JMIR Publications

ABSTRACT

Background:

Hand, Foot and Mouth Disease (HFMD) is a notable infectious disease predominantly affecting infants and children worldwide. Previous studies on HFMD have primarily focused on natural patterns, such as seasonality, but research on the influence of important social time points is lacking. Several studies have indicated correlations between birthdays and certain disease outcomes.

Objective:

To explore the association between birthdays and HFMD.

Methods:

Surveillance data on HFMD from 2008 to 2022 in Yunnan Province, China, were collected. We defined the period from six days before the birthday to the exact birthday as the “birthday week”. The effect of the birthday week was measured by the proportion of cases occurring during this period, termed the “birthday week proportion”. We conducted subgroup analyses to present the birthday week proportions across sexes, age groups, months of birth, and reporting years. Additionally, we employed a modified Poisson regression model to identify conditional subgroups more likely to contract HFMD during the birthday week.

Results:

Among the total 973,410 cases, 116,976 (12.02%) occurred during the birthday week, which is 6.27 times the average weekly proportion (7/365, 1.92%). While the birthday week proportions were similar between males and females (12.19% vs. 11.78%, χ2=153.25, P<0.001), significant differences were observed among different age groups (χ2=47,145, P<0.001) and months of birth (χ2=16,942, P<0.001). Compared to other age groups, the infant group aged 0-1 year had the highest birthday week proportion (33.67%), which is 17.57 times the average weekly proportion. Compared to other months, patients born from April to July and October to December, the peak months of the HFMD epidemic, had higher birthday week proportions (13.51%, 20.06%, 19.69%, 15.60%, 10.60%, 11.63%, 11.85%). Additionally, a decreasing trend in birthday week proportions from 2008 to 2022 was observed, dropping from 33.74% to 2.77% (Cochran-Armitage Trend Test, Z=-102.53, P<0.001). The results of the modified Poisson regression model further supported the findings from subgroup analyses. Compared with children aged over 7 years, infants aged 0-1 year were more likely to contract HFMD during the birthday week (RR: 1.182, 95% CI: 1.177-1.185, P<0.001). Those born during peak epidemic months exhibited a higher propensity for contracting HFMD during their birthday week. Compared with January, the highest RR was observed in May, at 1.087 (95% CI: 1.084-1.090, P<0.001).

Conclusions:

This study identified a novel “birthday week effect” of HFMD, particularly notable for infants approaching their first birthday and those born during peak epidemic months. Improvements in surveillance quality may explain the declining trend of the birthday week effect over the years. Higher exposure risk during the birthday period and potential biological mechanisms might also account for this phenomenon. Raising public awareness of the heightened risk during the birthday week could benefit HFMD prevention and control.