| Objective:Analyze the case data of hand,foot and mouth disease in a city in Guangdong Province from 2013 to 2019,and understand its epidemiological characteristics.Establish an early warning model for hand,foot and mouth disease based on mem,formulate epidemic thresholds and divide epidemic periods to achieve epidemic level classification.To evaluate the feasibility of mem model in bimodal distribution data of hand,foot and mouth disease.Establish a daily time series model with temperature as the main dependent variable based on dlnm,and analyze the nonlinear effect of daily average temperature on hand,foot and mouth disease.Methods:Collect data on hand,foot and mouth disease cases in a city in Guangdong Province from 2013 to 2019 through the infectious disease reporting system,and describe the three distributions of the cases.The data of hand,foot and mouth disease cases in a city in Guangdong Province from 2013 to 2019 were cleaned and sorted into the weekly incidence time series data of each week year by year.According to the bimodal distribution characteristics of the incidence curve,it was disassembled into a unimodal distribution,and the peak period was established(6-33 weeks)and sub-peak period(34-5 weeks in the following year)mem model,calculate the sensitivity,specificity and Youden index and other indicators of the two to evaluate the pros and cons of the model.Finally,the prevalence of hand,foot and mouth disease in 2019/2020 is warned based on the baseline year.Clean the data of hand,foot and mouth disease cases from 2013 to 2019 in a city in Guangdong Province,and organize them into daily incidence counttype time series data;at the same time collect the daily meteorological data of a city in Guangdong Province from 2013 to 2019,including average temperature,maximum temperature,minimum temperature,and average Air pressure,average relative humidity,average rainfall,average sunshine time and average wind speed,etc.,match the daily incidence data with the daily weather data one by one to form a day-to-weather time series data.Based on the time series,establish a two-dimensional cross-base with daily average temperature as the research independent variable,and then construct dlnm by connecting the log function with the number of daily incidences as the Quasi Poisson distribution,and use the generalized additive model(gam)to fit and analyze the daily average temperature.Impact on the incidence of hand,foot and mouth disease in the general population.Classify the original time series data by age(0,1,2,3,4,5),gender(male,female),and group classification(scattered children,kindergarten children,and students),and form their own time series data After modeling,analyze the influence of daily average temperature on the incidence of hand,foot and mouth disease in different subgroups.Results:A total of 110,459 cases of hand-foot-mouth disease were reported from2013 to 2019 in a city in Guangdong Province,with an incidence between402.97(1/100,000)and 595.31(1/100,000),with an average annual incidence of 485.40(1/10 Million).The incidence follows a southern bimodal distribution.The average age of onset of the cases was 2.2±2.53 years,and the male-tofemale ratio was 1.47.The main population was children aged 5 years and under and scattered children.The sensitivity,specificity,and Youden index of the mem model during the peak epidemic period(6～33 weeks)are 0.987,0.913,0.9;the sensitivity,specificity,and approximation of the mem model during the second peak epidemic period(34～5 weeks of the following year)The index is 0.808,0.962,0.770.The early warning results showed that the peak period of 2019/2020(6～33 weeks)entered the prevalence week of hand,foot and mouth disease from the 15 th week,and continued until the last week of the epidemic season for a total of 19 weeks;the overall prevalence level was low.The second peak period of 2019/2020(34～5 weeks of the following year)will enter the prevalence week of hand,foot and mouth disease from 34 weeks to 43 weeks,lasting 10 weeks in total,and the overall prevalence level is also low.Temperature has a nonlinear effect on the incidence of hand,foot and mouth disease in a city in Guangdong Province from 2013 to 2019.The relationship between temperature and cumulative incidence is similar to the "M" type,which can be specifically classified as increasing the cumulative risk of incidence(RR>1)Low temperature range(6.04℃～10.87℃)and high temperature range(23.2℃～31.27℃),the optimum temperature range(10.87℃～23.2℃)that has a protective effect on cumulative disease(RR<1).The cold and heat effects of temperature coexist and have different characteristics;the cold effect can quickly increase the risk of disease in a short time,and then disappear;the heat effect slowly and steadily increase the risk of disease,the trend of change is single,and it is maintained during a long lag period.The “harvesting” phenomenon is only observed in the “lower temperature” interval(p5～p25);the lower the temperature in the “lower temperature” interval,the more obvious the “harvesting” phenomenon;females,3-year-olds and children in kindergartens are at 14.7℃ Belongs to the susceptible population,susceptible to hand,foot and mouth disease,but the disease is not recurrent.Extreme low temperature(p0.5)can increase the risk of cumulative disease during the lagging period.At this time,the disease is recurrent and the "harvesting" phenomenon disappears;extreme high temperature(p99.5)directly protects the cumulative effect.The previous "high temperature" The cumulative risk increase effect caused by the interval disappeared,and the effect was reversed.Conclusion:1.There were no specific findings on the incidence of hand-foot-mouth disease from 2013 to 2019 in a city in Guangdong Province,and the distribution was bimodal in time.Children aged 0 to 5 were the main population with the disease.The incidence is roughly the same as that of Guangdong Province and other cities in the Pearl River Delta.2.The mem model can be better applied to the distribution data of bimodal hand,foot and mouth disease.3.Temperature has a non-linear hysteresis effect on the incidence of hand,foot and mouth disease in a city in Guangdong Province from 2013 to 2019;cold and heat effects coexist,with different characteristics.4.According to the "harvesting" phenomenon in dlnm,the sensitive population without recurrence in the subgroup analysis can be identified. |
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