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Association of PM2.5 and its components with lengths of hospital stay for hand foot and mouth disease in children

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Abstract

Hand foot and mouth disease (HFMD) is a widespread public health concern but the studies on air pollution and the lengths of hospital stay (LOS) of HFMD are scarce nevertheless. Clinic demographic features among 5135 hospitalized HFMD cases in Nanjing, China, had been characterized from 2012 to 2017. Then, we had analyzed the association between PM2.5 short-term exposure as well as its components (OM, BC, SO42–, NH4+, NIT, SOIL, and SS) and the LOS of HFMD. Among these cases that were involved in our study, 98.62% were aged 0–6 years old, and 3772 (73.46%) were hospitalized within 1 week or less. The LOS of HFMD patients was different in various age ranges, illness onset years, and illness onset seasons (P < 0.01). For per IQR increase in PM2.5 concentrations, LOS of HFMD increased by 0.52 (0.33, 0.71), 0.50 (95% CI, 0.31–0.69) and 0.46 (95% CI, 0.28–0.65) day in adjusted models at lag 3 days, lag 7 days, and lag 14 days, respectively. In addition, per IQR increase of BC, SO42−, NH4+, NIT, and SOIL was also significantly associated with the LOS of HFMD. Our findings corroborated that short-term PM2.5 exposure was associated with the increased LOS of HFMD, and its components (BC, SO42−, NH4+, NIT, and SOIL) of PM2.5 might play a key role in prolonged LOS of HFMD.

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Availability of data and materials

The datasets analyzed in this study are available from the corresponding author Xu Wang (sepnine@njmu.edu.cn) after coauthors’ approval of the request.

References

  • Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA (2014) Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax 69:660–665

    Article  CAS  Google Scholar 

  • Baek J, Kash BA, Xu X, Benden M, Roberts J, Carrillo G (2020a): Association between ambient air pollution and hospital length of stay among children with asthma in South Texas. International journal of environmental research and public health 17

  • Baek S, Park S, Park HK, Chun BC (2020) The epidemiological characteristics and spatio-temporal analysis of childhood hand, foot and mouth disease in Korea, 2011–2017. PLoS One 15:e0227803

    Article  CAS  Google Scholar 

  • Bell ML, Ebisu K, Peng RD, Samet JM, Dominici F (2009) Hospital admissions and chemical composition of fine particle air pollution. Am J Respir Crit Care Med 179:1115–1120

    Article  CAS  Google Scholar 

  • Blomqvist S, Klemola P, Kaijalainen S, Paananen A, Simonen ML, Vuorinen T, Roivainen M (2010) Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland. J Clin Virol 48:49–54

    Article  CAS  Google Scholar 

  • Buczyńska AJ, Krata A, Van Grieken R, Brown A, Polezer G, De Wael K, Potgieter-Vermaak S (2014) Composition of PM2.5 and PM1 on high and low pollution event days and its relation to indoor air quality in a home for the elderly. Sci Total Environ 490:134–143

    Article  Google Scholar 

  • Cao J, Xu H, Xu Q, Chen B, Kan H (2012) Fine particulate matter constituents and cardiopulmonary mortality in a heavily polluted Chinese city. Environ Health Perspect 120:373–378

    Article  CAS  Google Scholar 

  • Chang LY, Huang YC, Lin TY (1998) Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease. Lancet 352:367–368

    Article  CAS  Google Scholar 

  • Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY (2007) Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998–2005. Pediatrics 120:e244–e252

    Article  Google Scholar 

  • Chen Q, Zhang Q, Hu Z (2019) Profiles of human enteroviruses associated with hand, foot, and mouth disease in Nanjing, China. Disaster Med Public Health Prep 13:740–744

    Article  Google Scholar 

  • Clifford A, Lang L, Chen R, Anstey KJ, Seaton A (2016) Exposure to air pollution and cognitive functioning across the life course–a systematic literature review. Environ Res 147:383–398

    Article  CAS  Google Scholar 

  • Cosgrove SE (2006) The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 42(Suppl 2):S82–S89

    Article  Google Scholar 

  • Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, Samet JM (2006) Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA 295:1127–1134

    Article  CAS  Google Scholar 

  • Du Z, Huang Y, Bloom MS, Zhang Z, Yang Z, Lu J, Xu J, Hao Y (2021) Assessing the vaccine effectiveness for hand, foot, and mouth disease in Guangzhou, China: a time-series analysis. Hum Vaccin Immunother 17:217–223

    Article  Google Scholar 

  • Duan C, Zhang X, Jin H, Cheng X, Wang D, Bao C, Zhou M, Ahmad T, Min J (2018): Meteorological factors and its association with hand, foot and mouth disease in Southeast and East Asia areas: a meta-analysis. Epidemiol Infect, 1–18

  • Eber MR, Shardell M, Schweizer ML, Laxminarayan R, Perencevich EN (2011) Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients. PLoS One 6:e25298

    Article  CAS  Google Scholar 

  • Han J, Wang Y, Gan X, Song J, Sun P, Dong XP (2014) Serum cytokine profiles of children with human enterovirus 71-associated hand, foot, and mouth disease. J Med Virol 86:1377–1385

    Article  CAS  Google Scholar 

  • Hao J, Yang Z, Yang W, Huang S, Tian L, Zhu Z, Lu Y, Xiang H, Liu S (2020) Impact of ambient temperature and relative humidity on the incidence of hand-foot-mouth disease in Wuhan. International journal of environmental research and public health, China, p 17

    Google Scholar 

  • Hoang MTV et al (2019) Clinical and aetiological study of hand, foot and mouth disease in southern Vietnam, 2013–2015: Inpatients and outpatients. Int J Infect Dis 80:1–9

    Article  Google Scholar 

  • Hu YF, Yang F, Du J, Zhang T, Xue Y, Jin Q (2012) Coxsackievirus B5, associated with neurological hand, foot and mouth disease, China. J Infect 65:189–191

    Article  CAS  Google Scholar 

  • Huang J, Liao Q, Ooi MH, Cowling BJ, Chang Z, Wu P, Liu F, Li Y, Luo L, Yu S, Yu H, Wei S (2018): Epidemiology of recurrent hand, foot and mouth disease, China, 2008–2015. Emerg Infect Dis 24

  • Huang R, Ning H, He T, Bian G, Hu J, Xu G (2019) Impact of PM(10) and meteorological factors on the incidence of hand, foot, and mouth disease in female children in Ningbo, China: a spatiotemporal and time-series study. Environ Sci Pollut Res Int 26:17974–17985

    Article  Google Scholar 

  • Huang Y, Deng T, Yu S, Gu J, Huang C, Xiao G, Hao Y (2013) Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China. BMC Infect Dis 13:134

    Article  Google Scholar 

  • Kocak M, Mihalopoulos N, Tutsak E, Theodosi C, Zarmpas P, Kalegeri P (2015) PM10 and PM2.5 composition over the Central Black Sea: origin and seasonal variability. Environ Sci Pollut Res Int 22:18076–18092

    Article  CAS  Google Scholar 

  • Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, Chen MI, Horby P, Cook AR (2016) The epidemiology of hand, foot and mouth disease in asia: a systematic review and analysis. Pediatr Infect Dis J 35:e285-300

    Article  Google Scholar 

  • Li Y, Henze DK, Jack D, Kinney PL (2016) The influence of air quality model resolution on health impact assessment for fine particulate matter and its components. Air Qual Atmos Health 9:51–68

    Article  CAS  Google Scholar 

  • Liu H, Tian Y, Xu Y, Zhang J (2017) Ambient particulate matter concentrations and hospitalization for stroke in 26 Chinese cities: a case-crossover study. Stroke 48:2052–2059

    Article  Google Scholar 

  • Ma E, Chan KC, Cheng P, Wong C, Chuang SK (2010) The enterovirus 71 epidemic in 2008–public health implications for Hong Kong. Int J Infect Dis 14:e775–e780

    Article  Google Scholar 

  • Ma E, Wong S, Wong C, Chuang SK, Tsang T (2011) Effects of public health interventions in reducing transmission of hand, foot, and mouth disease. Pediatr Infect Dis J 30:432–435

    Article  Google Scholar 

  • Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E (2020) Environmental and health impacts of air pollution: a review. Front Public Health 8:14

    Article  Google Scholar 

  • Mirand A, Henquell C, Archimbaud C, Ughetto S, Antona D, Bailly JL, Peigue-Lafeuille H (2012) Outbreak of hand, foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study. Clin Microbiol Infect 18:E110–E118

    Article  CAS  Google Scholar 

  • Mukherjee A, Agrawal M (2018) A global perspective of fine particulate matter pollution and its health effects. Rev Environ Contam Toxicol 244:5–51

    Google Scholar 

  • Nunez Y, Boehme AK, Li M, Goldsmith J, Weisskopf MG, Re DB, Navas-Acien A, van Donkelaar A, Martin RV, Kioumourtzoglou MA (2021) Parkinson’s disease aggravation in association with fine particle components in New York State. Environ Res 201:111554

    Article  CAS  Google Scholar 

  • Onozuka D, Hashizume M (2011) The influence of temperature and humidity on the incidence of hand, foot, and mouth disease in Japan. Sci Total Environ 410–411:119–125

    Article  Google Scholar 

  • Podin Y, Gias EL, Ong F, Leong YW, Yee SF, Yusof MA, Perera D, Teo B, Wee TY, Yao SC, Yao SK, Kiyu A, Arif MT, Cardosa MJ (2006) Sentinel surveillance for human enterovirus 71 in Sarawak, Malaysia: lessons from the first 7 years. BMC Public Health 6:180

    Article  Google Scholar 

  • Rahmqvist M, Samuelsson A, Bastami S, Rutberg H (2016) Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements. Am J Infect Control 44:500–506

    Article  Google Scholar 

  • Repass GL, Palmer WC, Stancampiano FF (2014) Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. Cleve Clin J Med 81:537–543

    Article  Google Scholar 

  • Tian S, Liu Y, Wang J, Wang J, Hou L, Lv B, Wang X, Zhao X, Yang W, Geng C, Han B, Bai Z (2020): Chemical compositions and source analysis of PM2.5 during autumn and winter in a heavily polluted city in China. Atmosphere 11

  • van Donkelaar A, Martin RV, Brauer M, Hsu NC, Kahn RA, Levy RC, Lyapustin A, Sayer AM, Winker DM (2016) Global estimates of fine particulate matter using a combined geophysical-statistical method with information from satellites, models, and monitors. Environ Sci Technol 50:3762–3772

    Article  Google Scholar 

  • van Donkelaar A, Martin RV, Li C, Burnett RT (2019) Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors. Environ Sci Technol 53:2595–2611

    Article  Google Scholar 

  • Wang J, Zhou J, Xie G, Zheng S, Lou B, Chen Y, Wu Y (2020) The epidemiological and clinical characteristics of hand, foot, and mouth disease in Hangzhou, China, 2016 to 2018. Clin Pediatr (phila) 59:656–662

    Article  Google Scholar 

  • Wang X, Zhu D, Yuan S (2021): Impact of enterovirus 71 vaccine vaccination on incidence of hand, foot and mouth disease among children in China mainland: an interrupted time series analysis. Chin J Public Health, 1–3

  • Wang YR, Sun LL, Xiao WL, Chen LY, Wang XF, Pan DM (2013) Epidemiology and clinical characteristics of hand foot, and mouth disease in a Shenzhen sentinel hospital from 2009 to 2011. BMC Infect Dis 13:539

    Article  Google Scholar 

  • Xing W, Liao Q, Viboud C, Zhang J, Sun J, Wu JT, Chang Z, Liu F, Fang VJ, Zheng Y, Cowling BJ, Varma JK, Farrar JJ, Leung GM, Yu H (2014) Hand, foot, and mouth disease in China, 2008–12: an epidemiological study. Lancet Infect Dis 14:308–318

    Article  Google Scholar 

  • Yu G, Li Y, Cai J, Yu D, Tang J, Zhai W, Wei Y, Chen S, Chen Q, Qin J (2019) Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China. Sci Total Environ 646:460–470

    Article  CAS  Google Scholar 

  • Zhong R, Wu Y, Cai Y, Wang R, Zheng J, Lin D, Wu H, Li Y (2018) Forecasting hand, foot, and mouth disease in Shenzhen based on daily level clinical data and multiple environmental factors. Biosci Trends 12:450–455

    Article  Google Scholar 

  • Zou XN, Zhang XZ, Wang B, Qiu YT (2012) Etiologic and epidemiologic analysis of hand, foot, and mouth disease in Guangzhou city: a review of 4,753 cases. Braz J Infect Dis 16:457–465

    Article  Google Scholar 

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Author notes

  1. Wei Li and Jieguo Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Quality Management, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Wei Li

  2. Department of Emergency, Pediatric Intensive Care Unit, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Jieguo Wang

  3. Department of Infection, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Kai Zhou & Ye Tian

  4. Division of Rheumatology, Zhongda Hospital Southeast University, Nanjing, 210008, China

    Feiran Wei

  5. Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China

    Mingzhi Zhang

  6. Department of Endocrinology, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Xu Wang

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  1. Wei Li
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Contributions

Wei Li: methodology, software, formal analysis, writing. Jieguo Wang: conceptualization, project administration, writing. Kai Zhou: data curation. Ye Tian: conceptualization, writing. Feiran Wei: methodology. Mingzhi Zhang and Xu Wang: conceptualization, supervision, writing. The author(s) read and approved the final manuscript.

Corresponding authors

Correspondence to Mingzhi Zhang or Xu Wang.

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The authors declare no competing interests.

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Communicated by Lotfi Aleya.

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Li, W., Wang, J., Zhou, K. et al. Association of PM2.5 and its components with lengths of hospital stay for hand foot and mouth disease in children. Environ Sci Pollut Res 29, 50598–50607 (2022). https://doi.org/10.1007/s11356-022-19448-9

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  • DOI: https://doi.org/10.1007/s11356-022-19448-9

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