上海市杨浦区2012年手足口病聚集性疫情流行特征分析

Epidemiological features of clustered cases with hand-foot-mouth disease in Yangpu of Shanghai,2012

目的分析上海市杨浦区2012年手足口病聚集性疫情流行特征,为制定手足口病防控措施提供科学依据。方法应用描述性流行病学方法,对杨浦区2012年手足口病聚集性疫情进行分析,计数资料用χ2检验,计量资料用方差分析,P〈0.05为差异有统计学意义。结果 2012年杨浦区共报告手足口病聚集性疫情80起,波及18 384人,涉及病例337例,平均患病率1.83%,无重症、死亡病例。发生在中小学3起,占3.75%,为不同的3家学校,发生率为2.94%;发生在托幼机构77起,占96.25%,涉及托幼机构56家,发生率为52.83%。报告高峰在4~6月份。疫情的持续时间与疫情非及时处理（首发病例发病时间-停课时间间隔）（r=0.352,P=0.002）及发病人数（r=0.458,P〈0.001）之间呈显著正相关,在控制发病人数影响后,疫情持续时间与疫情非及时处理的统计学相关性增强（r=0.385,P=0.001）。在因素不变的情况下,聚集性疫情每延迟处理2d,或发病人数每增加1人,疫情时间均会延长1d,即：y=0.09＋0.81x1＋0.51x2。采样的34起疫情中,由EV71、Cox A16、其他肠道病毒引起的疫情数分别为10（29.41%）、6（17.65%）和9起（26.47%）。结论防控的重点仍是托幼机构,加强全年监测,深入研究病原变异,督促学校做好晨检和及时上报工作,规范处置能很好的控制疫情的发展。

Objective To analyze the epidemiological characteristics of clustered cases with hand-foot-mouth disease（HFMD）in Yangpu district of Shanghai in 2012,and to provide scientific evidence for disease prevention and control. Methods A descriptive epidemiological analysis was conducted among HFMD clustered cases in Yangpu.Chi-square test and t test were used for data analysis. Results A total of 80clustered events with 337cases out of 18 384close contacts were reported.The average incidence was 1.83%.No severe and dead cases were found.There were 3clustered events occurred in 3primary and middle schools with the incidence of 2.94%,and the other 77occurred in 56kindergartens with the incidence of 52.83%.Majority of cases appeared in April to June.The duration of each clustered event was positively related to non-prompt case handling（r=0.352,P=0.002）and number of cases（r=0.458,P0.001）.Adjusted by the number of cases,significant positive correlation was noticed between duration and non-prompt case handling（r=0.385, P=0.001）.Two days delay of case handling or one extra patient would add one more day to the duration period.Etiological analysis showed that out of total 34clustered events sampled,29.41%（10）,17.65%（6） and 26.47%（9）were found to be caused by EV71,Cox A16and other enterovirus. Conclusions Kindergartens and preschools are major places where clustered HFMD cases pop up.Prompt case handling and reporting as well as monitoring virus mutations are very important for HFMD control.