Regional disease surveillance as well as data transparency and sharing are the global trend for mitigating the threat of infectious diseases. The WHO has already played a leading role in FluNet (http:// www.who.int/influenza/gisrs_laboratory/flunet/en/ ) and DenguNet (http://www.who.int/csr/disease/dengue/denguenet/en/). However, the enterovirus-related infections which caused a high disease burden for pre-school children in South-East Asian regions over the last two decades still lack a comprehensive surveillance system in the region [1]. If the spreading pattern and a possible alert mechanism can be identified and set up, it will be beneficial for controlling hand, foot and mouth disease (HFMD) epidemics in East Asia. In some research findings, the transmission of HFMD was correlated with temperature, relative humidity, wind speed, precipitation, population density and the periods in which schools were open [2]. A delayed temporal trend was also found with the increase in latitude [3,4] . In this study, we tried to apply publicly available weekly surveillance data in Japan, Taiwan and Singapore to evaluate the spatio-temporal evolution of HFMD epidemics and how the weather conditions affect the HFMD epidemics.
Objective
Enterovirus epidemics, especially affecting young children, have occurred in South-East Asia every year. If the epidemic periods are inter-correlated among different areas, early warning signals could be issued to prevent or reduce the severity of the later epidemics in other areas. In this study, we integrated the available surveillance and weather data in East Asia to elucidate possible spatio-temporal correlations and weather conditions among different areas from low to high latitude.