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基于分布滞后非线性模型的南昌市气象因素与手足口病发病风险分析
丁越怡, 彭子婧, 刘小芳, 潘欢弘, 黄星魁, 张天琛, 李晨薇
安徽预防医学杂志 ›› 2026, Vol. 32 ›› Issue (2) : 148-154.
PDF(3994 KB)
PDF(3994 KB)
基于分布滞后非线性模型的南昌市气象因素与手足口病发病风险分析
Meteorological factors and risk of hand, foot and mouth disease in Nanchang City based on distributed lag nonlinear model
目的 探讨南昌市主要气象因素对手足口病（hand, foot and mouth disease, HFMD）发病风险滞后效应，旨在揭示气象条件对疾病传播的驱动机制，为当地开展精准防控和早期预警提供理论支撑。方法 从中国疾病预防控制信息系统和中国气象数据网收集2009－2019年南昌市HFMD日发病数据及同期逐日气象资料，采用分布滞后非线性模型（distributed lag non-linear model, DLNM）分析气温、相对湿度、日照时数、风速和昼夜温差对HFMD发病风险的滞后效应与累积效应。结果 2009—2019年南昌市共报告HFMD 47 768例，年平均发病率为93.9/10万。各气象因素与HFMD发病风险均存在非线性关系。与其中位值相比，当日均气温为30 ℃、日照时数为3.5 h、风速为3.7 m/s时，HFMD发病风险最高（RR=2.031，95%CI：1.772~2.283；RR=1.168，95%CI：1.024~1.237；RR=1.684，95%CI：1.237~2.351）。相对湿度40%为保护因素（RR=0.383，95%CI：0.249~0.589），昼夜温差15 ℃为保护因素（RR=0.253，95%CI：0.166~0.433）。极端高温和极端低温的最大累积RR值分别为1.743 （95%CI: 1.426~2.099）和1.455 （95%CI: 1.211~1.651）。多数气象因素的累积效应随滞后时间延长而增强。结论 气温、日照时数、风速、相对湿度和昼夜温差均是影响南昌市HFMD传播的重要气象因素，其效应均呈非线性且具有显著的滞后特征。温暖、高湿和高风速的环境可增加发病风险，而较长时间的日照和较大的昼夜温差则表现出保护作用。
Objective To explore the lag effect of main meteorological factors on the risk of hand, foot and mouth disease (HFMD) in Nanchang city, in order to reveal the driving mechanisms of meteorological conditions on disease transmission, and to provide theoretical support for local precise prevention and early warning. Methods We collected daily HFMD incidence data and concurrent daily meteorological data from 2009 to 2019 in Nanchang City from the China Disease Prevention and Control Information System and the China Meteorological Data Service Center, and applied a distributed lag non-linear model (DLNM) to analyze the lagged and cumulative effects of temperature, relative humidity, sunshine duration, wind speed, and diurnal temperature range on the risk of HFMD. Results From 2009 to 2019, a total of 47 768 HFMD cases were reported in Nanchang, with an average annual incidence rate of 93.9/100 000. Nonlinear relationships were observed between all meteorological factors and HFMD incidence risk. Compared with their median values, the highest incidence risk of HFMD occurred when the daily average temperature was 30 °C, sunshine duration was 3.5 h, and wind speed was 3.7 m/s (RR=2.031, 95%CI: 1.772-2.283; RR=1.168, 95%CI: 1.024-1.237; RR=1.684, 95%CI: 1.237-2.351). A relative humidity of 40% was a protective factor (RR=0.383, 95%CI: 0.249-0.589), while a diurnal temperature range of 15 °C was a protective factor （RR=0.253, 95%CI: 0.166-0.433）. The maximum cumulative RR values for extreme high temperature and extreme low temperature were 1.743 （95%CI: 1.426-2.099） and 1.455 （95%CI: 1.211-1.651）, respectively. The cumulative effects of most meteorological factors increased with prolonged lag time. Conclusion Temperature, sunshine duration, wind speed, relative humidity, and diurnal temperature range are all important meteorological factors influencing the transmission of HFMD in Nanchang. Their effects are nonlinear and exhibit significant lag characteristics. Warm, humid and windy environments can increase the risk of the disease, while longer periods of sunlight and larger difference in temperature between day and night show protective effects.
Hand, foot and mouth disease / Meteorological factors / Distributed lag nonlinear model
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Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. These symptoms typically resolve spontaneously within a few days without complications. Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. These findings reveal clinical, epidemiological, pathological, and etiological characteristics that are quite different from initial understandings of the illness. It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. At present, there is no specific pharmaceutical intervention for HFMD. An inactivated Enterovirus A71 (EV-A71) vaccine that has been approved by the China Food and Drug Administration (CFDA) has been shown to provide a high level of protection against EV-A71-related HFMD. However, the simultaneous circulation of multiple pathogens and the evolution of the molecular epidemiology of infectious agents make interventions based solely on a single agent comparatively inadequate. Enteroviruses are highly contagious and have a predilection for the nervous system, particularly in child populations, which contributes to the ongoing outbreak. Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.© 2023. The Author(s).
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In a period starting around 2007, the Hand, Foot, and Mouth Disease (HFMD) became wide-spreading in China, and the Chinese public health was seriously threatened. To prevent the outbreak of infectious diseases like HFMD, effective disease surveillance systems would be especially helpful to give signals of disease outbreaks as early as possible. Statistical process control (SPC) charts provide a major statistical tool in industrial quality control for detecting product defectives in a timely manner. In recent years, SPC charts have been used for disease surveillance. However, disease surveillance data often have much more complicated structures, compared to the data collected from industrial production lines. Major challenges, including lack of in-control data, complex seasonal effects, and spatio-temporal correlations, make the surveillance data difficult to handle. In this article, we propose a three-step procedure for analyzing disease surveillance data, and our procedure is demonstrated using the HFMD data collected during 2008-2009 in China. Our method uses nonparametric longitudinal data and time series analysis methods to eliminate the possible impact of seasonality and temporal correlation before the disease incidence data are sequentially monitored by a SPC chart. At both national and provincial levels, our proposed method can effectively detect the increasing trend of disease incidence rate before the disease becomes wide-spreading. © 2015, The International Biometric Society.
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宋飏, 刘艳晓, 张瑜, 等. 中国手足口病时空分异特征及影响因素[J]. 地理学报, 2022, 77(3):574-588.
健康中国战略是中国新时期的重大战略之一,手足口病作为全球关注的公共卫生问题,已成为中国影响范围较为广泛和普遍的典型传染性疾病,尤其对婴幼儿健康造成巨大威胁。本文构建健康地理学视角下的传染病研究理论框架,采用集中度和空间分析方法解析中国2008—2017年手足口病发病时空分异特征和变化规律,对18个影响其发病的风险因子进行空间相关和地理探测,揭示手足口病地理分异的主要影响因素和作用机理。结果表明：① 健康地理学视角下的传染病研究理论框架由传染病发病的基本环节、影响因素和分布扩散状态3个子系统构成,各子系统之间及子系统内部相互影响相互作用。② 2008—2017年中国手足口病发病率呈现波动上升、两年为一周期且偶数年份高于奇数年份的发病规律,春末夏初及秋末冬初为发病高峰。③ 2008—2010年手足口病发病率未体现明显的空间集聚特征;2011—2017年发病率存在较强的空间自相关性,热点地区主要集中在广东、广西、海南等地区,且呈现自北向南、自小而分散向大而集中的演变趋势;发病典型地区可以总结为气候湿热区、经济落后且医疗水平低的地区和易集聚感染的人口密集区3种。④ 有12项因素通过了相关分析和地理探测的显著性检验,与手足口病发病率体现正向作用的因素解释力从大到小依次为“气温>年降水量>湿度>气压>人口密度>路网密度>人均GDP”,负向相关关系作用大小依次为“日照时数>风速>AQI指数>海拔>千人床位数”,气温和降水量与其他因子的交互作用最为明显。本文为健康地理学、手足口病病理学、流行病学的相关研究提供实证检验基础,为服务健康中国战略和流行病预防与控制提供重要科学支撑和政策参考。
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沈秀莲, 郑尔达, 黄甜, 等. 基于分布滞后非线性模型探讨日均气温对曲靖市手足口病发病的影响[J]. 中华疾病控制杂志, 2020, 24(11):1275-1281.
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Background: To determine the linear and non-linear interacting relationships between weather factors and hand, foot and mouth disease (HFMD) in children in Gansu, China, and gain further traction as an early warning signal based on weather variability for HFMD transmission.Method: Weekly HFMD cases aged less than 15 and meteorological information from 2010 to 2014 in Jiuquan, Lanzhou and Tianshu, Gansu, China were collected. Generalized linear regression models (GLM) with Poisson link and classification and regression trees (CART) were employed to determine the combined and interactive relationship of weather factors and HFMD in both linear and non-linear ways.Results: GLM suggested an increase in weekly HFMD of 5.9% [95% confidence interval (CI): 5.4%, 6.5%] in Tianshui, 2. 8% [2.5%, 3.1%] in Lanzhou and 1.8% [1.4%, 2.2%] in Jiuquan in association with a 1 degrees C increase in average temperature, respectively. And 1% increase of relative humidity could increase weekly HFMD of 2.47% [2.23%, 2.71%] in Lanzhou and 1.11% [0.72%, 1.51%] in Tianshui. CART revealed that average temperature and relative humidity were the first two important determinants, and their threshold values for average temperature deceased from 20 degrees C of Jiuquan to 16 degrees C in Tianshui; and for relative humidity, threshold values increased from 38% of Jiuquan to 65% of Tianshui.Conclusion: Average temperature was the primary weather factor in three areas, more sensitive in southeast Tianshui, compared with northwest Jiuquan; Relative humidity's effect on HFMD showed a non-linear interacting relationship with average temperature.
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Hand, foot, and mouth disease (HFMD) is a serious disease burden in the Asia-Pacific region, including China. This study calculated the transmissibility of HFMD at county levels in Jiangsu Province, China, analyzed the differences of transmissibility and explored the possible influencing factors of its transmissibility. We built a mathematical model for seasonal characteristics of HFMD, estimated the effective reproduction number (R), and compared the incidence rate and transmissibility in different counties using non-parametric tests, rapid cluster analysis and rank-sum ratio in 97 counties in Jiangsu Province from 2015 to 2020. The average daily incidence rate was between 0 and 4 per 100,000 people in Jiangsu Province from 2015-2020. The Quartile of R in Jiangsu Province from 2015 to 2020 was 1.54 (0.49, 2.50). Rugao District and Jianhu District had the highest transmissibility according to the rank-sum ratio. R generally decreased in 2017 and increased in 2018 in most counties, and the median level of R was the lowest in 2017 (P < 0.05). The transmissibility was different in 97 counties in Jiangsu Province. The reasons for the differences may be related to the climate, demographic characteristics, virus subtypes, vaccination, hygiene and other infectious diseases.© 2022. The Author(s).
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Hand, foot and mouth disease (HFMD) reinfection is common because of the limited cross-protection from infections of different enterovirus. We aimed to investigate the epidemiological characteristics and its influential factors of HFMD reinfection in Guangzhou, China.Data on HFMD patients aged ≤5 yr from 2012 to 2017 were extracted from surveillance system. Influential factors of reinfection were assessed using the logistic regression model.Of 369,054 HFMD patients, 11,321 patients (3.07%) were classified as reinfection. The reinfection rate in male was higher than in female (χ=60.11, <0.001). The reinfection rate in patients ≤1 yr was 3.86%, which showed a downward trend with age (Z=37.37, <0.001). The highest reinfection rate was observed in the scattered children (3.38%), followed by nursery care children and others (χ=514.75, <0.001). Besides, higher risk of reinfection was detected among those who were male, lower age group, rural residence and other enteroviruses infection compared with their respective counterparts. Seasonality was illustrated according to the number of reinfections peaked from April to July. Time intervals curves revealed the number of reinfections gradually increased after 13 months from the initial infection.Male ≤4 yr, living rural area, especially those lived scattered and infected with other enteroviruses were more likely to be reinfection.Copyright © 2022 Zhong et al. Published by Tehran University of Medical Sciences.
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Hand, foot and mouth disease (HFMD) is a serious infectious disease, which has become a public health problem. Previous studies have shown that temperature may influence the incidence of HFMD, but most only focus on single city and the results are highly heterogeneous. Therefore, a multicity study was conducted to explore the association between temperature and HFMD in different cities and search for modifiers that influence the heterogeneity.We collected daily cases of childhood HFMD (aged 0-5 years) and meteorological factors of 21 cities in Guangdong Province in the period of 2010-2013. Distributed lag non-linear model (DLNM) with quasi-Poisson was adopted to quantify the effects of temperature on HFMD in 21 cities. Then the effects of each city were pooled by multivariate meta-analysis to obtain the heterogeneity among 21 cities. Potential city-level factors were included in meta-regression to explore effect modifiers.A total of 1,048,574 childhood cases were included in this study. There was a great correlation between daily childhood HFMD cases and temperature in each city, which was non-linear and lagged. High heterogeneity was showed in the associations between temperature and HFMD in 21 cities. The pooled temperature-HFMD association was peaking at the 79th percentile of temperature with relative risk (RR) of 2.474(95% CI: 2.065-2.965) as compared to the median temperature. Latitude was the main modifier for reducing the heterogeneity to 69.28% revealed by meta-analysis.There was a strong non-linear and lagged correlation between temperature and HFMD. Latitude was strongly associated with the relationship between temperature and HFMD. Meanwhile, it had an effect on modifying the relationship. These findings can conducive to local governments developing corresponding preventive measures.
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Background: As an emerging infectious disease, the prevention and control of hand, foot, and mouth disease (HFMD) poses a significant challenge to the development of public health in China. In this study, we aimed to explore the mechanism of the seasonal transmission characteristics of HFMD and to reveal the correlation and potential path between key meteorological factors and the transmissibility of HFMD.
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Hand-foot-mouth disease (HFMD) is caused by a group of enteroviruses (EVs) and has a high incidence in children; some subtypes had high mortalities in children. The subtypes of HFMD had a different incidence across seasons. Thereby, we suspect that the infection of HFMD is varied by meteorological factors. However, studies examining serotype-specific associations between meteorological factors and HFMD incidence were rare.
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梁东旭, 康强, 曾毅, 等. 基于分布滞后非线性模型探讨南宁市手足口病的发病与气象因素的关联[J]. 中华疾病控制杂志, 2023, 27(11):1254-1261.
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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.
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Hand, foot and mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide and has caused huge economic and disease burdens in many countries. The average annual incidence rate of HFMD was 11.66% in Shaanxi during the time span from 2009 to 2018. There are distinct differences within Shaanxi, as it is a special region that crosses three temperature zones. Hence, in this study, a spatiotemporal analysis of Shaanxi was performed to reveal the characteristics of the distribution of HFMD and to explore the meteorological determinants of HFMD.The county-level and municipal data from Shaanxi Province from 2009 to 2018 were applied to research the spatiotemporal characteristics of HFMD and its meteorological determinants. Time series and spatial autocorrelation analyses were applied to assess the spatiotemporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors based on the data of 107 counties and 10 municipalities.The incidence rate of HFMD displayed no variable trend throughout the whole research period. A high incidence rate of HFMD was observed from June to September, corresponding to a time when the climate is characterized by heavy rain, high temperature, and high humidity. The high-incidence areas were mainly located in the central region in Shaanxi, whereas the low-incidence spots were mainly found in Northern Shaanxi. Regarding the meteorological factors analysed in this study, in general, the incidence rate of HFMD in specific regions was positively associated with the rainfall, temperature and humidity.These results could be applied by the government and the general public to take effective measures to prevent disease. Region-targeted policies could be enacted and implemented in the future according to specific situations in different areas and the relevant meteorological determinants. Additionally, meteorological conditions normally extend to a wide-ranging region; thus, cooperation among surrounding regions is necessary.
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Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model.
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Previous studies have demonstrated that SARS-CoV-2 is stable on surfaces for extended periods under indoor conditions. In the present study, simulated sunlight rapidly inactivated SARS-CoV-2 suspended in either simulated saliva or culture media and dried on stainless steel coupons. Ninety percent of infectious virus was inactivated every 6.8 minutes in simulated saliva and every 14.3 minutes in culture media when exposed to simulated sunlight representative of the summer solstice at 40°N latitude at sea level on a clear day. Significant inactivation also occurred, albeit at a slower rate, under lower simulated sunlight levels. The present study provides the first evidence that sunlight may rapidly inactivate SARS-CoV-2 on surfaces, suggesting that persistence, and subsequently exposure risk, may vary significantly between indoor and outdoor environments. Additionally, these data indicate that natural sunlight may be effective as a disinfectant for contaminated nonporous materials.© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
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陈玲, 项朝军, 严图, 等. 2018—2022年广元市手足口病流行特征与气象因素相关性分析[J]. 预防医学情报杂志, 2025, 41(7):907-913,931.
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This study aimed to evaluate the effect of hand hygiene interventions on the overall hand hygiene (HH) status of teaching instruction of hand hygiene in kindergartens, given the vulnerability of kindergarten children and their high risk due to infectious diseases and the current COVID-19 epidemic. We investigated the HH status of teachers from two kindergartens in the same community. The participants were recruited from 28 classes in both kindergartens. After completing the baseline survey, the intervention program consisted of three components: lectures on infectious diseases, lectures on HH, and seven-step hand washing techniques conducted in two kindergartens. The intervention program effectively increased teachers’ perceived disease susceptibility (p < 0.05), reduced the total bacterial colonization of children’s hands (p < 0.001), and improved the HH environment (p < 0.01). We recommend that health authorities or kindergartens adopt this HH intervention program to effectively improve the HH status in kindergartens and allow for preventive responses to the COVID-19 epidemic or other emerging infectious diseases.
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Hand-foot-and-mouth disease (HFMD) is a highly contagious viral infection, and real-time predicting of HFMD outbreaks will facilitate the timely implementation of appropriate control measures. By integrating a susceptible-exposed-infectious-recovered (SEIR) model and an ensemble Kalman filter (EnKF) assimilation method, we developed an integrated compartment model and assimilation filtering forecast model for real-time forecasting of HFMD. When applied to HFMD outbreak data collected for 2008-11 in Beijing, China, our model successfully predicted the peak week of an outbreak three weeks before the actual arrival of the peak, with a predicted maximum infection rate of 85% or greater than the observed rate. Moreover, dominant virus types enterovirus 71 (EV-71) and coxsackievirus A16 (CV-A16) may account for the different patterns of HFMD transmission and recovery observed. The results of this study can be used to inform agencies responsible for public health management of tailored strategies for disease control efforts during HFMD outbreak seasons.
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