2010～2014年郴州市手足口病重症和死亡病例的流行病学及病原学特征研究

Epidemiological and etiological features of severe and dead cases with hand, foot and mouth disease in Chenzhou between 2010 and 2014

目的 分析郴州市手足口病（HFMD）重症和死亡病例的流行病学及病原学特征,为制定防控措施提供科学依据.方法 采用描述性流行病学方法对2010 ～ 2014年郴州市HFMD重症和死亡病例的流行病学和病原学特征进行统计分析.结果 2010 ～ 2014年郴州市共报告HFMD重症病例665例,年均报告重症率和重症病死率分别为1.49％和4.66％.51.61％的重症病例集中在4月和5月;全市11个县市区有重症病例报告,宜章县报告最多（25.56％）,各县市区重症率比较差异有统计学意义（x 2=160.68,P=0.000）;以散居儿童为主（95.34％）,职业分布比较差异有统计学意义（x 2=1727.25,P=0.000）;年龄＜3岁儿童占81.81％,年龄分布比较差异有统计学意义（x 2=549.33,P=0.000）.重症病例从发病到诊断重症的中位时间为3d;初次诊断到诊断重症中位时间为2d;初诊中64.84％诊断为HFMD,35.16％未诊断出HFMD.重症病例感染病毒类型以人肠道病毒71型（HEV71）为主（71.74％）;死亡病例中HEV71感染率较重症病例高（x2=18.26,P=0.000）.结论 郴州市HFMD重症病例感染病毒类型趋向多元化,应加强重症病例的早期识别,以有效预防控制HFMD暴发流行,降低重症和死亡病例的发生率.

[Objective] To analyze the epidemiological and etiological features of severe and dead cases of hand, foot and mouth disease （HFMD） in Chenzhou, and to provide references for the scientific prevention and control. [Methods] The descriptive epidemiological method was used for statistical analysis of severe and dead HFMD cases in Chenzhou from 2010 to 2014. [Results] Totally 665 severe HFMD cases were reported in Chenzhou from 2010 to 2014. The average annual incidence of severe cases was 1.49% and the mortality of severe cases was 4.66%. The majority （51.61%） of the HFMD cases were reported in April and May. Severe cases were reported in all the 11 counties of the city. Yizhang County had the highest incidence （25.56%）. There were significant differences in the rate of severe cases among the counties. Scattered children were the main population （95.34%） and the difference was statistically significance （X2 = 1,727.25, P= 0.000）. The children under 3 years accounted for 81.81% of the severe cases and the comparison among different age groups showed statistical difference （X2= 549.33, P= 0.000）. The time from onset to the first diagnosis was 3 d and that from the first diagnosis to diagnosis of severe cases was 2 d. In the first diagnosis, 64.84% of the severe cases were diagnosed as HFMD, while 35.16% were not diagnosed. The mainly infected virus type of severe cases was HEVT1 （71.74%）. The rate of HEVT1 infection in the dead cases was higher than that in the severe cases （X2= 18.26, P=0.000）. [Conclusions] The types of infected viruses are diverse in severe HFMD cases. Early identification should be strengthened to effectively prevent and control the epidemic out- break of HFMD and to decrease the incidence of severe and dead HFMD cases.