Time Series Analyses of Hand,Foot and Mouth Disease Integrating Weather Variables

Background

The past decade witnessed an increment in the incidence of hand foot mouth disease (HFMD) in the Pacific Asian region; specifically, in Guangzhou China. This emphasized the requirement of an early warning system designed to allow the medical community to better prepare for outbreaks and thus minimize the number of fatalities.

Methods

Samples from 1,556 inpatients (hospitalized) and 11,004 outpatients (non-admitted) diagnosed with HFMD were collected in this study from January 2009 to October 2013. Seasonal Autoregressive Integrated Moving Average (SARIMA) model was applied to establish high predictive model for inpatients and outpatient as well as three viral serotypes (EV71, Pan-EV and CA16). To integrate climate variables in the data analyses, data from eight climate variables were simultaneously obtained during this period. Significant climate variable identified by correlation analyses was executed to improve time series modeling as external repressors.

Results

Among inpatients with HFMD, 248 (15.9%) were affected by EV71, 137 (8.8%) were affected by Pan-EV+, and 436 (28.0%) were affected by CA16. Optimal Univariate SARIMA model was identified: (2,0,3)(1,0,0)₅₂ for inpatients, (0,1,0)(0,0,2)₅₂ for outpatients as well as three serotypes (EV71, (1,0,1)(0,0,1)₅₂; CA16, (1,0,1)(0,0,0)₅₂; Pan-EV, (1,0,1)(0,0,0)₅₂). Using climate as our independent variable, precipitation (PP) was first identified to be associated with inpatients (r = 0.211, P = 0.001), CA16-serotype (r = 0.171, P = 0.007) and outpatients (r = 0.214, P = 0.01) in partial correlation analyses, and was then shown a significant lag in cross-autocorrelation analyses. However, inclusion of PP [lag -3 week] as external repressor showed a moderate impact on the predictive performance of the SARIMA model described here-in.

Conclusion

Climate patterns and HFMD incidences have been shown to be strongly correlated. The SARIMA model developed here can be a helpful tool in developing an early warning system for HFMD.     

山西省森林生态系统服务功能评估

森林生态系统服务功能评估一直是国内外研究热点之一,森林不仅具有经济价值,更有巨大的生态价值。基于山西省2016年森林资源2类调查数据,根据中华人民共和国林业行业标准LY/T1721—2008《森林生态系统服务功能评估规范》,对山西省11个地市的主要植被类型生态系统服务功能进行评估。结果表明:1)2016年,山西省森林生态系统服务功能总价值为3172.64亿元,其价值量由大到小的顺序为涵养水源、净化大气环境、保育土壤、固碳释氧、生物多样性保护、林木积累营养物质、森林游憩,其中涵养水源、净化大气环境和保育土壤的价值量共占山西省森林生态系统服务功能总价值的78.98%;2)山西省各市森林生态系统服务功能价值量由大到小的顺序为吕梁市、忻州市、临汾市、晋中市、长治市、运城市、晋城市、大同市、太原市、朔州市、阳泉市,而单位面积价值量最大的是晋城市,最小的是朔州市;3)不同林分类型生态系统服务功能价值量由大到小的顺序为乔木林(油松、栎类、针阔混、阔叶混、桦木及山杨类、落叶松、杨树及软阔类、槐类、柏木、针叶混、云杉、硬阔类和竹林)、灌木林和经济林;4)不同龄组提供的生态系统服务功能价值量由大到小的顺序为中龄林、幼龄林、成过熟林、近熟林。     

山西不同地域菜粉蝶RAPD遗传多样性

采用RAPD技术分析了山西省菜粉蝶5个地域种群间的遗传多样性和遗传关系,用筛选出的12对引物扩增共得到143条带,其中127(88.8%)条带具有多态性,5个种群变异程度由大到小的顺序为:大同的(76.3%)＞太原的(74.7%)＞长治的(74.5%)＞代县的(73.7%)＞夏县的(70.7%).Shannon's信息指数分析结果显示大多数变异发生在种群内(73.7%).种群间的Nei's遗传距离较低(均＜0.1).用UPGMA和 Neighbor-joining做的基于RAPD标记的Nei's遗传距离的聚类图显示,各种群内的个体首先聚在一起,种群之间有一定分化,5个地域种群间较远距离的代县种群与夏县种群遗传关系最近并优先相聚.经过对试验结果的分析讨论认为:环境类型及其生态条件对山西省菜粉蝶地域种群的遗传多样性和遗传变异产生了重要的影响,其中农药的施用对菜粉蝶种群遗传结构的影响有可能是深刻的.     

山西省苹果树腐烂病菌的种群结构分析

为明确山西省苹果树腐烂病菌的分布与组成,本研究采集并分离得到来自山西省8个苹果树种植区有代表性的78株腐烂病菌,通过形态特征观察及利用2个DNA片段（ITS和EF1α）构建系统发育树等方法对其遗传结构进行了研究。结果表明山西省苹果树腐烂病由苹果黑腐皮壳菌Valsa mali和梨黑腐皮壳菌Valsa pyri 2个致病种所致,其中V. pyri是优势种,分布于山西省各个苹果树种植区,占菌株总数的58.97%。以山西省8个苹果树种植区腐烂病菌各个种的相对频率进行聚类分析,欧式距离9作为聚类分割点将其种群结构分为3类。第Ⅰ类包括忻州、朔州2个苹果树种植区,V. pyri为该类型苹果树种植区的致病菌、相对频率为100%。第Ⅱ类包括晋城、长治、临汾、太原、运城5个苹果树种植区,V. pyri是这5个种植区的优势种。第Ⅲ类包含晋中1个苹果树种植区,V. mali是该种植区的优势种。     

Spatiotemporal Dynamics of Hand-Foot-Mouth Disease and Its Relationship with Meteorological Factors in Jiangsu Province,China

Hand, foot and mouth disease (HFMD) is an important public health issue in mainland China, including Jiangsu Province. The main purpose of this study was to depict the epidemiological characteristics of HFMD and evaluate the effects of meteorological variables on its dynamics via spatiotemporal analytic methods, which is essential for formulating scientific and effective prevention and control strategies and measures. In total, 497,910 cases of HFMD occurred in the 2009-2013 period, with an average annual incidence of 126.3 per 100,000 in Jiangsu. Out of these, 87.7% were under 5 years old with a male-to-female incidence ratio of 1.4. The dominant pathogens of the laboratory-confirmed cases were EV71 and CoxA16, accounting for 44.8% and 30.6% of all cases, respectively. Two incidence peaks were observed in each year, the higher occurring between April and June, the lower between November and December. The incidence ranged between 16.8 and 233.5 per 100,000 at the county level. The incidence in the South of the province was generally higher than that in the northern regions. The most likely spatiotemporal cluster detected by space–time scan analysis occurred in May-June of 2012 in the southern region. Average temperature and rainfall were positively correlated with HFMD incidence, while the number of days with rainfall ≥ 0.1mm, low temperature, high temperature and hours of sunshine were negatively related. Particularly, relative humidity had no relationship. In conclusion, the prevalence of HFMD in Jiangsu Province has an obvious feature of seasonality. The etiological composition changed dynamically and might be a latent driving force for the temporal variation of the incidence of HFMD. A moderately warm environment promotes the transmission of the HFMD viruses, while particularly cold and hot climate conditions restrain their transmission.     

山西省六个负蝗种群的遗传多样性

用等位酶电泳分析方法对短额负蝗(A tractom orpha sinensis)和奇异负蝗(A tractom orpha p ereg rina)各3个自然种群10种酶(AAT,CK,G 3PD,HEX,IDH,LDH,M DH,M E,PG I,PGM)进行检测。结果显示:两种负蝗在某些基因座上共享常见的等位基因,如A a t-1-b、A a t-2-b、G 3p d-a、Ck-1-b和Ldh-b;除个别基因座在部分种群符合H ardy-W e inberg平衡外,两种负蝗的大多数基因座的基因型频率显著偏离H ardy-W e inberg平衡。此外,奇异负蝗M e-c(0.318~0.740)、短额负蝗H ex-1-a(0.800~1.000)及Ldh-b(0.487~0.750)等位基因频率呈现出由北向南递增的趋势,表明M e和H ex、Ldh基因座上的等位基因频率与地理分布存在一定的相关关系。短额负蝗平均每个基因座的等位基因数(A)为1.9~2.3、多态基因座百分率(P)为56.3%~68.8%、平均观察杂合度(Ho)为0.072~0.096;而奇异负蝗的相应值依次为A=1.7~2.2,P=43.8~56.3%,Ho=0.070~0.107。从A、P和Ho3个参数可知,短额负蝗遗传多样性明显高于奇异负蝗。6个负蝗种群的平均观察杂合度均明显低于H ardy-W e inberg平衡预期值,表明6个负蝗种群均出现了杂合体缺乏现象。短额负蝗3种群I值为0.971~0.996,奇异负蝗3种群I值为0.982~0.995,短额负蝗与奇异负蝗I值为0.379~0.451,表明种内遗传相似度明显高于种间,从种间I值可知奇异负蝗和短额负蝗属于近缘种。根据R oger's遗传距离进行的聚类分析表明,两种负蝗可分为两支,且两种负蝗的遗传距离与地理距离均存在明显的相关趋势。两种负蝗的平均FST值都不显著偏离0值(奇异负蝗FST=0.087,p>0.05,短额负蝗FST=0.045,p>0.05),表明该两种负蝗种群间的分化不明显。     

Climate variations and salmonellosis transmission in Adelaide,South Australia: a comparison between regression models

This is the first study to identify appropriate regression models for the association between climate variation and salmonellosis transmission. A comparison between different regression models was conducted using surveillance data in Adelaide, South Australia. By using notified salmonellosis cases and climatic variables from the Adelaide metropolitan area over the period 1990–2003, four regression methods were examined: standard Poisson regression, autoregressive adjusted Poisson regression, multiple linear regression, and a seasonal autoregressive integrated moving average (SARIMA) model. Notified salmonellosis cases in 2004 were used to test the forecasting ability of the four models. Parameter estimation, goodness-of-fit and forecasting ability of the four regression models were compared. Temperatures occurring 2 weeks prior to cases were positively associated with cases of salmonellosis. Rainfall was also inversely related to the number of cases. The comparison of the goodness-of-fit and forecasting ability suggest that the SARIMA model is better than the other three regression models. Temperature and rainfall may be used as climatic predictors of salmonellosis cases in regions with climatic characteristics similar to those of Adelaide. The SARIMA model could, thus, be adopted to quantify the relationship between climate variations and salmonellosis transmission.     

2014年陕西省柯萨奇病毒A10型相关手足口病的流行特征和其VP1区基因特征研究

了解陕西省手足口病(Hand,foot and mouth disease,HFMD)的致病病原体柯萨奇病毒A10型(CV-A10)的流行特征及VP1区基因特征。对2014年收集的HFMD病例标本,通过荧光定量PCR检测确定肠道病毒型别,对CV-A10引起的HFMD流行特征进行描述性分析。使用RD细胞进行病毒分离,RT-PCR扩增CV-A10的VP1区基因片段并进行序列测定,使用Meg Align软件进行核苷酸及氨基酸的同源性分析,并使用MEGA5.0软件构建系统进化树。2014年CV-A10是陕西HFMD病原谱中的第三大病原,占其他肠道病毒的57.71%,13例重症HFMD病例的致病病原体鉴定为CV-A10,占重症病例的9.03%。CV-A10感染HFMD病例以≤3岁年龄组儿童为主(83.07%),男女性别比为1.15∶1。发病时间主要集中在4～7月。实验室分离出101株CV-A10,覆盖全省10市(区)。完成测序的18株CV-A10核苷酸和氨基酸同源性分别为94.0%～100.0%和97.3%～100.0%,与A型原型株的核苷酸和氨基酸同源性分别为76.2%～77.5%和91.9%～93.0%,与近年来河北、湖南和河南地区流行株具有较高的同源性。系统进化显示陕西CV-A10分离株属于C基因型。CV-A10是2014年陕西HFMD的优势病原,能引起重症HFMD,本次分离到的CV-A10毒株均属于C基因型。     

Early warning of hand,foot, and mouth disease transmission: A modeling study in mainland,China

BackgroundHand, 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.MethodsThis study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, “epidemic acceleration week (EAW)” and “recommended warning week (RWW)”, were calculated to show the early warning time.ResultsThe mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R² > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions.ConclusionsThe disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.     

Short-term effects of meteorological factors on children hand,foot and mouth disease in Guangzhou,China

Hand, foot and mouth disease (HFMD) is a contagious viral illness that commonly affects infants and children. The underlying risk factors have not yet been systematically examined. This study analyzed the short-term effects of meteorological factors on children HFMD in Guangzhou, China. Daily count of HFMD among children younger than 15 years and meteorological variables from 2009 to 2011 were collected to construct the time series. A generalized additive model was applied to estimate the effects of meteorological factors on HFMD occurrence, after adjusting for long-term trend, seasonal trend, day of week, and public holidays. A negative association between temperature and children HFMD occurrence was observed at lag days 1–3, with the relative risk (RR) for a 1 °C increase on lag day 2 being 0.983 (95 % confidence intervals (CI) 0.977 to 0.989); positive effect was found for temperature at lag days 5–9, with the highest effect at lag day 6 (RR?=?1.014, 95 % CI 1.006 to 1.023). Higher humidity was associated with increased HFMD at lag days 3–10, with the highest effect at lag day 8 (RR?=?1.009 for 1 % increase in relative humidity, 95 % CI 1.007 to 1.010). And we also observed significant positive effect for rainfall at lag days 4 and 8 (RR?=?1.001, 95 % CI 1.000 to 1.002) for 1-mm increase. Subgroup analyses showed that the positive effects of temperature were more pronounced among younger children. This study suggests that meteorological factors might be important predictors of children HFMD occurrence in Guangzhou.     

Epidemiological Characteristics and Spatial-Temporal Clusters of Hand,Foot, and Mouth Disease in Zhejiang Province,China, 2008-2012

Hand, foot and mouth disease (HFMD) is one of the major public health concerns in China. Being the province with high incidence rates of HFMD, the epidemiological features and the spatial-temporal patterns of Zhejiang Province were still unknown. The objective of this study was to investigate the epidemiological characteristics and the high-incidence clusters, as well as explore some potential risk factors. The surveillance data of HFMD during 2008–2012 were collected from the communicable disease surveillance network system of Zhejiang Provincial Center for Disease Control and Prevention. The distributions of age, gender, occupation, season, region, pathogen’s serotype and disease severity were analyzed to describe the epidemiological features of HFMD in Zhejiang Province. Seroprevalence survey for human enterovirus 71 (EV71) in 549 healthy children of Zhejiang Province was also performed, as well as 27 seroprevalence publications between 1997 and 2015 were summarized. The spatial-temporal methods were performed to explore the clusters at county level. Furthermore, pathogens’ serotypes such as EV71 and coxsackievirus A16 (Cox A16) and meteorological factors were analyzed to explore the potential factors associated with the clusters. A total of 454,339 HFMD cases were reported in Zhejiang Province during 2008–2012, including 1688 (0.37%) severe cases. The annual average incidence rate was 172.98 per 100,000 (ranged from 72.61 to 270.04). The male-to-female ratio for mild cases was around 1.64:1, and up to 1.87:1 for severe cases. Of the total cases, children aged under three years old and under five years old accounted for almost 60% and 90%, respectively. Among all enteroviruses, the predominant serotype was EV71 (49.70%), followed by Cox A16 (26.05%) and other enteroviruses (24.24%) for mild cases. In severe cases, EV71 (82.85%) was the major causative agent. EV71 seroprevalence survey in healthy children confirmed that occult infection was common in children. Furthermore, literature summary for 26 seroprevalence studies during 1997–2015 confirmed that 0–5 years group showed lowest level of EV71 seroprevalence (29.1% on average) compared to the elder children (6–10 years group: 54.6%; 11–20 years group: 61.8%). Global positive spatial autocorrelation patterns (Moran’s Is>0.25, P<0.05) were discovered not only for mild cases but also for severe cases, and local positive spatial autocorrelation patterns were revealed for counties from the eastern coastal and southern regions. The retrospective space-time cluster analysis also confirmed these patterns. Risk factors analyses implied that more EV71 and less sunshine were associated with the clusters of HFMD in Zhejiang Province. Our study confirmed that Zhejiang Province was one of the highly epidemic provinces in China and that the epidemiological characteristics of HFMD were similar to other provinces. Occult infection in elder children and adults was one of the important reasons why most HFMD cases were children aged under-five. Combining the results of spatial autocorrelation analysis and the space-time cluster analysis, the major spatial-temporal clusters were from the eastern coastal and southern regions. The distribution of pathogens’ serotypes and the level of sunshine could be risk factors for, and serve as an early warning of, the outbreak of HFMD in Zhejiang Province.     

Visualized Exploratory Spatiotemporal Analysis of Hand-Foot-Mouth Disease in Southern China

Objectives

In epidemiological research, major studies have focused on theoretical models; however, few methods of visual analysis have been used to display the patterns of disease distribution.

Design

For this study, a method combining the space-time cube (STC) with space-time scan statistics (STSS) was used to analyze the pattern of incidence of hand-foot-mouth disease (HFMD) in Guangdong Province from May 2008 to March 2009. In this research, STC was used to display the spatiotemporal pattern of incidence of HFMD, and STSS were used to detect the local aggregations of the disease.

Setting

The hand-foot-mouth disease data were obtained from Guangdong Province from May 2008 to March 2009, with a total of 68,130 cases.

Results

The STC analysis revealed a differential pattern of HFMD incidence among different months and cities and also showed that the population density and average precipitation are correlated with the incidence of HFMD. The STSS analysis revealed that the most likely aggregation includes the Shenzhen, Foshan and Dongguan populations, which are the most developed regions in Guangdong Province.

Conclusion

Both STC and STSS are efficient tools for the exploratory data analysis of disease transmission. STC clearly displays the spatiotemporal patterns of disease. Using the maximum likelihood ratio, the STSS model precisely locates the most likely aggregation.     

Non-Linear Association between Exposure to Ambient Temperature and Children’s Hand-Foot-and-Mouth Disease in Beijing,China

BackgroundHand, foot and mouth disease (HFMD) was listed as a notifiable communicable disease in 2008 and is an emerging public health problem in China, especially for children. However, few data are available on the risk assessment of the potential reasons for HFMD in Beijing. This study examined the association of temperature with the incidence of children’s HFMD in Beijing at the daily scale for the first time.MethodsA newly developed case-crossover design with a distributed lag nonlinear model (DLNM) was used to assess the delayed and cumulative associations of daily temperature with gender- and age-specific HFMD in Beijing, China, during 2010–2012. Relative humidity, day of the week, public holiday, season and long-term trends were controlled in the model.ResultsAmong the total of 113,475 cases, the ratio between males and females was 1.52:1. HFMD was more prevalent in May-July. The temperature-HFMD relationships were non-linear in most age groups except for children aged 6–15 years, with a peak at 25.0~27.5°C. The high-temperature risks were greater, appeared earlier and lasted longer than the low-temperature risks. The relative risks for female children and those aged 6–15 years were higher than those among other groups.ConclusionRising temperatures increased the incidence of children’s HFMD, with the largest association at 25.0~27.5°C. Females and children aged 6–15 years were more vulnerable to changes in temperature with regard to the transmission of HFMD than males and other age groups, respectively. Further studies are warranted to confirm these findings in other populations.     

Remote sensing-based time series models for malaria early warning in the highlands of Ethiopia

ABSTRACT: BACKGROUND: Malaria is one of the leading public health problems in most of sub-Saharan Africa, particularly in Ethiopia. Almost all demographic groups are at risk of malaria because of seasonal and unstable transmission of the disease. Therefore, there is a need to develop malaria early-warning systems to enhance public health decision making for control and prevention of malaria epidemics. Data from orbiting earth-observing sensors can monitor environmental risk factors that trigger malaria epidemics. Remotely sensed environmental indicators were used to examine the influences of climatic and environmental variability on temporal patterns of malaria cases in the Amhara region of Ethiopia. METHODS: In this study seasonal auto regressive integrated moving average (SARIMA) models were used to quantify the relationship between malaria cases and remotely sensed environmental variables, including rainfall, land-surface temperature (LST), vegetation indices (NDVI and EVI), and actual evapotranspiration (ETa) with lags ranging from one to three months. Predictions from the best model with environmental variables were compared to the actual observations from the last 12 months of the time series. RESULTS: Malaria cases exhibited positive associations with LST at a lag of one month and positive associations with indicators of moisture (rainfall, EVI and ETa) at lags from one to three months. SARIMA models that included these environmental covariates had better fits and more accurate predictions, as evidenced by lower AIC and RMSE values, than models without environmental covariates. CONCLUSIONS: Malaria risk indicators such as satellite-based rainfall estimates, LST, EVI, and ETa exhibited significant lagged associations with malaria cases in the Amhara region and improved model fit and prediction accuracy. These variables can be monitored frequently and extensively across large geographic areas using data from earth-observing sensors to support public health decisions.     

Change in rainfall drives malaria re-emergence in anhui province, china

Malaria is re-emerging in Anhui Province, China after a decade long’ low level of endemicity. The number of human cases has increased rapidly since 2000 and reached its peak in 2006. That year, the malaria cases accounted for 54.5% of total cases in mainland China. However, the spatial and temporal patterns of human cases and factors underlying the re-emergence remain unclear. We established a database containing 20 years’ (1990–2009) records of monthly reported malaria cases and meteorological parameters. Spearman correlations were used to assess the crude association between malaria incidence and meteorological variables, and a polynomial distributed lag (PDL) time-series regression was performed to examine contribution of meteorological factors to malaria transmission in three geographic regions (northern, mid and southern Anhui Province), respectively. Then, a two-year (2008–2009) prediction was performed to validate the PDL model that was created by using the data collected from 1990 to 2007. We found that malaria incidence decreased in Anhui Province in 1990s. However, the incidence has dramatically increased in the north since 2000, while the transmission has remained at a relatively low level in the mid and south. Spearman correlation analyses showed that the monthly incidences of malaria were significantly associated with temperature, rainfall, relative humidity, and the multivariate El Niño/Southern Oscillation index with lags of 0–2 months in all three regions. The PDL model revealed that only rainfall with a 1–2 month lag was significantly associated with malaria incidence in all three regions. The model validation showed a high accuracy for the prediction of monthly incidence over a 2-year predictive period. Malaria epidemics showed a high spatial heterogeneity in Anhui Province during the 1990–2009 study periods. The change in rainfall drives the reemergence of malaria in the northern Anhui Province.     

Short term effects of weather on hand, foot and mouth disease

Background

Hand, foot, and mouth disease (HFMD) outbreaks leading to clinical and fatal complications have increased since late 1990s; especially in the Asia Pacific Region. Outbreaks of HFMD peaks in the warmer season of the year, but the underlying factors for this annual pattern and the reasons to the recent upsurge trend have not yet been established. This study analyzed the effect of short-term changes in weather on the incidence of HFMD in Singapore.

Methods

The relative risks between weekly HFMD cases and temperature and rainfall were estimated for the period 2001–2008 using time series Poisson regression models allowing for over-dispersion. Smoothing was used to allow non-linear relationship between weather and weekly HFMD cases, and to adjust for seasonality and long-term time trend. Additionally, autocorrelation was controlled and weather was allowed to have a lagged effect on HFMD incidence up to 2 weeks.

Results

Weekly temperature and rainfall showed statistically significant association with HFMD incidence at time lag of 1–2 weeks. Every 1°C increases in maximum temperature above 32°C elevated the risk of HFMD incidence by 36% (95% CI = 1.341–1.389). Simultaneously, one mm increase of weekly cumulative rainfall below 75 mm increased the risk of HFMD by 0.3% (CI = 1.002–1.003). While above 75 mm the effect was opposite and each mm increases of rainfall decreased the incidence by 0.5% (CI = 0.995–0.996). We also found that a difference between minimum and maximum temperature greater than 7°C elevated the risk of HFMD by 41% (CI = 1.388–1.439).

Conclusion

Our findings suggest a strong association between HFMD and weather. However, the exact reason for the association is yet to be studied. Information on maximum temperature above 32°C and moderate rainfall precede HFMD incidence could help to control and curb the up-surging trend of HFMD.     

The Effect of Vaccination Coverage and Climate on Japanese Encephalitis in Sarawak,Malaysia

Background

Japanese encephalitis (JE) is the leading cause of viral encephalitis across Asia with approximately 70,000 cases a year and 10,000 to 15,000 deaths. Because JE incidence varies widely over time, partly due to inter-annual climate variability effects on mosquito vector abundance, it becomes more complex to assess the effects of a vaccination programme since more or less climatically favourable years could also contribute to a change in incidence post-vaccination. Therefore, the objective of this study was to quantify vaccination effect on confirmed Japanese encephalitis (JE) cases in Sarawak, Malaysia after controlling for climate variability to better understand temporal dynamics of JE virus transmission and control.

Methodology/principal findings

Monthly data on serologically confirmed JE cases were acquired from Sibu Hospital in Sarawak from 1997 to 2006. JE vaccine coverage (non-vaccine years vs. vaccine years) and meteorological predictor variables, including temperature, rainfall and the Southern Oscillation index (SOI) were tested for their association with JE cases using Poisson time series analysis and controlling for seasonality and long-term trend. Over the 10-years surveillance period, 133 confirmed JE cases were identified. There was an estimated 61% reduction in JE risk after the introduction of vaccination, when no account is taken of the effects of climate. This reduction is only approximately 45% when the effects of inter-annual variability in climate are controlled for in the model. The Poisson model indicated that rainfall (lag 1-month), minimum temperature (lag 6-months) and SOI (lag 6-months) were positively associated with JE cases.

Conclusions/significance

This study provides the first improved estimate of JE reduction through vaccination by taking account of climate inter-annual variability. Our analysis confirms that vaccination has substantially reduced JE risk in Sarawak but this benefit may be overestimated if climate effects are ignored.