{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:24:12Z","timestamp":1788791052165,"version":"build-2803163510"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012165","name":"Key Technologies Research and Development Program","doi-asserted-by":"publisher","award":["2022YFC2305305"],"award-info":[{"award-number":["2022YFC2305305"]}],"id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-016826"],"award-info":[{"award-number":["INV-016826"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n Studies have documented the impact of temperature on the incidence of hand, foot, and mouth disease (HFMD); however, no study has examined its impact on the transmissibility.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The longitudinal surveillance data of HFMD in Zhejiang Province during 2013-2019 were collected from National Notifiable Infectious Diseases Reporting Information System. The incidence of HFMD was represented by daily case counts, and the transmissibility was quantified as the instantaneous reproductive number (\n \n \n \n \n \n \n R<\/mml:mi>\n t<\/mml:mi>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ). The case time series design was applied to investigate the association between temperature and HFMD incidence at small-scale spatial patterns (i.e., townships). General additive model was further employed to analyze the effects of temperature and other driving factors on the transmissibility of HFMD. Separate models were also conducted for each city, along with seasonal and spatial stratified analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We observed an inverted V-shaped association between temperature and HFMD incidence, with the highest cumulative relative risk (RR: 3.81, 95% CI: 3.75-3.86) at 28\u00b0C compared to the reference temperature. Notably, we discovered that HFMD transmissibility exhibited a similar but more pronounced sensitivity to temperature changes, peaking at a lower temperature of 19.69\u00b0C. City-specific and stratified results were aligned with the overall provincial pattern. Additionally, other significant driving factors of HFMD transmissibility included the depletion of susceptible individuals, school holidays, vaccination program, relative humidity, and the Normalized Difference Vegetation Index.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Nonlinear associations between temperature and HFMD incidence, as well as transmissibility, are observed. Other driving factors potentially contribute to changes in HFMD dynamic transmission. These findings underscore the importance of implementing targeted policies aimed at early intervention, particularly when HFMD transmissibility begins to reach its peak.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0012884","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T13:37:15Z","timestamp":1742305035000},"page":"e0012884","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effects of temperature and environmental covariates on the dynamic transmission of hand, foot, and mouth disease in Zhejiang, China"],"prefix":"10.1371","volume":"19","author":[{"given":"Wanqi","family":"Wen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziping","family":"Miao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dashan","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengmin (Min)","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"de Foy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimin","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-9408","authenticated-orcid":true,"given":"Hualiang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"issue":"3","key":"pntd.0012884.ref001","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10096-018-3206-x","article-title":"Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention","volume":"37","author":"S Esposito","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"pntd.0012884.ref002","doi-asserted-by":"crossref","first-page":"e000442","DOI":"10.1136\/bmjgh-2017-000442","article-title":"Severity and burden of hand, foot and mouth disease in Asia: a modelling study","volume":"3","author":"WM Koh","year":"2018","journal-title":"BMJ Glob Health"},{"issue":"9","key":"pntd.0012884.ref003","doi-asserted-by":"crossref","first-page":"e2552","DOI":"10.1093\/cid\/ciaa1853","article-title":"Basic reproduction number of enterovirus 71 and Coxsackievirus a16 and a6: evidence from outbreaks of hand, foot, and mouth disease in China between 2011 and 2018","volume":"73","author":"Z Zhang","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pntd.0012884.ref004","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1097\/INF.0b013e3182116e95","article-title":"Estimation of the basic reproduction number of enterovirus 71 and coxsackievirus A16 in hand, foot, and mouth disease outbreaks","volume":"30","author":"E Ma","year":"2011","journal-title":"Pediatric Infectious Disease Journal"},{"issue":"5","key":"pntd.0012884.ref005","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1017\/S0950268815002137","article-title":"Basic reproduction number of coxsackievirus type A6 and A16 and enterovirus 71: estimates from outbreaks of hand, foot and mouth disease in Singapore, a tropical city-state","volume":"144","author":"CTK Lim","year":"2016","journal-title":"Epidemiol Infect"},{"issue":"10","key":"pntd.0012884.ref006","doi-asserted-by":"crossref","first-page":"E285","DOI":"10.1097\/INF.0000000000001242","article-title":"The epidemiology of hand, foot and mouth disease in Asia: A systematic review and analysis","volume":"35","author":"W Koh","year":"2016","journal-title":"Pediatr.\u00a0Infect.\u00a0Dis. 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