Review Article

Association between Meteorological Parameters and Hand, Foot and Mouth Disease in Mainland China: A Systematic Review and Meta-Analysis


Background: This study reports a systematic review of association between meteorological parameters and hand, foot and mouth disease (HFMD) in mainland China.

Methods: Using predefined study eligibility criteria, three electronic databases (PubMed, Web of Science, and Embase) were searched for relevant articles. Using a combination of search terms, including “Hand foot and mouth disease,” “HFMD,” “Meteorological,” “Climate,” and “China,” After removal of duplicates, our initial search generated 2435 studies published from 1990 to December 31, 2019. From this cohort 51 full-text articles were reviewed for eligibility assessment. The meta-analysis was devised in accordance with the published guidelines of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Effect sizes, heterogeneity estimates and publication bias were computed using R software and Review Manager Software.

Results: The meta-analysis of 18 eligible studies showed that the meteorological parameters played an important role in the prevalence of HFMD. Lower air pressure may be the main risk factor for the incidence of HFMD in Chinese mainland, and three meteorological parameters (mean temperature, rainfall and relative humidity) have a significant association with the incidence of HFMD in subtropical regions. Conclusion: Lower air pressure might be the main risk factor for the incidence of HFMD in Chinese mainland. The influence of meteorological parameters on the prevalence of HFMD is mainly through changing virus viability in aerosols, which may be different in different climate regions. In an environment with low air pressure, wearing a mask that filters the aerosol outdoors may help prevent HFMD infection.
1. Duff MF (1968).Hand-foot-and-mouth syndrome in humans: coxackie A10 infections in New Zealand. Br Med J, 2(5606):661-664.
2. Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY (2007). Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics, 120(2):e244-252.
3. Ma E, Lam T, Chan KC, Wong C, Chuang SK (2010). Changing epidemiology of hand, foot, and mouth disease in Hong Kong, 2001-2009. Jpn J Infect Dis, 63(6):422-426.
4. Ang LW, Koh BK, Chan KP, Chua LT, James L, Goh KT (2009). Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singap, 38(2):106-112.
5. Nguyen NT, Pham HV, Hoang CQ, Nguyen TM, Nguyen LT, Phan HC, Phan LT, Vu LN, Tran Minh NN (2014). Epidemiological and clinical characteristics of children who died from hand, foot and mouth disease in Vietnam, 2011. BMC Infect Dis, 14:341.
6. Mao QY, Wang Y, Bian L, Xu M, Liang Z (2016). EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD). Expert Rev Vaccines, 15(5):599-606.
7. Wu JT, Jit M, Zheng Y, et al (2016). Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis. PLoS Med, 13(3):e1001975.
8. Onozuka D, Hashizume M (2011). The influence of temperature and humidity on the incidence of hand, foot, and mouth disease in Japan. Sci Total Environ, 410-411:119-125.
9. Fujimoto T, Iizuka S, Enomoto M, et al (2012). Hand, foot, and mouth disease caused by coxsackievirus A6, Japan, 2011. Emerg Infect Dis, 18(2):337-339.
10. Pons-Salort M, Oberste MS, Pallansch MA, Abedi GR, Takahashi S, Grenfell BT, Grassly NC (2018).The seasonality of nonpolio enteroviruses in the United States: Patterns and drivers. Proc Natl Acad Sci U S A, 115(12):3078-3083.
11. Tian L, Liang F, Xu M, Jia L, Pan X, Clements ACA (2018). Spatio-temporal analysis of the relationship between meteorological factors and hand-foot-mouth disease in Beijing, China. BMC Infect Dis, 18(1):158.
12. Chen Z, Sun H, Yan Y, et al (2015). Epidemiological profiles of hand, foot, and mouth disease, including meteorological factors, in Suzhou, China. Arch Virol, 160(1):315-321.
13. Feng H, Duan G, Zhang R, Zhang W (2014).Time series analysis of hand-foot-mouth disease hospitalization in Zhengzhou: establishment of forecasting models using climate variables as predictors. PLoS One, 9(1):e87916.
14. Gou F, Liu X, Ren X, et al (2017). Socio-ecological factors and hand, foot and mouth disease in dry climate regions: a Bayesian spatial approach in Gansu, China. Int J Biometeorol, 61(1):137-147.
15. Huang Y, Deng T, Yu S, Gu J, Huang C, Xiao G, Hao Y (2013). Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China. BMC Infect Dis, 13:134.
16. Huang R, Ning H, He T, Bian G, Hu J, Xu G (2019). Impact of PM10 and meteorological factors on the incidence of hand, foot, and mouth disease in female children in Ningbo, China: a spatiotemporal and time-series study. Environ Sci Pollut Res Int, 26(18):17974-17985.
17. Jiang FC, Yang F, Chen L, Jia J, Han YL, Hao B, Cao GW (2016). Meteorological factors affect the hand, foot, and mouth disease epidemic in Qingdao, China, 2007-2014. Epidemiol Infect, 144(11):2354-2362.
18. Li J, Zhang X, Wang L, Xu C, Xiao G, Wang R, Zheng F, Wang F (2019). Spatial-temporal heterogeneity of hand, foot and mouth disease and impact of meteorological factors in arid/ semi-arid regions: a case study in Ningxia, China. BMC Public Health, 19(1):1482.
19. Li L, Qiu W, Xu C, Wang J (2018). A spatiotemporal mixed model to assess the influence of environmental and socioeconomic factors on the incidence of hand, foot and mouth disease. BMC Public Health, 18(1):274.
20. Liu S, Chen J, Wang J, Wu Z, Wu W, Xu Z, Hu W, Xu F, Tong S, Shen H (2018). Predicting the outbreak of hand, foot, and mouth disease in Nanjing, China: a time-series model based on weather variability. Int J Biometeorol, 62(4):565-574.
21. Liu W, Bao C, Zhou Y, et al (2019). Forecasting incidence of hand, foot and mouth disease using BP neural networks in Jiangsu province, China. BMC Infect Dis, 19(1):828.
22. Wu X, Hu S, Kwaku AB, Li Q, Luo K, Zhou Y, Tan H (2017). Spatio-temporal clustering analysis and its determinants of hand, foot and mouth disease in Hunan, China, 2009-2015. BMC Infect Dis, 17(1):645.
23. Yan S, Wei L, Duan Y, et al (2019). Short-Term Effects of Meteorological Factors and Air Pollutants on Hand, Foot and Mouth Disease among Children in Shenzhen, China, 2009-2017. Int J Environ Res Public Health, 16(19):3639.
24. Zhang Q, Zhou M, Yang Y, You E, Wu J, Zhang W, Jin J, Huang F (2019). Short-term effects of extreme meteorological factors on childhood hand, foot, and mouth disease reinfection in Hefei, China: A distributed lag non-linear analysis. Sci Total Environ, 653:839-848.
25. Zheng S, Cao CX, Cheng JQ, Wu YS, Xie X, Xu M (2014). Epidemiological features of hand-foot-and-mouth disease in Shenzhen, China from 2008 to 2010. Epidemiol Infect, 142(8):1751-1762.
26. Xu M, Yu W, Tong S, Jia L, Liang F, Pan X (2015). Non-Linear Association between Exposure to Ambient Temperature and Children's Hand-Foot-and-Mouth Disease in Beijing, China. PLoS One, 10(5):e0126171.
27. Xu Z, Hu W, Jiao K, Ren C, Jiang B, Ma W (2019).The effect of temperature on childhood hand, foot and mouth disease in Guangdong Province, China, 2010-2013: a multicity study. BMC Infect Dis, 19(1):969.
28. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (2000). Improving the Quality of Reports of Meta-Analyses of Randomised Controlled Trials: The QUOROM Statement. Onkologie, 23(6):597-602.
29. Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2010).A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods, 1(2):97-111.
30. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology, 18(6):800-804.
31. Lowen AC, Mubareka S, Steel J, Palese P (2007). Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog, 3(10):1470-1476.
32. Abad FX, Pinto RM, Bosch A (1994). Survival of enteric viruses on environmental fomites. Appl Environ Microbiol, 60(10):3704-3710.
33. Mbithi JN, Springthorpe VS, Sattar SA (1991). Effect of relative humidity and air temperature on survival of hepatitis A virus on environmental surfaces. Appl Environ Microbiol, 57(5):1394-1399.
34. McGeady ML, Siak JS, Crowell RL (1979,). Survival of coxsackievirus B3 under diverse environmental conditions. Appl Environ Microbiol, 37(5):972-977.
35. MD S, JS M (2003). Virus survival in the environment with special attention to survival in sewage droplets and other environmental media of fecal or respiratory origin. WHO, Geneva, Switzerland.
36. Suminski RR, Poston WC, Market P, Hyder M, Sara PA (2008). Meteorological conditions are associated with physical activities performed in open-air settings. Int J Biometeorol, 52(3):189-197.
37. Belanger M, Gray-Donald K, O'Loughlin J, Paradis G, Hanley J (2009). Influence of weather conditions and season on physical activity in adolescents. Ann Epidemiol, 19(3):180-186.
IssueVol 50 No 9 (2021) QRcode
SectionReview Article(s)
Hand foot and mouth disease Meteorological parameters Meta-analysis

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How to Cite
Jiang Y, Xu J, Lai H, Lin H. Association between Meteorological Parameters and Hand, Foot and Mouth Disease in Mainland China: A Systematic Review and Meta-Analysis. Iran J Public Health. 2021;50(9):1757-1765.