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Background: Despite significant progress in sanitation status and public health awareness, intestinal infectious diseases (IID) have caused a serious disease burden in China. Little was known about the spatio-temporal pattern of IID at the county level in Zhejiang. Therefore, a spatio-temporal modelling study to identify high-risk regions of IID incidence and potential risk factors was conducted. Methods: Reported cases of notifiable IID from 2008 to 2021 were obtained from the China Information System for Disease Control and Prevention. Moran's I index and the local indicators of spatial association (LISA) were calculated using Geoda software to identify the spatial autocorrelation and high-risk areas of IID incidence. Bayesian hierarchical model was used to explore socioeconomic and climate factors affecting IID incidence inequities from spatial and temporal perspectives. Results: From 2008 to 2021, a total of 101 cholera, 55,298 bacterial dysentery, 131 amoebic dysentery, 5297 typhoid, 2102 paratyphoid, 27,947 HEV, 1,695,925 hand, foot and mouth disease (HFMD), and 1,505,797 other infectious diarrhea (OID) cases were reported in Zhejiang Province. The hot spots for bacterial dysentery, OID, and HEV incidence were found mainly in Hangzhou, while high-high cluster regions for incidence of enteric fever and HFMD were mainly located in Ningbo. The Bayesian model showed that Areas with a high proportion of males had a lower risk of BD and enteric fever. People under the age of 18 may have a higher risk of IID. High urbanization rate was a protective factor against HFMD (RR = 0.91, 95% CI: 0.88, 0.94), but was a risk factor for HEV (RR = 1.06, 95% CI: 1.01–1.10). BD risk (RR = 1.14, 95% CI: 1.10–1.18) and enteric fever risk (RR = 1.18, 95% CI:1.10–1.27) seemed higher in areas with high GDP per capita. The greater the population density, the higher the risk of BD (RR = 1.29, 95% CI: 1.23–1.36), enteric fever (RR = 1.12, 95% CI: 1.00–1.25), and HEV (RR = 1.15, 95% CI: 1.09–1.21). Among climate variables, higher temperature was associated with a higher risk of BD (RR = 1.32, 95% CI: 1.23–1.41), enteric fever (RR = 1.41, 95% CI: 1.33–1.50), and HFMD (RR = 1.22, 95% CI: 1.08–1.38), and with lower risk of HEV (RR = 0.83, 95% CI: 0.78–0.89). Precipitation was positively correlated with enteric fever (RR = 1.04, 95% CI: 1.00–1.08), HFMD (RR = 1.03, 95% CI: 1.00–1.06), and HEV (RR = 1.05, 95% CI: 1.03–1.08). Higher HFMD risk was also associated with increasing relative humidity (RR = 1.20, 95% CI: 1.16–1.24) and lower wind velocity (RR = 0.88, 95% CI: 0.84–0.92). Conclusions: There was significant spatial clustering of IID incidence in Zhejiang Province from 2008 to 2021. Spatio-temporal patterns of IID risk could be largely explained by socioeconomic and meteorological factors. Preventive measures and enhanced monitoring should be taken in some high-risk counties in Hangzhou city and Ningbo city. [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) is a common communicable disease among children and has been a global health problem in recent decades. Literature has shown that meteorological factors possibly drive the epidemic of HFMD, but the natures differ across regions. To elucidate the associations between meteorological factors and the epidemic of HFMD in Zhejiang province, China, the incidence rate and the number of probable and laboratory-confirmed cases of HFMD as well as meteorological factors (ambient temperature, relative humidity, total rainfall, wind speed, and total sunshine duration) during the year of 2013–2017 in the province were modelled by the Bayesian hierarchical Poisson spatiotemporal model with distributed lag nonlinear components, so as to capture spatiotemporal associations and potentially nonlinear or lagged effects of the meteorological factors. During the study period, there were altogether 689,898 HFMD cases in Zhejiang province, and the disease exhibited a strong spatiotemporal association. On average, Ningbo had the highest weekly incidence rate of 6.83/100,000. The cumulative adjusted relative risk (ARR) increased with average ambient temperature until 24.6 °C (ARR = 1.14, 95% CI: 1.04–1.30), at which the pattern reverted. The cumulative ARR also increased statistically significantly with average relative humidity. It was estimated that 1% increase in relative humidity corresponded to 1.07%–1.16% increase in ARR. Total rainfall, average wind speed, and total sunshine duration were not statistically significantly associated with the incidence rate. In conclusion, the existence of the associations between meteorological factors and the incidence rate of HFMD implies that the local government could make use of meteorological information for disease surveillance, allowing early preparation for the outbreak of HFMD when favorable conditions (wet and moderately hot) are forecasted, in order to reduce the heavy burden induced by the disease. Image 1 • Bayesian hierarchical spatiotemporal model was used to explore the associations. • HFMD tended to be more prevalent in eastern coastal areas and southern areas. • Warmer and wetter conditions favoured HFMD. • Rainfall, wind speed, and sunshine duration did not show significant associations. [ABSTRACT FROM AUTHOR]