The study area, Changsha, China.

<p>The study area, Changsha, China.</p

Summary of model performance and the estimated coefficients.

<p>Abbreviations: ARIMA = Autoregressive Integrated Moving Average; S = Seasonal; X = with explanatory variables; LST = Land Surface Temperature; AP = Accumulative Precipitation; NDVI = Normalized Difference Vegetation Index; TVDI = Temperature Vegetation Dryness Index; MRPE = Mean Relative Prediction Error; AIC = Akaike’s Information Criterion; AR = Autoregressive coefficients; MA = Moving Average Coefficients; Est = Estimated values through conditional least square method.</p

Cross-correlations between pre-whitened series and the rodent density.

*<p><i>p</i><0.05,</p>**<p><i>p</i><0.01.</p

Observed versus predicted rodent density in Changsha.

<p><b>(a) Temporal dynamics and (b) scatterplot.</b></p

Environmental variables in Changsha.

<p><b>(a) monthly average of temperature, (b) monthly accumulated rainfall and (c) monthly NVDI and TVDI for rice paddies.</b></p

Geographic location of Changsha, China.

<p>Geographic location of Changsha, China.</p

Hand, Foot, and Mouth Disease in Hunan Province, China, 2009-2014: Epidemiology and Death Risk Factors

<div><p>Hand, foot, and mouth disease (HFMD) is an arising public health problem in Asia, including China. Epidemiological data is necessary to enable judicious public health responses and interventions. We analyzed the epidemiological and laboratory data of 759,301 HFMD cases reported to the Hunan Provincial Center for Disease Control and Prevention from 1 January 2009 to 31 December 2014. Univariate and multivariable conditional logistic regression analyses were used to identify risk factors of fatality in HFMD. The incidence of HFMD was highest among children aged 1–3 years, compared with other age groups. Of the total HFMD cases, 7,222 (0.95%) were considered severe and 338 (0.04%) were fatal. Enterovirus-A71 was the major cause of severe and fatal cases (65.75% and 88.78%, respectively). For severe cases, the median time from symptom onset to diagnosis was 0.5 days (interquartile range [IQR] 0–1.5 days); the median time from diagnosis to severe illness was 2 days (IQR 1–3 days). For fatal cases, the median time from symptom onset to diagnosis was 0.5 days (IQR 0–1.5 days); the median time from diagnosis to death was 1.5 days (IQR 0.5–2.5 days). In multivariable analysis, the abuse of antibiotic, glucocorticoid and pyrazolone in village clinics at basic medical institutions were identified as independent risk factors for HFMD fatal cases. In conclusion, our results suggest that the future direction to control and respond to HFMD is intensive surveillance of enterovirus-A71 and improving the ability to diagnose disease and treat patients, especially in basic medical institutions.</p></div

Time interval of HFMD development in severe cases and fatal cases.

<p>(A) A:Symptom onset; B: diagnosis; C: start of severe illness; D: death. (B) The time 0 is symptom onset, and the mean in each block is in reference to the location of the previous block.</p

Wavelet power spectrum of HFRS incidence in Changsha.

<p>(<i>A</i>) Temporal variation in climatic variables and the number of hemorrhagic fever with renal syndrome (HFRS) cases in Changsha, 1991–2010. (<i>B</i>) The wavelet power spectrum of monthly number of HFRS cases by date of symptoms onset reported through the surveillance system in Changsha during the period 1991–2010 (square root transformed). The left panel illustrates the wavelet power spectrum for the different series (x-axia: time in year; y-axis: period in year). The power is coded from low values, in dark blue, to high values, in dark red. Statistically significant areas (threshold of 5% confidence interval) in wavelet power spectrum (left panels) are highlighted with dashed line; the cone of influence (region not influenced by edge effects) is also indicated. Finally, the right panels show the mean spectrm (solid line) with its significant threshold value of 5% (dashed line).</p

Maximum cross-correlation coefficients of monthly environmental variables and notifications of HFRS: Changsha, China, 1991–2010

*<p><i>p</i><0.01.</p>a<p>Chi-square test for cross-correlations.</p