Spatial-temporal Heterogeneity of Hand, Foot and Mouth Disease in China from 2008 to 2018

Hand, Foot and Mouth Disease (HFMD) is a common infectious disease in infants and children and has an important impact on their health. In order to reveal the spatiotemporal heterogeneity of HFMD in China and provide a scientific basis for the prevention and control of HFMD, we select HFMD from 2008 (when HFMD was listed as category C infectious disease) to 2018 as the study period and apply spatial statistical methods including Moran's I, Getis-Ord Gi *, emerging hot spots analysis, and standard deviational ellipse to analyze the general and local spatiotemporal variation and trend of HFMD in China. Results show that: ① from 2008 to 2018, HFMD exhibits a spatial clustering pattern and the intensity of the clustering increases significantly over time; ② the hot spots of HFMD mainly concentrate in the southeast coast and gradually expand towards inland and northern coastal areas. The cold spots mainly concentrate in the northwest inland and the northeast; ③ the emerging hot spots in mainland China mainly occur in Yunnan, Chongqing, and Sichuan provinces, while the emerging cold spots mostly locate in the same regions with the persistent cold spots. Stable hot spots mainly locate in Hainan province in southern China; and ④ high incidence rate of HFMD mainly occurs in the southwest during 2008 and 2018 and gradually occur in the north during 2008-2009, 2013-2014, and 2017-2018. In general, HFMD remains primarily in the south of China. This pattern remains relatively stable throughout the years of observation, indicating that public intervention should be strengthen in the south of China. However, the underlying mechanism of the spatiotemporal distribution of HFMD in China still needs further investigation. Combination of multiple scientific disciplines such as geography, spatial statistics, virology, molecular biology, and public health provides multi-perspectives that can aid the research on the underlying mechanism of HFMD transmission. © 2021, Science Press. All right reserved.