2010年北海市手足口病重症病例的流行病学及临床特征

Epidemiological and clinical characters of severe HFMD cases in Beihai City in 2010

目的探索手足口病重症病例的流行规律,为今后的预防控制工作提供科学依据。方法对2010年全市报告的HFMD重症病例进行现场流行病学调查及分析,采集患者粪便、肛拭子、咽拭子、疱疹液检测病毒核酸。结果 121例重症病例中:男61.2%,女38.8%;最小发病年龄为2月龄,最大为9岁10个月,3岁以下占85.1%;病例构成以散居儿童及农村儿童为多;6月至8月为高发时段;重症发生率为1.5%,病死率为6.6%,EV71为主要病原体。临床表现普遍有发热及手足口部位出现疱疹/丘疹/口腔溃疡或疱疹症状,多数并发有神经系统、循环系统、呼吸系统症状。病情进展迅速,从发病到发展为重症平均时间为3天,8例死亡病例从发病到死亡平均时间为2.8天。结论手足口病重症病例好发于3岁以下男性、散居、农村居住儿童,夏秋季节为重点防控救治时段。及早甄别救治重症病例,减少死亡及后遗症的发生是防治工作的重点。研制开发有效的EV71疫苗是控制HFMD重症病例的最有效方法。

Objective To explore the epidemiologic characters of severe cases of hand,foot and mouth disease（HFMD） in Beihai City and provide scientific evidence for control and prevention.Methods The field epidemiologic investigations and analysis of reported severe cases in Beihai City in 2010 were carried out。 A variety of specimens such as stool,rectum swabs,pharyngeal swabs,and vesicle exudation were tested to confirm EV71,CoxA16,or other type EV infection.Results Among the 121 reported severe cases： male and female accounted for 61.2% and 38.8% of cases,respectively;The age range varied between 2 months to 9 years and 10 months of age,with 85.1% of the cases being 3 years of age or younger;The scattered children accounted for 67.8% of cases and rural children accounted for 55.4%;Severe cases appeared only in April,June,July,August,and December,with the period of June to August accounting for 95.0% of cases.Incidence rate of severe HFMD cases was 1.5%（121/8296） and case fatality rate was 6.6%（8 death cases）;The main pathogen of severe HFMD cases was EV71,accounting for 95.0%.All 121 severe cases occurred typical clinical symptoms： rashes on hands,feet and mouth with fever,and rapid deteriorating,with tachypnea,fast heart beat（≥120times/minute）,and some nervous system‘s complications such as myoclonia and twitching,stiff neck,etc.The average time from onset of illness to confirmed as severe case was 3days and with 2.8 days from illness onset to death{8 death cases}.Conclusion Severe HFMD cases mainly happen under 3 years old male children who scattered in countryside.Summer and autumn are the most important seasons for cases control and treatment.The early diagnosis,timely treatment,and more paying attention to severe cases were the keys to lower case fatality rate and sequelae.Researching and developing EV71 vaccine should be the most effective measures to control the epidemics of severe cases.