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Previous studies have shown that exposure to ambient air pollution is associated with hand, foot, and mouth disease (HFMD), but the results are limited. Our study aimed to investigate the effects of several major air pollutants on HFMD in the warm and cold seasons in central China. A Poisson Generalized additive model (GAM) was used to assess the association between short-term exposure to ambient air pollution and the incidence of HFMD at Wuhan, China during 20152016. Daily cases of HFMD were extracted from the infectious disease surveillance systems of Hubei provincial center for disease control and prevention (Hubei CDC). Data on air pollution, including sulfur dioxide (SO 2), nitrogen dioxide (NO 2), ground-level ozone (O 3), particulate matter (PM) with an aerodynamic diameter less than or equal to 10 μm (PM 10), and PM with an aerodynamic diameter less than or equal to 2.5 μm (PM 2.5) were obtained from 10 national air quality monitoring stations in Wuhan. We found that the association between air pollution and HFMD was most pronounced at lag days 10 and 11. The results of the single-pollutant model show that the associations of SO 2 , NO 2 , O 3 , PM 10 , and PM 2.5 with HFMD were all statistically significant. The results of the multi-pollutant model showed that NO 2 , O 3 , PM 10 , and PM 2.5 are reduced after excluding the confounding of co-pollutants. The seasonal analysis showed that the effect of air pollution in the cold season was higher than in the warm season. Our research provides more evidence related to air pollution and HFMD, and helps policy makers to develop regulations for the prevention and control of the disease. Image 1 • All pollutants are significantly associated with HFMD at lag 10 - 11. • Air pollution have a stronger effect on HFMD in the cold season. • The effects of NO 2 , O 3 , and PM are reduced in the multi-pollutant models. [ABSTRACT FROM AUTHOR]

Previous studies have estimated the association between meteorological factors and mumps outbreaks without assessing the influence of air pollution. In this research, we explored the effects of short-term exposure to air pollution on the incidence of mumps. Our time-series analysis was conducted using data collected in Wuhan, China from 2015 to 2017. Daily number of mumps cases was obtained from Disease Reporting System in Hubei Provincial Center for Disease Control and Prevention. Data on air pollution was obtained from 10 national air quality monitoring stations, including nitrogen dioxide (NO 2), sulfur dioxide (SO 2), ground-level ozone (O 3), particulate matter less than or equal to 10 μm in aerodynamic diameter (PM 10), and particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM 2.5). Daily meteorological data including temperature and relative humidity were obtained from Hubei Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to explore the association between the incidence of mumps and exposure to air pollution. We observed that the effects of air pollutants were statistically significant mainly in two periods, lag 0 to lag 5 and lag 20 to lag 25, with the strongest effects appearing at lag 2 and lag 23. The cumulative effects were stronger than single-day lag effects. The stratified analysis showed the effect of pollutants during the hot season was stronger than that during the cold season, especially for NO 2 and SO 2. We found that exposure to NO 2 and SO 2 was significantly associated with higher risk of developing mumps. Our findings could help deepen the understanding of how air pollution exposure affects the incidence of mumps. • The first study to explore the association between air pollution and risk of mumps. • NO 2 and SO 2 were significantly associated with risk of mumps. • The effects of air pollution were stronger in the hot season than the cold season. [ABSTRACT FROM AUTHOR]