Hand, foot, and mouth disease (HFMD), also known as enterovirus outbreaks, which cause fever and rash in young children, are common in the summer months, similar to historic polio cases in the US. While different enterovirus species cause both infections and a wide group of RNA viruses, the causes for these seasonal trends are not entirely known.

A recent study by researchers from Brown University, Princeton University, and Johns Hopkins, published in ‘Nature Communications’, investigates the shared factors impacting the timing of HFMD and polio outbreak.

“We discovered that even after accounting for other factors, temperature significantly increases enterovirus transmission,” stated Rachel Baker, the John and Elizabeth Irving Family Assistant Professor of Climate and Health at Brown University and the study’s lead author. “Importantly, we observed a similar impact on polio historically and on more recent enterovirus serotypes that cause HFMD.”

Saki Takahashi, Assistant Professor of Epidemiology at Johns Hopkins University and co-author of the study added, “Enterovirus outbreaks display distinct spatial patterns. In higher latitudes, large HFMD outbreaks occur every two to three years, while closer to the tropics, outbreaks happen twice a year—our findings effectively capture these broad-scale patterns.”

The researchers used an epidemiological model to show that temperature and demographic factors, particularly the timing of school semesters, can explain the two-yearly HFMD outbreaks in southern China. Temperature has a greater effect in northern locations, while school timetables have less of an impact.

“What truly matters is the seasonal climate range, meaning the highest and lowest temperatures,” explained Wenchang Yang, Associate Research Scholar in Geosciences at Princeton University. “This could have important implications for how we consider future impacts.”

Using data from 14 different climate models, the scientists investigated the impact of climate change on enterovirus epidemics.

“A crucial finding is the role of variability,” said Gabriel Vecchi, the Knox Taylor Professor of Geosciences and Director of the High Meadows Environmental Institute at Princeton University. “The influence of climate variability on disease dynamics is not well understood, and this study marks a significant step forward in addressing this gap.”

The research revealed that climate change could increase the peak size of enterovirus outbreaks by up to 40%, though the impact varies depending on location and climate model. Enhanced surveillance of enterovirus activity could help monitor these potential effects. “Serological surveys are essential for tracking susceptibility to enteroviruses and other pathogens,” Takahashi added.

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