title: Spatiotemporal Cluster Patterns of Hand, Foot, and Mouth Disease at the County Level in Mainland China, 2008-2012.
abstract: BACKGROUND
  Hand, foot, and mouth disease (HFMD) is known to be a highly contagious childhood illness. In recent years, the number of reported cases of HFMD has significantly increased in mainland China. This study aims at the epidemiological features, spatiotemporal patterns of HMFD at the county/district level in mainland China.
  
  
  METHODS
  Data on reported HFMD cases for each county from 1 January 2008 to 31 December 2012 were obtained from the Chinese Center for Disease Control and Prevention. Cluster analysis, spatial autocorrelation, and retrospective scan methods were used to explore the spatiotemporal patterns of the disease.
  
  
  RESULTS
  The annual incidences varied greatly among the counties, ranging from 0 to 74.31‰ with the median of 5.42‰ (interquartile range: 1.54‰-13.55‰) during 2008-2012 in mainland China. Counties close to provincial capital cities generally had higher incidences than rural counties. A seasonal distribution was observed between the northern and southern China, of which dual epidemic were shown in southern China and usually only one in northern China. Based on the global and local spatial autocorrelation analysis, we found that the spatial distribution of HFMD was presented a significant clustering pattern for each year (P<0.001), and hotspots of the disease were mostly distributed in coastal provinces of China. The retrospective scan statistic further identified the dynamics of spatiotemporal clustering areas of the disease, which were mainly distributed in the counties of eastern and southern China, as well as provincial capitals and their surrounding counties.
  
  
  CONCLUSIONS
  The spatiotemporal clustering areas of the disease identified in this way were relatively stable, and imminent public health planning and resource allocation should be focused within those areas.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.|Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.affiliation: National Center for Public Health, Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Cao
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Tao
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Gao
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.|School of Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Fang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Guo
mesh_terms: D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D062211:Spatio-Temporal Analysis
references.citation: Am J Trop Med Hyg. 1998 Mar;58(3):287-98
references.pmid: 9546405
references.citation: Am J Epidemiol. 1997 Jul 15;146(2):161-70
references.pmid: 9230778
references.citation: Emerg Infect Dis. 2007 Nov;13(11):1733-41
references.pmid: 18217559
references.citation: Ann Acad Med Singapore. 2009 Feb;38(2):106-12
references.pmid: 19271036
references.citation: Malar J. 2009;8:68
references.pmid: 19374738
references.citation: Int J Infect Dis. 2010 Sep;14(9):e775-80
references.pmid: 20599410
references.citation: Lancet Infect Dis. 2010 Nov;10(11):778-90
references.pmid: 20961813
references.citation: Jpn J Infect Dis. 2010 Nov;63(6):422-6
references.pmid: 21099093
references.citation: Zhonghua Liu Xing Bing Xue Za Zhi. 2011 Mar;32(3):274-8
references.pmid: 21457665
references.citation: Int J Health Geogr. 2011;10:25
references.pmid: 21466689
references.citation: J Microbiol Immunol Infect. 2011 Aug;44(4):265-73
references.pmid: 21524954
references.citation: Virol Sin. 2011 Aug;26(4):221-8
references.pmid: 21847753
references.citation: Arch Virol. 2011 Nov;156(11):2007-13
references.pmid: 21898187
references.citation: Biomed Environ Sci. 2011 Aug;24(4):349-56
references.pmid: 22108323
references.citation: PLoS One. 2012;7(6):e38978
references.pmid: 22723913
references.citation: Zhonghua Liu Xing Bing Xue Za Zhi. 2012 Aug;33(8):808-12
references.pmid: 22967334
references.citation: Zhonghua Liu Xing Bing Xue Za Zhi. 2012 Aug;33(8):813-7
references.pmid: 22967335
references.citation: PLoS One. 2013;8(2):e56943
references.pmid: 23437278
references.citation: BMC Infect Dis. 2013;13:134
references.pmid: 23497074
references.citation: PLoS One. 2013;8(5):e63447
references.pmid: 23704909
references.citation: Geospat Health. 2013 May;7(2):381-90
references.pmid: 23733299
references.citation: PLoS One. 2013;8(7):e68336
references.pmid: 23874592
references.citation: PLoS One. 2014;9(2):e88065
references.pmid: 24505378
references.citation: PLoS One. 2014;9(3):e92745
references.pmid: 24663329
references.citation: Lancet Infect Dis. 2014 Apr;14(4):308-18
references.pmid: 24485991
references.citation: Epidemiol Infect. 2015 Mar;143(4):831-8
references.pmid: 25703402
references.citation: Int J Infect Dis. 2015 May;34:66-70
references.pmid: 25770912
references.citation: PLoS One. 2015;10(5):e0126158
references.pmid: 25993120
references.citation: Br Med J. 1968 Jun 15;2(5606):661-4
references.pmid: 5658411
references.citation: PLoS One. 2007;2(12):e1284
references.pmid: 18074010