河北省2008年手足口病的流行病学分析

Analysis on Epidemiology of Hand-Foot-Mouth Disease in Hebei Province in 2008

目的分析河北省2008年儿童手足口病（HFMD）的流行病学特征及死亡病例特点,探讨HFMD的主要危险因素,为HFMD的预防和控制提供理论和实践依据。方法使用国家疾病监测信息报告管理系统开展HFMD监测,以河北省2008年1月1日-12月31日诊断为HFMD的29 499例患儿为研究对象。采用描述性流行病学方法对此次疫情的流行特征及死亡病例进行分析。结果 29 499例HFMD患儿中,重症病例135例,其中死亡10例。发病时间主要集中在5-7月份,发病例数占全年疫情总数的79.81%;男：女为1.71：1;≤3岁发病20 850例（占70.68%）,≤5岁发病26 728例（占90.61%）;其中1~2岁年龄组发病数最多（9 308例,占31.55%）;散居和幼托儿童多见,分别占79.01%和16.03%。不同地区HFMD发病率差异有统计学意义,发病率随气温的升高而降低,随降水量的增加而升高。EV71感染较非EV71（柯萨奇病毒A16型和其他肠道病毒）感染更易引起重症病例。死亡病例以EV71感染为主,年龄6个月~4岁;患儿从开始发病至到达死亡所在医院的时间（院前时间）平均为3.1 d;到达死亡所在医院平均13.8 h死亡;大都诊断为HFMD并脑炎;死亡原因均为神经源性肺水肿、肺出血。结论河北省2008年手足口病好发人群主要为≤5岁儿童,以散居儿童和幼托儿童多见;发病时间主要集中在5-7月份;发病率随气温升高而降低,随降水量增加而升高。在临床工作中对EV71感染患儿更要加强监护。对≤5岁儿童进行健康教育和管理、落实好对托幼机构的防控措施,并研发能有效控制EV71流行的疫苗是预防本病的关键。到定点医院接受规范诊疗是防止发生重症和死亡病例的关键。

Objective To analyze the epidemic situation of hand-foot-mouth disease(HFMD) and their death characteristics in Hebei province in 2008,and explore the key risk factors as to facilitate the prevention and control of the disease.Methods A total 29 499 cases were collected,who were diagnosed as HFMD from Jan.to Dec.2008.The criteria for HFMD were based on HFMD Control and Prevention Guide formulated by the Ministry of Health.All the data of HFMD epidemic situation in Hebei province in 2008 were reported from China Di-sease Reporting Information System Databases.Results Of all 29 499 HFMD,135 cases were severe cases including 10 death cases.The peak incidence occurred in May to July(79.81%).Sex ratio(male vs female) was 1.71:1.These patients less than 3 years old were 20 850(70.68%),the HFMD cases under 5 years old were 26 728(90.61%),there were 9 308 cases(31.55%) reported from 1 to 2 years old.The patients were predominantly inhabited sporadically(79.01%) or in the kindergartens(16.03%).The incidence of each city was varied and morbidity increased with the drop of temperature and the increase of humidity.The number of EV71 infected severe cases was higher compared with that of non-EV71(CoxA 16 and other enterovirus) infected children.It showed that severe cases were mainly caused by EV71.The age of the death was from 6 months to 4 years old,and the mean time from the onset of disease to death was 3.1 days,the ave-rage hospitalization of 13.8 hours for dead cases.The death cases had been diagnosed with HFMD complicated with central nervous system involvement and died of neurogenic pulmonary edema and pulmonary hemorrhage.Conclusions HFMD is a common infectious illness in young children,particularly under 5 years old children.The prevalence peak is from May to July.The morbidity may increase with the drop of temperature and the increase of precipitation.Severe cases are mainly caused by EV71.So more intensive care should be given to children infected by EV71.To prevent and control HFMD,education of the children less than 5 years old is important and effective prevention and control measures should introduce to the kindergartens.To develop EV71 vaccine is also necessary.It is critical for the infected children to go to the designated hospitals for a better treatment so as to control severe cases and deaths.