{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:41:36Z","timestamp":1779205296417,"version":"3.51.4"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The purpose of this study is to describe the epidemiological situation of HFMD in Pingdu over the past decade, and investigate the relationship between environmental factors, specifically temperature, and the incidence of hand, foot and mouth disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:bold>S<\/jats:bold>\n                      tatistical techniques, including Distributed Lag Non-linear Models and spatial autocorrelation analysis, were employed to elucidate epidemiological characteristics of hand, foot and mouth disease in Pingdu and the non-linear effects time-lagged relationships of temperature on the incidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of hand, foot and mouth disease in Pingdu exhibits seasonal distribution, and the incidence rate is highest from May to August each year. The spatial distribution shows almost no spatial autocorrelation. Children under the age of 7 account for 91.09% of HFMD cases, with an obvious trend of increased incidence in older age groups by 2023. Notably, severe cases predominantly occurred in children under 3 years old, and EV-A71 accounts for a higher proportion compared with other enteroviruses. The pathogen types of hand, foot and mouth disease have changed from mainly EV-A71 and CVA16 to other enteroviruses. When the daily maximum temperature reaches 33.4\u00b0C, the relative risk (RR\u2009=\u20091.33) is highest at the one lag day.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals the epidemiological characteristics and climate risk factors of hand, foot and mouth disease in Pingdu. It is important to note that children, especially those under the age of 3, are the key population for the prevention and control of hand, foot and mouth disease. It is recommended that health authorities incorporate temperature into the formulation of hand, foot and mouth disease prevention and control policies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0333124","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T17:33:27Z","timestamp":1761327207000},"page":"e0333124","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiological characteristics of hand, foot and mouth disease in Pingdu, Shandong, China from 2013 to 2023 and DLNM analysis of its variation with temperature"],"prefix":"10.1371","volume":"20","author":[{"given":"Hua","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ChangLan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DaiXia","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ShouJie","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9118-0727","authenticated-orcid":true,"given":"XiaoLin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"pone.0333124.ref001","doi-asserted-by":"crossref","first-page":"1377861","DOI":"10.3389\/fpubh.2024.1377861","article-title":"Epidemiological and etiological investigations of hand, foot, and mouth disease in Jiashan, northeastern Zhejiang Province, China, during 2016 to 2022","volume":"12","author":"Y Yuan","year":"2024","journal-title":"Front Public Health"},{"issue":"4","key":"pone.0333124.ref002","doi-asserted-by":"crossref","first-page":"475","DOI":"10.4103\/idoj.idoj_423_22","article-title":"Hand, foot, and mouth disease (HFMD) in India: A review on clinical manifestations, molecular epidemiology, pathogenesis, and prevention","volume":"14","author":"M Lavania","year":"2023","journal-title":"Indian Dermatol Online J"},{"issue":"42","key":"pone.0333124.ref003","article-title":"Case report: Features of hand, foot and mouth disease in neonates","volume":"96","author":"W-W Chen","year":"2017","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"pone.0333124.ref004","article-title":"Forecasting hand-foot-and-mouth disease cases using wavelet-based SARIMA-NNAR hybrid model","volume":"16","author":"G Yu","year":"2021","journal-title":"PLoS One"},{"issue":"12","key":"pone.0333124.ref005","doi-asserted-by":"crossref","first-page":"6400","DOI":"10.3390\/v7122947","article-title":"Epidemiological Research on Hand, Foot, and Mouth Disease in Mainland China","volume":"7","author":"Z-C Zhuang","year":"2015","journal-title":"Viruses"},{"issue":"5","key":"pone.0333124.ref006","doi-asserted-by":"crossref","first-page":"2049168","DOI":"10.1080\/21645515.2022.2049168","article-title":"Disease burden in patients with severe hand, foot, and mouth disease in Jiangsu Province: a cross-sectional study","volume":"18","author":"Y Han","year":"2022","journal-title":"Hum Vaccin Immunother"},{"issue":"1","key":"pone.0333124.ref007","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/17460441.2021.1965987","article-title":"Novel strategies for the development of hand, foot, and mouth disease vaccines and antiviral therapies","volume":"17","author":"C-Y Fang","year":"2022","journal-title":"Expert Opin Drug Discov"},{"issue":"5","key":"pone.0333124.ref008","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s00430-016-0465-y","article-title":"Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategy","volume":"205","author":"S Aswathyraj","year":"2016","journal-title":"Med Microbiol Immunol"},{"issue":"1","key":"pone.0333124.ref009","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s12985-023-02169-x","article-title":"Molecular epidemiology and clinical characteristics of enteroviruses associated HFMD in Chengdu, China, 2013-2022","volume":"20","author":"Q Yang","year":"2023","journal-title":"Virol J"},{"key":"pone.0333124.ref010","unstructured":"World Health Organization Regional Office for the Western Pacific. 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