title: Hand, foot and mouth disease: spatiotemporal transmission and climate.
abstract: BACKGROUND
  The Hand-Foot-Mouth Disease (HFMD) is the most common infectious disease in China, its total incidence being around 500,000~1,000,000 cases per year. The composite space-time disease variation is the result of underlining attribute mechanisms that could provide clues about the physiologic and demographic determinants of disease transmission and also guide the appropriate allocation of medical resources to control the disease.
  
  
  RESULTS
  HFMD cases were aggregated into 1456 counties and during a period of 11 months. Suspected climate attributes to HFMD were recorded monthly at 674 stations throughout the country and subsequently interpolated within 1456 × 11 cells across space-time (same as the number of HFMD cases) using the Bayesian Maximum Entropy (BME) method while taking into consideration the relevant uncertainty sources. The dimensionalities of the two datasets together with the integrated dataset combining the two previous ones are very high when the topologies of the space-time relationships between cells are taken into account. Using a self-organizing map (SOM) algorithm the dataset dimensionality was effectively reduced into 2 dimensions, while the spatiotemporal attribute structure was maintained. 16 types of spatiotemporal HFMD transmission were identified, and 3-4 high spatial incidence clusters of the HFMD types were found throughout China, which are basically within the scope of the monthly climate (precipitation) types.
  
  
  CONCLUSIONS
  HFMD propagates in a composite space-time domain rather than showing a purely spatial and purely temporal variation. There is a clear relationship between HFMD occurrence and climate. HFMD cases are geographically clustered and closely linked to the monthly precipitation types of the region. The occurrence of the former depends on the later.
authors.affiliation: LREIS, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China. wangjf@igsnrr.ac.cn
authors.forename: Jin-feng
authors.initials: JF
authors.lastname: Wang
authors.forename: Yan-Sha
authors.initials: YS
authors.lastname: Guo
authors.forename: George
authors.initials: G
authors.lastname: Christakos
authors.forename: Wei-Zhong
authors.initials: WZ
authors.lastname: Yang
authors.forename: Yi-Lan
authors.initials: YL
authors.lastname: Liao
authors.forename: Zhong-Jie
authors.initials: ZJ
authors.lastname: Li
authors.forename: Xiao-Zhou
authors.initials: XZ
authors.lastname: Li
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Lai
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Chen
mesh_terms: D002681:China / Q000208:ethnology; D002980:Climate; D006232:Hand, Foot and Mouth Disease / Q000208:ethnology* / Q000635:transmission*; D006801:Humans; D013997:Time Factors