Early warning of hand, foot, and mouth disease transmission: A modeling study in mainland, china

Jia Rui, Kaiwei Luo, Qiuping Chen, Dexing Zhang, Qinglong Zhao, Yanhong Zhang, Xiongjie Zhai, Zeyu Zhao, Siyu Zhang, Yuxue Liao, Shixiong Hu, Lidong Gao, Zhao Lei, Mingzhai Wang, Yao Wang, Xingchun Liu, Shanshan Yu, Fang Xie, Jia Li, Ruoyun LiuYi Chen Chiang, Benhua Zhao, Yanhua Su*, Xu Sheng Zhang*, Tianmu Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
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Background: Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model. 

Methods: This study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, “epidemic acceleration week (EAW)” and “recommended warning week (RWW)”, were calculated to show the early warning time. 

Results: The mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R2 > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions. 

Conclusions: The disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.

Original languageEnglish
Article numbere0009233
Number of pages23
JournalPLoS Neglected Tropical Diseases
Issue number3
Publication statusPublished - 24 Mar 2021

Bibliographical note

Funding Information: This study was partly supported by the Bill & Melinda Gates Foundation (No: INV-005834), Science and Technology Program of Fujian Province (No: 2020Y0002), the Xiamen New Coronavirus Prevention and Control Emergency Tackling Special Topic Program (No: 3502Z2020YJ03), the XMU Training Program of Innovation and Enterpreneurship for Undergraduates (2019Y1497, 2019Y1500, 2019Y1501), the Chinese Preventive Medicine Association (20101801), the Scientific Research Project of Hunan Provincial Health Commission (B2019039), the Hunan Provincial Natural Science Foundation (2019JJ80115), and the Scientific Research Project of Hunan Provincial Health Commission (B2019038). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and
source are credited.

Publisher Copyright: © 2021 Rui et al.

Citation: Rui J, Luo K, Chen Q, Zhang D, Zhao Q, Zhang Y, et al. (2021) Early warning of hand, foot, and mouth disease transmission: A modeling study in mainland, China. PLoS Negl Trop Dis 15(3):e0009233.

DOI: https://doi.org/10.1371/journal.pntd.0009233


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