title: Detecting spatial-temporal cluster of hand foot and mouth disease in Beijing, China, 2009-2014.
abstract: The incidence of hand, foot, and mouth disease (HFMD) is extremely high, and has constituted a huge disease burden throughout Beijing in recent years. This study aimed to determine the spatiotemporal distribution and epidemic characteristics of HFMD.
  
  
  
  Descriptive statistics was used to analyze the data and estimate the epidemic peaks in 2009-2014. Space-time scanning detected spatiotemporal clusters and identified high-risk locations. Global and local Moran's I statistics were used to measure the spatial autocorrelation. Geocoding was performed in ArcGIS, based on the present address codes of the patients and the centroids of the towns. Maps were created in ArcGIS to show the geographic spread of HFMD.
  
  
  
  In total, 220,451probable cases of HFMD were reported in Beijing between January 2009 and December 2014: 12,749 (5.78 %) were laboratory confirmed, and 35 (0.02 %) were fatal. The median age of reported cases was 3.12 years (interquartile range 1.96-4.39). Coxsackievirus A16 (CV-A16), enterovirus 71 (EV-A71), and other enteroviruses accounted for 39.31, 35.36, and 25.33 % of the 12,749 confirmed cases, respectively. Many more severe cases were caused by EV-A71 (χ (2) = 186.41, df = 1, P < 0.001) and other enteroviruses (χ (2) = 156.44, df = 1, P < 0.001) than by CV-A16. A large single distinct peak occurred between May and July each year. Spatiotemporal clusters of HFMD were identified in Beijing during 2009-2014. The most likely clusters were detected and tended to move from the southwest (Fengtai and Daxing) southeastwards to Daxing and Tongzhou in 2009-2014. The incidence of HFMD was not randomly distributed, but showed global and local spatial autocorrelations.
  
  
  
  There were obvious spatiotemporal clusters of HFMD in Beijing in 2009-2014. High-incidence areas mainly occurred at the junctions of urban and rural zones. More attention should be paid to the epidemiological and spatiotemporal characteristics of HFMD to establish new strategies for its control. Health issues should be especially promoted in kindergartens and at urban-rural junctions.
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Haikun
authors.initials: H
authors.lastname: Qian
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Da
authors.initials: D
authors.lastname: Huo
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Wang
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jia
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Xitai
authors.initials: X
authors.lastname: Li
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Baiwei
authors.initials: B
authors.lastname: Liu
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
authors.forename: Xiaona
authors.initials: X
authors.lastname: Wu
authors.affiliation: Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China. bjcdcxm@126.com.
authors.forename: Quanyi
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000818:Animals; D000068476:Beijing / Q000453:epidemiology; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004770:Enterovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058872:Epidemics; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011247:Pregnancy; D062206:Spatial Analysis
keywords: Epidemiology; Hand, foot, and mouth disease; Space–time clustering; Spatial distribution; Spatiotemporal