Temperature and hand, foot and mouth disease in California: An exploratory analysis of emergency department visits by season, 2005-2013.

ABSTRACT

BACKGROUND: For the past decade, hand, foot and mouth disease (HFMD), caused by entero and coxsackie viruses, has been spreading in Asia, particularly among children, overloading healthcare settings and creating economic hardships for parents. Recent studies have found meteorological factors, such as temperature, are associated with HFMD in Asia. However, few studies have explored the relationship in the United States, although HFMD cases have steadily increased recently. As concerns of climate change grow, we explored the association between temperature and HFMD admissions to the Emergency Department (ED) in California. METHODS: Weekly counts of HFMD for 16 California climate zones were collected from 2005 to 2013. We calculated weekly temperature for each climate zone using an inverse distance-weighting method. For each climate zone stratified by season, we conducted a time-series using Poisson regression models. We adjusted models for weekly averaged relative humidity, average number of HFMD cases in previous weeks and long-term temporal trends. Climate zone estimates were combined to obtain an overall seasonal estimate. We attempted stratified analyses by region, race/ethnicity, and sex to identify sensitive subpopulations. RESULTS: Risk of ED visits for HFMD per 1 °F increase in mean temperature during the same week increased 2.00% (95% confidence intervals 1.15, 2.86%) and 2.35% (1.38, 3.33%) during the warm and cold seasons, respectively. The coastal region showed a higher, though not statistically different, association during the cold season [3.18% (1.99, 4.39)] than the warm season [1.64% (0.47, 2.82)]. CONCLUSIONS: Our findings indicated an association between temperature and ED visits for HFMD, with variation by season and region. Thus, the causative pathogen's ability to persist in the atmosphere may vary by season. Furthermore, the mild and wet winter in the coastal region of California may contribute to different results than studies in Asia. With the onset of climate change, HFMD cases will likely grow in California, warranting further investigation on this relationship, including new populations at-risk.