title: Hand, Foot and Mouth Disease in Hong Kong: A Time-Series Analysis on Its Relationship with Weather.
abstract: BACKGROUND
  Hand, foot and mouth disease (HFMD) is an emerging enterovirus-induced infectious disease for which the environmental risk factors promoting disease circulation remain inconclusive. This study aims to quantify the association of daily weather variation with hospitalizations for HFMD in Hong Kong, a subtropical city in China.
  
  
  METHODS
  A time series of daily counts of HFMD public hospital admissions from 2008 through 2011 in Hong Kong was regressed on daily mean temperature, relative humidity, wind speed, solar radiation and total rainfall, using a combination of negative binomial generalized additive models and distributed lag non-linear models, adjusting for trend, season, and day of week.
  
  
  RESULTS
  There was a positive association between temperature and HFMD, with increasing trends from 8 to 20°C and above 25°C with a plateau in between. A hockey-stick relationship of relative humidity with HFMD was found, with markedly increasing risks over 80%. Moderate rainfall and stronger wind and solar radiation were also found to be associated with more admissions.
  
  
  CONCLUSIONS
  The present study provides quantitative evidence that short-term meteorological variations could be used as early indicators for potential HFMD outbreaks. Climate change is likely to lead to a substantial increase in severe HFMD cases in this subtropical city in the absence of further interventions.
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Pin
authors.initials: P
authors.lastname: Wang
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: William B
authors.initials: WB
authors.lastname: Goggins
authors.affiliation: Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Emily Y Y
authors.initials: EY
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D006813:Humidity; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D017711:Nonlinear Dynamics; D012307:Risk Factors; D012621:Seasons; D013472:Sunlight; D013696:Temperature; D014887:Weather; D014919:Wind