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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.

Original publication




Journal article


PLoS One

Publication Date





Adolescent, Child, Child, Preschool, Female, Hand, Foot and Mouth Disease, Hong Kong, Hospitalization, Humans, Humidity, Infant, Infant, Newborn, Male, Models, Statistical, Nonlinear Dynamics, Risk Factors, Seasons, Sunlight, Temperature, Weather, Wind