2013-2017年广东省中山市手足口病重症病例流行病学和病原学特征分析
|
摘要
目的了解广东省中山市手足口病重症病例流行病学和病原学特征,为防控工作提供依据。方法对2013—2017年中山市报告的手足口病重症病例开展个案调查和实验室检测,采用Excel 2007和SPSS 13.0软件进行数据整理和描述性分析,率的比较用χ~2检验。结果 2013—2017年共报告手足口病重症病例209例,占手足口病病例的0.25%(209/84 021),年均发病率为1.31/10万,每年3—7月为发病高峰。病例主要为1～3岁的散居儿童,占73.68%(154/209);男性发病高于女性(χ~2=15.171,P=0.000);以农村的常住人口为主。209例重症病例均有出疹,95.22%的病例有发热,皮疹类型以疱疹为主(71.29%)。病例发病到初诊时间间隔<3 d的占91.87%(192/209);初次就诊时能被正确诊断为手足口病的占63.64%(133/209);不同级别的医院手足口病诊断正确率差异具有统计学意义(χ~2=23.831,P=0.000)。203例手足口病重症病例采集了标本送检,阳性率为93.10%(189/203)。病原体以肠道病毒71型(EV71)为主(118例,占58.13%),4—5月为检出高峰。结论中山市重症手足口病有明显的时间、人群和地区分布特征, EV71是主要病原体。应针对其特征落实综合性的防控措施,并提高EV71灭活疫苗的接种率,以降低手足口病重症的发生率。
Objective To understand the epidemiology and etiological characteristics of severe cases of hand foot and mouth disease(HFMD) in Zhongshan of Guangdong province and provides evidence for the prevention and control of HFMD.Methods Case investigation and laboratory test were conducted for the severe cases of HFMD reported in Zhongshan from2013 to 2017. Data analysis was done by using Excel 2007 and SPSS 13.0 softwares. Results A total of 209 severe cases of HFMD were reported in Zhongshan, accounting for 0.25%(209/84 021) of total HFMD cases, with an annual average incidence of 1.31/100 000. The incidence peak was during March-July. The cases were mainly in 1–3 years old children outside child care settings, accounting for 73.68%(154/209). The incidence in boys was higher than that in girls. All the 209 severe HFMD cases had skin rash,95.22% of the cases had fever, and the main type of rash was herpes(71.29%). The time interval between onset and initial diagnosis was less than 3 days, accounting for 91.87%(192/209). Up to 63.64% of the cases(133/209) were correctly diagnosed with HFMD at the first visit. The differences in diagnostic accuracy of HFMD among hospitals at different levels were significant. The specimens of 203 severe HFMD cases were detected, the positive rate was93.10%(189/203). The major pathogen was EV71(58.13%), the detection peak time was during April-May. Conclusion The incidence of severe HFMD had obvious time, population and area specific characteristics in Zhongshan. The major pathogen was EV71. It is necessary to take comprehensive measures and increase the vaccination coverage of EV71 inactivated vaccine to reduce the incidence of severe cases of HFMD.
Objective To understand the epidemiology and etiological characteristics of severe cases of hand foot and mouth disease(HFMD) in Zhongshan of Guangdong province and provides evidence for the prevention and control of HFMD.Methods Case investigation and laboratory test were conducted for the severe cases of HFMD reported in Zhongshan from2013 to 2017. Data analysis was done by using Excel 2007 and SPSS 13.0 softwares. Results A total of 209 severe cases of HFMD were reported in Zhongshan, accounting for 0.25%(209/84 021) of total HFMD cases, with an annual average incidence of 1.31/100 000. The incidence peak was during March-July. The cases were mainly in 1–3 years old children outside child care settings, accounting for 73.68%(154/209). The incidence in boys was higher than that in girls. All the 209 severe HFMD cases had skin rash,95.22% of the cases had fever, and the main type of rash was herpes(71.29%). The time interval between onset and initial diagnosis was less than 3 days, accounting for 91.87%(192/209). Up to 63.64% of the cases(133/209) were correctly diagnosed with HFMD at the first visit. The differences in diagnostic accuracy of HFMD among hospitals at different levels were significant. The specimens of 203 severe HFMD cases were detected, the positive rate was93.10%(189/203). The major pathogen was EV71(58.13%), the detection peak time was during April-May. Conclusion The incidence of severe HFMD had obvious time, population and area specific characteristics in Zhongshan. The major pathogen was EV71. It is necessary to take comprehensive measures and increase the vaccination coverage of EV71 inactivated vaccine to reduce the incidence of severe cases of HFMD.
引文
[1]赵益樊,田春园,冀林立,等.2007-2016年内蒙古自治区鄂尔多斯市手足口病流行病学及病原学特征分析[J].疾病监测,2018,33(4):316-319.DOI:10.3784/j.issn.1003-9961.2018.04.013.Zhao YF,Tian CY,Ji LL,et al.Epidemiology and etiology of hand,foot and mouth disease in Ordos,Inner Mongolia,2007-2016[J].Dis Surveill,2018,33(4):316-319.DOI:10.3784/j.issn.1003-9961.2018.04.013.
[2]李萌,张清慧,郭晓芹.2012-2016年上海市松江区手足口病流行病学及病原学特征分析[J].现代预防医学,2017,44(18):3421-3425.Li M,Zhang QH,Guo XQ.Analysis on epidemiological and etiological characteristics of hand,foot and mouth disease in Songjiang district of Shanghai between 2012 and 2016[J].Mod Prev Med,2017,44(18):3421-3425.
[3]陈秀云,王曼.2004-2016年广东省某市丙类传染病流行特征分析[J].现代预防医学,2018,45(10):1740-1744.Chen XY,Wang M.Analysis on the epidemiological characteristics of category C infectious diseases in a city of Guangdong province from 2004 to 2016[J].Mod Prev Med,2018,45(10):1740-1744.
[4]中华人民共和国卫生部.手足口病预防控制指南(2008年版)[EB/OL].(2008-05-02)[2019-03-13].http://www.nhc.gov.cn/jkj/s3577/200805/e73df45b7b1549188b1d4e1efd604da9.shtml.Ministry of Health of the People's Republic of China.Guidelines for prevention and control of hand,foot and mouth disease(2008Edition)[EB/OL].(2008-05-02)[2019-03-13].http://www.nhc.gov.cn/jkj/s3577/200805/e73df45b7b1549188b1d4e1efd604da9.shtml.
[5]袁伟.2016年四川省手足口重症病例流行特征分析[J].预防医学情报杂志,2018,34(7):932-934.Yuan W.Analysis of epidemiological characteristics of severe cases of hand,foot and mouth disease in Sichuan province in2016[J].J Prev Med Inf,2018,34(7):932-934.
[6]初艳慧,刘潇潇,孙小宇,等.重症手足口病例的临床特征和流行病学分析[J].实用预防医学,2014,21(9):1074-1076.DOI:10.3969/j.issn.1006-3110.2014.09.016.Chu YH,Liu XX,Sun XY,et al.Clinical features and epidemiological analysis of severe cases of hand,foot and mouth[J].P rac Prev Med,2014,21(9):1074-1076.DOI:10.3969/j.issn.1006-3110.2014.09.016.
[7]丁全明,安银翠,马辛瑶,等.2010-2015年陕西省汉中市手足口病流行特征分析[J].疾病监测,2017,32(1):34-37.DOI:10.3784/j.issn.1003-9961.2017.01.010.Ding QM,An YC,Ma XY,et al.Analysis on epidemiological characteristics of hand,foot and mouth disease in Hanzhong,Shaanxi,2010-2015[J].Dis Surveill,2017,32(1):34-37.DOI:10.3784/j.issn.1003-9961.2017.01.010.
[8]罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015,49(2):184-188.DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.Luo L,Xing WJ,Liao QH,et al.Research progress on seroepidemiological study of enterovirus 71 and coxsackievirus A16 infection among children[J].Chin J Prev Med,2015,49(2):184-188.DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.
[9]李国艳,冯莹,任泉钟,等.济南市2012-2013年手足口病重症患者流行病学及影响因素分析[J].中国公共卫生,2015,31(9):1199-1201.DOI:10.11847/zgggws2015-31-09-27.Li GY,Feng Y,Ren QZ,et al.Influence factors of severe hand, foot and mouth disease incidents in Jinan city,2012-2013[J].Chin J Public Health,2015,31(9):1199-1201.DOI:10.11847/zggg ws2015-31-09-27.
[10]Ji H,Li L,Liu YM,et al.Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province,China[J].Virol J,2012,9:248.DOI:10.1186/1743-422X-9-248.
[11]黄甜,李琼芬,沈秀莲,等.云南省手足口病重症病例危险因素分析[J].现代预防医学,2017,44(6):1115-1119.Huang T,Li QF,Shen XL,et al.Analysis of the risk factors for severe hand,foot and mouth disease(HFMD)in Yunnan province[J].Mod Prev Med,2017,44(6):1115-1119.
[12]曾舸,罗垲炜,胡世雄,等.湖南省2009-2015年手足口病重症病例流行病学分析[J].中国热带医学,2017,17(2):143-146.DOI:10.13604/j.cnki.46-1064/r.2017.02.09.Zeng G,Luo KW,Hu SX,et al.Epidemiological analysis of hand,foot and mouth disease severe cases in Hunan,2009-2015[J].China Trop Med,2017,17(2):143-146.DOI:10.13604/j.cnki.46-1064/r.2017.02.09.
[13]Koh WM,Bogich T,Siegel K,et al.The epidemiology of hand,foot and mouth disease in Asia:a systematic review and analysis[J].Pediatr Infect Dis J,2016,35(10):e285-300.DOI:10.1097/INF.0000000000001242.
[14]施宗湖,唐柳平,杨振兴,等.柳州市某综合性医院重症手足口病危险因素研究[J].中华疾病控制杂志,2014,18(10):960-963.Shi ZH,Tang LP,Yang ZX,et al.Study on the influencing factors of severe hand,foot and mouth disease in a general hospital of Liuzhou city[J].Chin J Dis Control Prev,2014,18(10):960-963.
[15]李平,陈银苗,王海亮,等.儿童手足口病重症病例的危险因素研究现状[J].实用预防医学,2017,24(2):251-253.DOI:10.3969/j.issn.1006-3110.2017.02.039.Li P,Chen YM,Wang HL,et al.Current status of research on risk factors for severe cases in children with hand,foot and mouth disease[J].Pract Prev Med,2017,24(2):251-253.DOI:10.3969/j.issn.1006-3110.2017.02.039.
[2]李萌,张清慧,郭晓芹.2012-2016年上海市松江区手足口病流行病学及病原学特征分析[J].现代预防医学,2017,44(18):3421-3425.Li M,Zhang QH,Guo XQ.Analysis on epidemiological and etiological characteristics of hand,foot and mouth disease in Songjiang district of Shanghai between 2012 and 2016[J].Mod Prev Med,2017,44(18):3421-3425.
[3]陈秀云,王曼.2004-2016年广东省某市丙类传染病流行特征分析[J].现代预防医学,2018,45(10):1740-1744.Chen XY,Wang M.Analysis on the epidemiological characteristics of category C infectious diseases in a city of Guangdong province from 2004 to 2016[J].Mod Prev Med,2018,45(10):1740-1744.
[4]中华人民共和国卫生部.手足口病预防控制指南(2008年版)[EB/OL].(2008-05-02)[2019-03-13].http://www.nhc.gov.cn/jkj/s3577/200805/e73df45b7b1549188b1d4e1efd604da9.shtml.Ministry of Health of the People's Republic of China.Guidelines for prevention and control of hand,foot and mouth disease(2008Edition)[EB/OL].(2008-05-02)[2019-03-13].http://www.nhc.gov.cn/jkj/s3577/200805/e73df45b7b1549188b1d4e1efd604da9.shtml.
[5]袁伟.2016年四川省手足口重症病例流行特征分析[J].预防医学情报杂志,2018,34(7):932-934.Yuan W.Analysis of epidemiological characteristics of severe cases of hand,foot and mouth disease in Sichuan province in2016[J].J Prev Med Inf,2018,34(7):932-934.
[6]初艳慧,刘潇潇,孙小宇,等.重症手足口病例的临床特征和流行病学分析[J].实用预防医学,2014,21(9):1074-1076.DOI:10.3969/j.issn.1006-3110.2014.09.016.Chu YH,Liu XX,Sun XY,et al.Clinical features and epidemiological analysis of severe cases of hand,foot and mouth[J].P rac Prev Med,2014,21(9):1074-1076.DOI:10.3969/j.issn.1006-3110.2014.09.016.
[7]丁全明,安银翠,马辛瑶,等.2010-2015年陕西省汉中市手足口病流行特征分析[J].疾病监测,2017,32(1):34-37.DOI:10.3784/j.issn.1003-9961.2017.01.010.Ding QM,An YC,Ma XY,et al.Analysis on epidemiological characteristics of hand,foot and mouth disease in Hanzhong,Shaanxi,2010-2015[J].Dis Surveill,2017,32(1):34-37.DOI:10.3784/j.issn.1003-9961.2017.01.010.
[8]罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015,49(2):184-188.DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.Luo L,Xing WJ,Liao QH,et al.Research progress on seroepidemiological study of enterovirus 71 and coxsackievirus A16 infection among children[J].Chin J Prev Med,2015,49(2):184-188.DOI:10.3760/cma.j.issn.0253-9624.2015.02.018.
[9]李国艳,冯莹,任泉钟,等.济南市2012-2013年手足口病重症患者流行病学及影响因素分析[J].中国公共卫生,2015,31(9):1199-1201.DOI:10.11847/zgggws2015-31-09-27.Li GY,Feng Y,Ren QZ,et al.Influence factors of severe hand, foot and mouth disease incidents in Jinan city,2012-2013[J].Chin J Public Health,2015,31(9):1199-1201.DOI:10.11847/zggg ws2015-31-09-27.
[10]Ji H,Li L,Liu YM,et al.Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province,China[J].Virol J,2012,9:248.DOI:10.1186/1743-422X-9-248.
[11]黄甜,李琼芬,沈秀莲,等.云南省手足口病重症病例危险因素分析[J].现代预防医学,2017,44(6):1115-1119.Huang T,Li QF,Shen XL,et al.Analysis of the risk factors for severe hand,foot and mouth disease(HFMD)in Yunnan province[J].Mod Prev Med,2017,44(6):1115-1119.
[12]曾舸,罗垲炜,胡世雄,等.湖南省2009-2015年手足口病重症病例流行病学分析[J].中国热带医学,2017,17(2):143-146.DOI:10.13604/j.cnki.46-1064/r.2017.02.09.Zeng G,Luo KW,Hu SX,et al.Epidemiological analysis of hand,foot and mouth disease severe cases in Hunan,2009-2015[J].China Trop Med,2017,17(2):143-146.DOI:10.13604/j.cnki.46-1064/r.2017.02.09.
[13]Koh WM,Bogich T,Siegel K,et al.The epidemiology of hand,foot and mouth disease in Asia:a systematic review and analysis[J].Pediatr Infect Dis J,2016,35(10):e285-300.DOI:10.1097/INF.0000000000001242.
[14]施宗湖,唐柳平,杨振兴,等.柳州市某综合性医院重症手足口病危险因素研究[J].中华疾病控制杂志,2014,18(10):960-963.Shi ZH,Tang LP,Yang ZX,et al.Study on the influencing factors of severe hand,foot and mouth disease in a general hospital of Liuzhou city[J].Chin J Dis Control Prev,2014,18(10):960-963.
[15]李平,陈银苗,王海亮,等.儿童手足口病重症病例的危险因素研究现状[J].实用预防医学,2017,24(2):251-253.DOI:10.3969/j.issn.1006-3110.2017.02.039.Li P,Chen YM,Wang HL,et al.Current status of research on risk factors for severe cases in children with hand,foot and mouth disease[J].Pract Prev Med,2017,24(2):251-253.DOI:10.3969/j.issn.1006-3110.2017.02.039.