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      Associations between ambient air pollution and daily incidence of pediatric hand, foot and mouth disease in Ningbo, 2014–2016: a distributed lag nonlinear model

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      Author(s): 1 , 2 , 1 , 2 , 1
      Publication date (Electronic, collection):
      Publication date (Electronic, pub):
      Journal: Epidemiology and Infection
      Publisher: Cambridge University Press
      Keywords: Air pollutants, HFMD

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          Abstract

          Hand, foot and mouth disease (HFMD) has high prevalence around the world, with serious consequences for children. Due to the long survival period of HFMD virus in ambient air, air pollutants may play a critical role in HFMD epidemics. We collected data on daily cases of HFMD among children aged 0–14 years in Ningbo City between 2014 and 2016. Distributed lag nonlinear models were used to assess the effects of particulate matter (PM 2.5), sulphur dioxide (SO 2), nitrogen dioxide (NO 2) and ozone (O 3) on the daily incidence of HFMD among children, with analyses stratified by gender and age. Compared with moderate levels of air pollution, high SO 2 levels had a relative risk (RR) of 2.32 (95% CI 1.42–3.79) and high NO 2 levels had a RR of 2.01 (95% CI 1.22–3.31). The RR of O 3 was 2.12 (95% CI 1.47–3.05) and that of PM 2.5 was 0.77 (95% CI 0.64–0.92) at moderate levels of air pollution. Specifically, high levels of SO 2 and NO 2 had RRs of 2.39 (95% CI 1.44–3.96) and 2.02 (95% CI 1.21–3.39), respectively, among 0–4-year-old children, while high O 3 had an RR of 2.31 (95% CI 1.09–4.89) among 5–14-year-old children. Our findings suggest significant associations of high SO 2 and NO 2 levels and moderate O 3 levels in HFMD epidemics, and also indicate that air pollution causes lagged effects on HFMD epidemics. Our study provides practical and useful data for targeted prevention and control of HMFD based on environmental evidence.

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          Short-Term Effects of PM10 and NO2 on Respiratory Health among Children with Asthma or Asthma-like Symptoms: A Systematic Review and Meta-Analysis

          Gudrun Weinmayr, Elisa Romeo, Manuela De Sario … (2009)
          Objective Our goal was to quantify the short-term effects of particulate matter with aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2) on respiratory health of asthmatic children from published panel studies, and to investigate the influence of study and population characteristics as effect modifiers. Data extraction After a systematic literature review, we extracted quantitative estimates of the association of PM10 and/or NO2 with respiratory symptoms and peak expiratory flow (PEF). Combined effect estimates for an increase of 10 μg/m3 were calculated by random effects meta-analysis for all studies and for different strata defined by study characteristics. The effect of publication bias was investigated with Egger’s and Begg’s tests and “trim-and-fill” analyses. Data synthesis We identified 36 studies; 14 were part of the European Pollution Effects on Asthmatic Children in Europe (PEACE) study. Adverse associations of PM10 with asthma symptoms were statistically significant [odds ratio (OR) = 1.028; 95% confidence interval (CI), 1.006–1.051]. There were also associations, although not statistically significant, of PM10 with cough (OR = 1.012; 95% CI, 0.997–1.026) and on PEF (decrease of −0.082 L/min; 95% CI, −0.214 to 0.050). NO2 had statistically significant associations with asthma symptoms in the overall analysis considering all possible lags (OR = 1.031; 95% CI, 1.001–1.062), but not when we evaluated only the 0–1 lag. We found no publication bias, although it appeared when excluding the PEACE studies. When we applied the trim-and-fill method to the data set without the PEACE studies, the results were similar to the overall estimates from all studies. There was an indication for stronger PM10 associations for studies conducted in summer, outside of Europe, with longer lags, and in locations with higher NO2 concentrations. Conclusions We found clear evidence of effects of PM10 on the occurrence of asthma symptom episodes, and to a lesser extent on cough and PEF. The results for NO2 are more difficult to interpret because they depend on the lag times examined. There was an indication of effect modification by several study conditions.
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            Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategy.

            S Aswathyraj, G Arunkumar, E Alidjinou … (2016)
            Hand, foot, and mouth disease (HFMD) is a contagious viral disease and mainly affects infants and young children. The main manifestations are fever, vesicular rashes on hand, feet and buttocks and ulcers in the oral mucosa. Usually, HFMD is self-limiting, but a small proportion of children may experience severe complications such as meningitis, encephalitis, acute flaccid paralysis and neurorespiratory syndrome. Historically, outbreaks of HFMD were mainly caused by two enteroviruses: the coxsackievirus A16 (CV-A16) and the enterovirus 71 (EV-A71). In the recent years, coxsackievirus A6 and coxsackievirus A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide, particularly in India, South East Asia and Europe with an increased frequency of neurological complications as well as mortality. Currently, there is no pharmacological intervention or vaccine available for HFMD. A formalin-inactivated EV-A71 vaccine has completed clinical trial in several Asian countries. However, this vaccine cannot protect against other major emerging etiologies of HFMD such as CV-A16, CV-A6 and CV-A10. Therefore, the development of a globally representative multivalent HFMD vaccine could be the best strategy.
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              Allergy and asthma: Effects of the exposure to particulate matter and biological allergens.

              S Baldacci, S Maio, S Cerrai … (2015)
              The prevalence of asthma and allergies including atopy has increased during the past decades, particularly in westernized countries. The rapid rise in the prevalence of such diseases cannot be explained by genetic factors alone. Rapid urbanization and industrialization throughout the world have increased air pollution and population exposures, so that most epidemiologic studies are focusing on possible links between air pollution and respiratory diseases. Furthermore, a growing body of evidence shows that chemical air pollution may interact with airborne allergens enhancing the risk of atopic sensitization and exacerbation of symptoms in sensitized subjects. These phenomena are supported by current in vitro and animal studies showing that the combined exposure to air pollutants and allergens may have a synergistic or additive effect on asthma and allergies, although there is an insufficient evidence about this link at the population level. Further research is needed in order to elucidate the mechanisms by which pollutants and biological allergens induce damage in exposed subjects. The abatement of the main risk factors for asthma and allergic diseases may achieve huge health benefits. Thus, it is important to raise awareness of respiratory allergies as serious chronic diseases which place a heavy burden on patients and on society as a whole.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Epidemiol Infect
                Journal ID (iso-abbrev): Epidemiol. Infect
                Journal ID (publisher-id): HYG
                Title: Epidemiology and Infection
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 0950-2688
                ISSN (Electronic): 1469-4409
                Publication date (Electronic, collection): 2020
                Publication date (Electronic, pub): 04 March 2020
                Volume: 148
                Electronic Location Identifier: e46
                Affiliations
                [1 ]Ningbo Municipal Center for Disease Control and Prevention , Ningbo 315010, China
                [2 ]Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University , Changsha 410078, China
                Author notes
                Author for correspondence: Ruixue Huang, E-mail: huangruixue@ 123456csu.edu.cn
                Author information
                https://orcid.org/0000-0001-9280-6551
                Article
                Publisher Item ID: S0950268820000321
                DOI: 10.1017/S0950268820000321
                PMC ID: 7058833
                PubMed ID: 32127063
                SO-VID: fb20ca33-09e4-4f51-b2c9-bbda5b0921d1
                Copyright © © The Author(s) 2020
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 03 September 2019
                Date revision received : 09 December 2019
                Date accepted : 29 January 2020
                Page count
                Figures: 4, Tables: 5, References: 47, Pages: 9
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Public health
                Keywords: air pollutants,hfmd
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: air pollutants, hfmd

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