. The real part of the wavelet coefficient’s changing process on weekly and monthly scales.
(A) Weekly scale. (B) Monthly scale.
Fig 7
Fig 7. The real part of the wavelet coefficient’s changing process of cases caused by EV-A71 on a monthly scale.
Fig 8
Fig 8. Comparison of the annual incidence rates of 17 cities in Hubei from 2009 to 2019.
See this image and copyright information in PMC

References

    1. Ministry of Health of the People’s Republic of China. Guidelines for prevention and control of HFMD (2009). Clinical Education of General Practice, 2010, 8(2): 125–127. doi: 10.13558/j.cnki.issn1672-3686.2010.02.039 - DOI
    1. Van Tu P, Thao N T T, Perera D, Truong K H, Tien N T K, Thuong T C, et al. Epidemiologic and virologic investigation of hand, foot, and mouth disease, southern Vietnam, 2005. Emerging infectious diseases, 2007, 13(11): 1733. doi: 10.3201/eid1311.070632 - DOI - PMC - PubMed
    1. Blomqvist S, Klemola P I, Kaijalainen S, Paananen A, Simonen M L, Vuorinen T, et al. Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland. Journal of Clinical Virology, 2010, 48(1): 49–54. doi: 10.1016/j.jcv.2010.02.002 - DOI - PubMed
    1. Solomon T, Lewthwaite P, Perera D, Cardosa M J, Ooi M H. Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infectious Diseases, 2010, 10(11): 778–790. doi: 10.1016/S1473-3099(10)70194-8 - DOI - PubMed
    1. Robinson C R, Doane F W, Rhodes A J. Report of an outbreak of febrile illness with pharyngeal lesions and exanthem: Toronto, summer 1957—isolation of group A coxsackie virus. Canadian Medical Association Journal, 1958, 79(8): 615. - PMC - PubMed

Publication types