{"id":"https://openalex.org/W7225320146","doi":"https://doi.org/10.1186/s12879-026-14665-w","title":"Risk factors and prediction model for repeated hand, foot, and mouth disease infections in Songjiang District, Shanghai, China: a retrospective cohort study (2016\u20132019) with temporal external validation using 2021\u20132025 surveillance data","display_name":"Risk factors and prediction model for repeated hand, foot, and mouth disease infections in Songjiang District, Shanghai, China: a retrospective cohort study (2016\u20132019) with temporal external validation using 2021\u20132025 surveillance data","publication_year":2026,"publication_date":"2026-11-05","ids":{"openalex":"https://openalex.org/W7225320146","doi":"https://doi.org/10.1186/s12879-026-14665-w"},"language":"en","primary_location":{"id":"doi:10.1186/s12879-026-14665-w","doi":"https://doi.org/10.1186/s12879-026-14665-w","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12879-026-14665-w","pdf_url":null,"source":{"id":"https://openalex.org/S171015910","display_name":"BMC Infectious Diseases","issn_l":"1471-2334","issn":["1471-2334"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Infectious Diseases","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s12879-026-14665-w","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5101604263","display_name":"Ning Han","orcid":"https://orcid.org/0000-0003-0291-356X","observed_orcids":["https://orcid.org/0000-0003-0291-356X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ning Han","raw_affiliation_strings":["Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160836842","display_name":"Meng Li","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Meng Li","raw_affiliation_strings":["Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160783913","display_name":"Xihong Lv","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Xihong Lv","raw_affiliation_strings":["Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160780598","display_name":"Zhongxing Sun","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Zhongxing Sun","raw_affiliation_strings":["Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5050858824","display_name":"\u5b54\u5143\u539f","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yuanyuan Kong","raw_affiliation_strings":["Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Songjiang District Center for Disease Control and Prevention (Songjiang District Health Inspection Institute), Shanghai, 201600, China","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5160780598","https://openalex.org/A5160783913"],"corresponding_institution_ids":[],"apc_list":{"value":3090,"currency":"USD","value_usd":3090},"apc_paid":{"value":3090,"currency":"USD","value_usd":3090},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11581","display_name":"Viral Infections and Outbreaks Research","score":0.6039999723434448,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11581","display_name":"Viral Infections and Outbreaks Research","score":0.6039999723434448,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13847","display_name":"Literature Analysis and Criticism","score":0.11909999698400497,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11112","display_name":"Viral Infections and Immunology Research","score":0.0697999969124794,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/hand-foot-and-mouth-disease","display_name":"hand, foot and mouth disease","score":0.9819999933242798},{"id":"https://openalex.org/keywords/recurrent-infections","display_name":"recurrent infections","score":0.7879999876022339},{"id":"https://openalex.org/keywords/risk-factors","display_name":"risk factors","score":0.8050000071525574},{"id":"https://openalex.org/keywords/predictive-model","display_name":"prediction model","score":0.8420000076293945},{"id":"https://openalex.org/keywords/kindergarten-attendance","display_name":"kindergarten attendance","score":0.5600000023841858},{"id":"https://openalex.org/keywords/child-care","display_name":"child care","score":0.3330000042915344},{"id":"https://openalex.org/keywords/seasonal-variation","display_name":"seasonal variation","score":0.4790000021457672},{"id":"https://openalex.org/keywords/male-sex","display_name":"male sex","score":0.550000011920929},{"id":"https://openalex.org/keywords/children","display_name":"children","score":0.30300000309944153},{"id":"https://openalex.org/keywords/rate-ratio","display_name":"rate ratios","score":0.375},{"id":"https://openalex.org/keywords/poisson-regression","display_name":"Poisson regression","score":0.5370000004768372},{"id":"https://openalex.org/keywords/songjiang-district-shanghai","display_name":"Songjiang District, Shanghai","score":0.8259999752044678},{"id":"https://openalex.org/keywords/summer-seasonality","display_name":"summer seasonality","score":0.34200000762939453},{"id":"https://openalex.org/keywords/overdispersion","display_name":"overdispersion","score":0.37599998712539673}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8036999702453613},{"id":"https://openalex.org/C117236510","wikidata":"https://www.wikidata.org/wiki/Q7113620","display_name":"Overdispersion","level":4,"score":0.7235000133514404},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.6588000059127808},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.6442000269889832},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.5807999968528748},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.4763999879360199},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.44859999418258667},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.4413999915122986},{"id":"https://openalex.org/C2776361769","wikidata":"https://www.wikidata.org/wiki/Q821775","display_name":"Public health surveillance","level":3,"score":0.3912000060081482},{"id":"https://openalex.org/C199335787","wikidata":"https://www.wikidata.org/wiki/Q743364","display_name":"Negative binomial distribution","level":3,"score":0.38580000400543213},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.34610000252723694},{"id":"https://openalex.org/C102959455","wikidata":"https://www.wikidata.org/wiki/Q7313954","display_name":"Repeated measures design","level":2,"score":0.3411000072956085},{"id":"https://openalex.org/C58471807","wikidata":"https://www.wikidata.org/wiki/Q327120","display_name":"Receiver operating characteristic","level":2,"score":0.33730000257492065},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.33730000257492065},{"id":"https://openalex.org/C2778173179","wikidata":"https://www.wikidata.org/wiki/Q25339289","display_name":"Attendance","level":2,"score":0.33399999141693115},{"id":"https://openalex.org/C77350462","wikidata":"https://www.wikidata.org/wiki/Q1125472","display_name":"Confounding","level":2,"score":0.3165999948978424},{"id":"https://openalex.org/C2780221984","wikidata":"https://www.wikidata.org/wiki/Q131191","display_name":"Body mass index","level":2,"score":0.31310001015663147},{"id":"https://openalex.org/C83546350","wikidata":"https://www.wikidata.org/wiki/Q1139051","display_name":"Regression","level":2,"score":0.3093999922275543},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.30649998784065247},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.29899999499320984},{"id":"https://openalex.org/C2777382242","wikidata":"https://www.wikidata.org/wiki/Q6017816","display_name":"Index (typography)","level":2,"score":0.28200000524520874},{"id":"https://openalex.org/C37701844","wikidata":"https://www.wikidata.org/wiki/Q3955915","display_name":"Attack rate","level":3,"score":0.28130000829696655},{"id":"https://openalex.org/C27403532","wikidata":"https://www.wikidata.org/wiki/Q5532474","display_name":"Generalized estimating equation","level":2,"score":0.27549999952316284},{"id":"https://openalex.org/C2987315675","wikidata":"https://www.wikidata.org/wiki/Q1773974","display_name":"Disease control","level":2,"score":0.2752000093460083},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.2718000113964081},{"id":"https://openalex.org/C2776480101","wikidata":"https://www.wikidata.org/wiki/Q3555250","display_name":"Disease surveillance","level":3,"score":0.2711000144481659},{"id":"https://openalex.org/C140556311","wikidata":"https://www.wikidata.org/wiki/Q214746","display_name":"Biostatistics","level":3,"score":0.27059999108314514},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.26669999957084656},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.26420000195503235},{"id":"https://openalex.org/C161584116","wikidata":"https://www.wikidata.org/wiki/Q1952580","display_name":"Multivariate statistics","level":2,"score":0.2639000117778778},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2614000141620636},{"id":"https://openalex.org/C100906024","wikidata":"https://www.wikidata.org/wiki/Q205692","display_name":"Poisson distribution","level":2,"score":0.25589999556541443},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.2533999979496002}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1186/s12879-026-14665-w","doi":"https://doi.org/10.1186/s12879-026-14665-w","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12879-026-14665-w","pdf_url":null,"source":{"id":"https://openalex.org/S171015910","display_name":"BMC Infectious Diseases","issn_l":"1471-2334","issn":["1471-2334"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Infectious Diseases","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1186/s12879-026-14665-w","doi":"https://doi.org/10.1186/s12879-026-14665-w","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12879-026-14665-w","pdf_url":null,"source":{"id":"https://openalex.org/S171015910","display_name":"BMC Infectious Diseases","issn_l":"1471-2334","issn":["1471-2334"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Infectious Diseases","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2360488218","https://openalex.org/W2358275808","https://openalex.org/W2370417451","https://openalex.org/W2392458732","https://openalex.org/W4415918666","https://openalex.org/W7147156869","https://openalex.org/W4415728476","https://openalex.org/W2890642047","https://openalex.org/W4296394297","https://openalex.org/W4408636018"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Hand,":[2],"foot,":[3],"and":[4,43,154,213,241,303],"mouth":[5],"disease":[6],"(HFMD)":[7],"is":[8,333],"a":[9,21,37,45,77,142,188,311],"major":[10],"public":[11],"health":[12],"concern":[13],"in":[14,20,139],"China,":[15],"with":[16,32,40,49,69,95,141,187,227,253,283,310,335],"repeated":[17,33,169],"infections":[18],"occurring":[19],"subset":[22],"of":[23,98],"children.":[24],"We":[25],"aimed":[26],"to":[27,105],"identify":[28],"factors":[29],"independently":[30,308],"associated":[31,186,226,252,309],"HFMD":[34],"infection":[35,75,131],"using":[36,92],"rate-based":[38],"framework":[39],"person-time":[41],"offsets":[42],"develop":[44],"fixed-window":[46],"prediction":[47,128,279,331],"model":[48,129,280,332],"temporal":[50,290],"external":[51,291],"validation.":[52],"Methods":[53],"A":[54,126],"retrospective":[55],"cohort":[56],"study":[57],"used":[58,135],"surveillance":[59],"data":[60],"from":[61],"Songjiang":[62],"District,":[63],"Shanghai":[64],"(2016\u20132019),":[65],"including":[66],"14,408":[67,166],"individuals":[68,140],"valid":[70],"18-digit":[71],"identification":[72],"numbers.":[73],"Repeated":[74],"was":[76,111,185],"second":[78],"episode":[79,104,145],"\u2265":[80],"14":[81],"days":[82],"later.":[83],"The":[84,278,330],"primary":[85],"analysis":[86],"estimated":[87],"repeat-infection":[88,190,313],"rate":[89,191],"ratios":[90],"(RRs)":[91],"Poisson":[93],"regression":[94,138],"the":[96,180,275,316],"logarithm":[97],"each":[99],"individual\u2019s":[100],"observation":[101],"time":[102],"(index":[103],"end-2019)":[106],"as":[107,117],"an":[108],"offset;":[109],"overdispersion":[110],"assessed;":[112],"negative":[113],"binomial":[114],"models":[115],"served":[116],"sensitivity":[118],"analyses.":[119],"Sparse":[120],"categories":[121],"were":[122,225,251,261,307],"merged":[123],"before":[124],"fitting.":[125],"two-year":[127],"(repeated":[130],"within":[132],"730":[133],"days)":[134],"L2-regularized":[136],"logistic":[137],"2016\u20132017":[143],"index":[144,157,249],"(":[146],"n":[147,159],"=":[148,160,193,199,205,217,223,236,239,244,247],"7,684,":[149],"130":[150],"events),":[151],"validated":[152],"internally":[153],"temporally":[155],"(2021\u20132023":[156],"episodes;":[158],"5,191,":[161],"39":[162],"events).":[163],"Results":[164],"Among":[165],"individuals,":[167],"236":[168],"episodes":[170],"occurred":[171],"over":[172],"30,339":[173],"person-years":[174],"(0.78":[175],"per":[176],"100":[177],"person-years).":[178],"In":[179],"multivariable":[181],"model,":[182],"male":[183],"sex":[184,302],"higher":[189,312],"(RR":[192,204,216,235,243],"1.380,":[194],"95%":[195,207,219,294],"CI:":[196,208,220,295],"1.053\u20131.808,":[197],"P":[198,210,222,238,246],"0.020),":[200],"whereas":[201,315],"kindergarten":[202],"attendance":[203],"0.549,":[206],"0.393\u20130.769,":[209],"<":[211],"0.001)":[212],"student":[214],"status":[215],"0.279,":[218],"0.106\u20130.733,":[221],"0.010)":[224],"lower":[228,254],"rates":[229,255],"than":[230,256],"scattered":[231,304],"(home-cared)":[232,305],"childcare.":[233],"Summer":[234],"0.638,":[237],"0.008)":[240],"autumn":[242],"0.570,":[245],"0.004)":[248],"onsets":[250],"spring":[257],"onset;":[258],"these":[259],"associations":[260,318],"attenuated":[262],"after":[263],"adjustment":[264],"for":[265],"calendar":[266],"season":[267],"during":[268],"follow-up,":[269],"indicating":[270],"that":[271],"they":[272,324],"partly":[273,325],"reflect":[274,326],"exposure":[276,328],"structure.":[277,329],"remained":[281],"exploratory":[282,334],"limited":[284,336],"predictive":[285,337],"utility":[286],"(apparent":[287],"AUC":[288,292],"0.649;":[289],"0.612,":[293],"0.532\u20130.696;":[296],"calibration":[297],"slope":[298],"0.508).":[299],"Conclusions":[300],"Male":[301],"childcare":[306],"rate,":[314],"index-season":[317],"should":[319],"be":[320],"interpreted":[321],"cautiously":[322],"because":[323],"calendar-time":[327],"utility.":[338],"Findings":[339],"may":[340],"help":[341],"characterize":[342],"higher-risk":[343],"subgroups":[344],"pending":[345],"prospective":[346],"confirmation.":[347]},"counts_by_year":[],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2026-11-06T00:00:00"}