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Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China

Yong Huang1, Te Deng1, Shicheng Yu2, Jing Gu1, Cunrui Huang3, Gexin Xiao2 and Yuantao Hao1*

Author Affiliations

1 Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Zhongshan Road II, Guangzhou, Guangdong Province, 510080, China

2 Chinese Center for Disease Control and Prevention, Beijing, 102206, China

3 School of Public Health & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia

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BMC Infectious Diseases 2013, 13:134  doi:10.1186/1471-2334-13-134

Published: 13 March 2013



Over the last decade, major outbreaks of hand, foot, and mouth disease (HFMD) have been reported in Asian countries, resulting in thousands of deaths among children. However, less is known regarding the effect of meteorological variables on the incidence of HFMD in children. This study aims at quantifying the relationship between meteorological variables and the incidence of HFMD among children in Guangzhou, China.


The association between weekly HFMD cases in children aged <15 years and meteorological variables in Guangzhou from 2008 to 2011 were analyzed using the generalized additive model (GAM) and time-series method, after controlling for long-term trend and seasonality, holiday effects, influenza period and delayed effects.


Temperature and relative humidity with one week lag were significantly associated with HFMD infection among children. We found that a 1°C increase in temperature led to an increase of 1.86% (95% CI: 0.92, 2.81%) in the weekly number of cases in the 0–14 years age group. A one percent increase in relative humidity may lead to an increase of 1.42% (95% CI: 0.97, 1.87%) in the weekly number of cases in the 0–14 years age group.


This study provides quantitative evidence that the incidence of HFMD in children was associated with high average temperature and high relative humidity. The one-week delay in the effects of temperature and relative humidity on HFMD is consistent with the enterovirus incubation period and the potential time lag between onset of children’s sickness and parental awareness and response.

Children; Generalized additive model; Hand, foot, and mouth disease; Meteorological variables; Time series analysis; China