Spatial-temporal clusters and risk factors of hand, foot, and mouth disease at the district level in Guangdong Province, China. PLoS One 8:e56943

Objective: Hand, foot, and mouth disease (HFMD) has posed a great threat to the health of children and become a public health priority in China. This study aims to investigate the epidemiological characteristics, spatial-temporal patterns, and risk factors of HFMD in Guangdong Province, China, and to provide scientific information for public health responses and interventions. Methods: HFMD surveillance data from May 2008 to December 2011were provided by the Chinese Center for Disease Control and Prevention. We firstly conducted a descriptive analysis to evaluate the epidemic characteristics of HFMD. Then, Kulldorff scan statistic based on a discrete Poisson model was used to detect spatial-temporal clusters. Finally, a spatial paneled model was applied to identify the risk factors. Results: A total of 641,318 HFMD cases were reported in Guangdong Province during the study period (total population incidence: 17.51 per 10,000). Male incidence was higher than female incidence for all age groups, and approximately 90 % of the cases were children ƒ5 years old. Spatial-temporal cluster analysis detected four most likely clusters and several secondary clusters (P,0.001) with the maximum cluster size 50 % and 20 % respectively during 2008–2011. Monthly average temperature, relative humidity, the proportion of population ƒ5 years, male-to-female ratio, and total sunshine were demonstrated to be the risk factors for HFMD