{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:54:09Z","timestamp":1791266049349,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n In China, hand, foot, and mouth disease (HFMD) persists as a prevalent infectious disease with high transmissibility. Nevertheless, the link between environmental determinants and HFMD incidence has not been fully elucidated. The study assessed associations between air pollution, meteorological conditions, and HFMD incidence in Shenzhen, China, while also evaluating shifts in these associations before and after the Enterovirus 71 vaccine and during the COVID-19 epidemic.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Daily data on HFMD cases, air pollutants (such as PM\n 2.5<\/jats:sub>\n , PM\n 10<\/jats:sub>\n , SO\n 2<\/jats:sub>\n , NO\n 2<\/jats:sub>\n , CO, and O\n 3<\/jats:sub>\n ), and meteorological variables (including mean temperature, relative humidity, atmospheric pressure, and wind speed) were collected for the period from 2013 to 2022. Associations were assessed using distributed lag non-linear models (DLNM), accounting for immediate and delayed effects.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Spearman correlation analysis showed that HFMD was positively correlated with SO\u2082, mean temperature, relative humidity, and wind speed, and negatively with PM\u2082.\u2085, PM\u2081\u2080, NO\u2082, CO, and atmospheric pressure. DLNM models revealed that SO\u2082 and CO both elevated cumulative risk at extremely high concentrations, with SO\u2082 showing delayed effects. However, SO\u2082 unexpectedly displayed protective effects in single-lag analysis. NO\u2082 exhibited a U-shaped risk at extreme concentrations despite an overall decreasing trend. O\u2083 showed dual peaks, with protective effects at extremely high concentrations after lag 1. PM\n 2.5<\/jats:sub>\n and PM\n 10<\/jats:sub>\n showed risk peaks at low concentrations but protective effects at extremely high concentrations. Temperature exhibited a dual-peak risk pattern at extremely low and extremely high temperatures, with extreme heat producing sustained effects and extreme cold shorter-lived risk. HFMD risk increased under conditions of extremely high humidity. In general, the risk associated with atmospheric pressure rose as pressure levels increased, and asymmetric lagged effects were observed at both low- and high-concentration extremes. Extremely high wind speed causing short-term harm and extremely low wind speed leading to delayed cumulative risk.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Meteorological factors exhibit more consistent associations than air pollutants. Mean temperature showed a dual-peak distribution with persistent effects from high temperatures, while atmospheric pressure presented long-lasting impacts of low pressure. There is a positive correlation between relative humidity and the incidence of HFMD. Air pollutants showed inconsistent associations with HFMD. These findings support targeted public health interventions for meteorological factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1920424","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:21:01Z","timestamp":1791264061000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ambient air pollution and meteorological factors associated with hand, foot, and mouth disease risk in Shenzhen, China: a time-series study"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuai","family":"Jiang","sequence":"first","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Liu","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, The University of Adelaide","place":["Adelaide, SA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajia","family":"Ji","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanpeng","family":"Cheng","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guomin","family":"Chen","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigao","family":"Chen","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoheng","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huawei","family":"Xiong","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Disease Control and Prevention","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0261629","DOI":"10.1371\/journal.pone.0261629","article-title":"Analysis and prediction of hand, foot and mouth disease incidence in China using random forest and XGBoost","volume":"16","author":"Meng","year":"2021","journal-title":"PLoS One"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s12519-018-0189-8","article-title":"Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)","volume":"14","author":"Li","year":"2018","journal-title":"World J Pediatr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1186\/s12879-024-10252-z","article-title":"Impact of non-pharmacological interventions on incidence of hand, foot and mouth disease during the COVID-19 pandemic: a large population-based observational study","volume":"24","author":"Ma","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12929-023-00908-4","article-title":"Current status of hand-foot-and-mouth disease","volume":"30","author":"Zhu","year":"2023","journal-title":"J Biomed Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1136\/bmj.2.5214.1708","article-title":"\u201cHand-foot-and-mouth disease\u201d In Birmingham in 1959","volume":"2","author":"Alsop","year":"1960","journal-title":"Br Med J"},{"key":"ref6","doi-asserted-by":"publisher","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":"Koh","year":"2018","journal-title":"BMJ Glob Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/j.ejpn.2018.04.007","article-title":"Outcomes following severe hand foot and mouth disease: a systematic review and meta-analysis","volume":"22","author":"Jones","year":"2018","journal-title":"Eur J Paediatr Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1590\/s1678-9946201860070","article-title":"Hand, foot and mouth disease and herpangina caused by enterovirus A71 infections: a review of enterovirus A71 molecular epidemiology, pathogenesis, and current vaccine development","volume":"60","author":"Chang","year":"2018","journal-title":"Rev Inst Med Trop Sao Paulo"},{"key":"ref9","doi-asserted-by":"publisher","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":"Esposito","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"04220","DOI":"10.7189\/jogh.16.04220","article-title":"Global epidemiological and aetiological patterns of hand, foot, and mouth disease: a country-level scoping synthesis","volume":"16","author":"Li","year":"2026","journal-title":"J Glob Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1278516","DOI":"10.3389\/fpubh.2023.1278516","article-title":"Impact of meteorological factors on the incidence of hand-foot-mouth disease in Yangzhou from 2017 to 2022: a time series study","volume":"11","author":"Guo","year":"2023","journal-title":"Front Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2825","DOI":"10.1186\/s12889-024-20342-x","article-title":"Air pollution's numerical, spatial, and temporal heterogeneous impacts on childhood hand, foot and mouth disease: a multi-model county-level study from China","volume":"24","author":"Tang","year":"2024","journal-title":"BMC Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3993","DOI":"10.1038\/s41598-023-31035-7","article-title":"Associations between ambient air pollutants and childhood hand, foot, and mouth disease in Sichuan, China: a spatiotemporal study","volume":"13","author":"Qian","year":"2023","journal-title":"Sci Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"481","DOI":"10.3390\/ijerph13050481","article-title":"Effects of meteorological parameters and PM10 on the incidence of hand, foot, and mouth disease in children in China","volume":"13","author":"Huang","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.scitotenv.2018.07.329","article-title":"Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China","volume":"646","author":"Yu","year":"2019","journal-title":"Sci Total Environ"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1038\/s41370-021-00291-y","article-title":"Daily mean temperature and HFMD: risk assessment and attributable fraction identification in Ningbo China","volume":"31","author":"Zhang","year":"2021","journal-title":"J Expo Sci Environ Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1186\/s12889-022-13365-9","article-title":"Relationship between meteorological factors, air pollutants and hand, foot and mouth disease from 2014 to 2020","volume":"22","author":"Peng","year":"2022","journal-title":"BMC Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.3390\/atmos14121806","article-title":"Ambient ozone and fine particular matter pollution in a megacity in South China: trends, concurrent pollution, and health risk assessment","volume":"14","author":"Zeng","year":"2023","journal-title":"Atmosphere (Basel)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"11141","DOI":"10.1007\/s13762-024-06112-7","article-title":"Driving factors of summer diurnal surface thermal environment in subtropical coastal cities: a Shenzhen case study","volume":"22","author":"Guo","year":"2024","journal-title":"Int J Environ Sci Technol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.3390\/vaccines12091028","article-title":"Effectiveness of EV-A71 vaccine and its impact on the incidence of hand, foot and mouth disease: a systematic review","volume":"12","author":"Hu","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"450","DOI":"10.5582\/bst.2018.01126","article-title":"Forecasting hand, foot, and mouth disease in Shenzhen based on daily level clinical data and multiple environmental factors","volume":"12","author":"Zhong","year":"2018","journal-title":"Biosci Trends"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"3639","DOI":"10.3390\/ijerph16193639","article-title":"Short-term effects of meteorological factors and air pollutants on hand, foot and mouth disease among children in Shenzhen, China, 2009-2017","volume":"16","author":"Yan","year":"2009","journal-title":"Int J Environ Res Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.scitotenv.2015.09.027","article-title":"Short-term effects of meteorological factors on hand, foot and mouth disease among children in Shenzhen, China: non-linearity, threshold and interaction","volume":"539","author":"Zhang","year":"2016","journal-title":"Sci Total Environ"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"20355","DOI":"10.1038\/s41598-023-47858-3","article-title":"Non-linear association between daily mean temperature and children's hand foot and mouth disease in Chongqing, China","volume":"13","author":"Yang","year":"2023","journal-title":"Sci Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"8017","DOI":"10.3390\/ijerph17218017","article-title":"Association of Short-Term Exposure to meteorological factors and risk of hand, foot, and mouth disease: a systematic review and Meta-analysis","volume":"17","author":"Liu","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1186\/s12889-025-22148-x","article-title":"Scoping review on assessing climate-sensitive health risks","volume":"25","author":"Yenew","year":"2025","journal-title":"BMC Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12940-024-01136-5","article-title":"The last decade of air pollution epidemiology and the challenges of quantitative risk assessment","volume":"23","author":"Forastiere","year":"2024","journal-title":"Environ Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.azn.2025.01.003","article-title":"Progress in the molecular epidemiology of chikungunya virus","volume":"1","author":"Zhang","year":"2025","journal-title":"Anim Zoonoses"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.scitotenv.2018.11.481","article-title":"Short-term exposure to sulfur dioxide and the risk of childhood hand, foot, and mouth disease during different seasons in Hefei, China","volume":"658","author":"Wei","year":"2019","journal-title":"Sci Total Environ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2663","DOI":"10.1186\/s12889-025-23517-2","article-title":"Association between ambient air pollution and risk of hand, foot, and mouth disease: a systematic review and meta-analysis","volume":"25","author":"Hu","year":"2025","journal-title":"BMC Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"117358","DOI":"10.1016\/j.atmosenv.2020.117358","article-title":"Acute effects of air pollution on the incidence of hand, foot, and mouth disease in Wuhan, China","volume":"225","author":"Yang","year":"2020","journal-title":"Atmos Environ"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e0010896","DOI":"10.1371\/journal.pntd.0010896","article-title":"Modification effects of socioeconomic factors on associations between air pollutants and hand, foot, and mouth disease: a multicity time-series study based on heavily polluted areas in the basin area of Sichuan Province, China","volume":"16","author":"Li","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.3390\/atmos15101208","article-title":"Source attribution analysis of an ozone concentration increase event in the Main urban area of Xi'an using the WRF-CMAQ model","volume":"15","author":"Wang","year":"2024","journal-title":"Atmosphere"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"37022","DOI":"10.1007\/s11356-020-09794-x","article-title":"Short-term effects of meteorological factors, air pollution, and sunspot on childhood hand, foot, and mouth disease in Tianjin, China: a new time series regression, 2014-2018","volume":"27","author":"Ji","year":"2020","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e50526","DOI":"10.1371\/journal.pone.0050526","article-title":"Activity change in response to bad air quality, National Health and nutrition examination survey, 2007-2010","volume":"7","author":"Wells","year":"2012","journal-title":"PLoS One"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s00168-019-00926-x","article-title":"Where do people spend their leisure time on dusty days? Application of spatiotemporal behavioral responses to particulate matter pollution","volume":"63","author":"Choi","year":"2019","journal-title":"Ann Reg Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.3390\/ijerph18052248","article-title":"Population response to air pollution and the risk of coronavirus disease in Chinese cities during the early pandemic period","volume":"18","author":"Yoon","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"11801","DOI":"10.1007\/s11356-021-16397-7","article-title":"Effects of temperature and PM(2.5) on the incidence of hand, foot, and mouth in a heavily polluted area, Shijiazhuang, China","volume":"29","author":"Liu","year":"2022","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.envint.2016.11.021","article-title":"The exposure-response relationship between temperature and childhood hand, foot and mouth disease: a multicity study from mainland China","volume":"100","author":"Xiao","year":"2017","journal-title":"Environ Int"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"428","DOI":"10.3390\/ijerph17020428","article-title":"Impact of ambient temperature and relative humidity on the incidence of hand-foot-mouth disease in Wuhan, China","volume":"17","author":"Hao","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1111\/j.1461-0248.2005.00879.x","article-title":"Seasonality and the dynamics of infectious diseases","volume":"9","author":"Altizer","year":"2006","journal-title":"Ecol Lett"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1186\/s12879-023-08184-1","article-title":"Study of the influence of meteorological factors on HFMD and prediction based on the LSTM algorithm in Fuzhou, China","volume":"23","author":"Zhu","year":"2023","journal-title":"BMC Infect Dis"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1002\/jmv.1890250306","article-title":"Spread of acute hemorrhagic conjunctivitis due to enterovirus-70: effect of air temperature and relative humidity on virus survival on fomites","volume":"25","author":"Sattar","year":"1988","journal-title":"J Med Virol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1098\/rsif.2024.0018","article-title":"Review of factors affecting virus inactivation in aerosols and droplets","volume":"21","author":"Longest","year":"2024","journal-title":"J R Soc Interface"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"448","DOI":"10.3390\/ijgi10070448","article-title":"Using geographically weighted regression to study the seasonal influence of potential risk factors on the incidence of HFMD on the Chinese mainland","volume":"10","author":"Sun","year":"2021","journal-title":"ISPRS Int J Geo Inf"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1017\/S0950268813002938","article-title":"Hand-foot-and-mouth disease and weather factors in Guangzhou, southern China","volume":"142","author":"Li","year":"2014","journal-title":"Epidemiol Infect"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"2912","DOI":"10.1017\/S0950268817001984","article-title":"Spatiotemporal risk mapping of hand, foot and mouth disease and its association with meteorological variables in children under 5 years","volume":"145","author":"Xu","year":"2017","journal-title":"Epidemiol Infect"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/1471-2334-13-134","article-title":"Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China","volume":"13","author":"Huang","year":"2013","journal-title":"BMC Infect Dis"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"3","DOI":"10.53941\/ges.2025.100002","article-title":"Synergistic effects of the urban-rural divide on outdoor airborne bioaerosol diffusion: a case study in the monsoon region of China","volume":"1","author":"Zhang","year":"2025","journal-title":"Glob Environ Sci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1920424\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:21:02Z","timestamp":1791264062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1920424\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2026.1920424"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1920424","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1920424"}}