成都市托幼机构手足口病高发危险因素研究

Risk factors of hand-foot-mouth disease in kindergartens in Chengdu

目的探讨成都市托幼机构手足口病高发的影响因素,为成都市托幼机构手足口病防控提供针对性的措施。方法采用分层随机方法抽取2014年成都市高发、低发托幼机构各58家,采用调查、访谈、现场观察等方式收集托幼机构硬件、人员配置、儿童洗手卫生习惯等资料。同时对纳入的托幼机构随机抽取3名健康儿童进行咽拭子采样,并进行实时荧光PCR检测,收集在园健康儿童病毒携带情况。采用Epidata3.1软件录入数据,使用SPSS 18.0进行单因素、多因素非条件logistic回归分析。结果单因素结果显示,健康儿童病毒携带、单独设置睡床、洗手规范、洗手设施数量是托幼机构手足口病高发的影响因素。多因素分析结果显示;健康儿童病毒携带（OR=8.77,95%CI：2.59~29.76）是托幼机构手足口病高发的危险因素,单独设置睡床（OR=0.10,95%CI：0.01~0.88）;规范洗手（OR=0.24,95%CI：0.08~0.72）为托幼机构手足口病高发的保护因素。结论健康儿童病毒携带、单独设置睡床、规范洗手是托幼机构手足口病高发的影响因素。因而,加强手足口病患者管理,隔离传染源,加强健康儿童的个人自我防护,督促托幼机构为幼儿单独设置睡床,培训幼儿采用规范方式洗手等措施,对成都市托幼机构手足口病防控具有现实意义。

Objective To discuss the risk factors of hand-foot-mouth disease （HFMD） in kindergartens in Chengdu, and to develop strategies for the prevention and control of HFMD. Methods Fifty-eight kinder- gartens with high incidence of HFMD and 58 with low incidence of HFMD were selected into the study using stratified random sampling method in Chengdu. Nurseries＇ hardware, staff allocation, children＇s hand washing habits and other information were gathered through survey, interview and observation. Swab samples of three healthy children in each kindergarten were also collected and tested for enterovirus with real-time PCR. Epidata （V3.1） was used for data entry. Univariate analysis and multivariate unconditional logistic regression analysis were adopted for data analysis. Results Univariate analysis showed that healthy children carrying enterovir us, separated bed, proper method of washing hands and the number of hand-washing facilities were related to the incidence of HFMD in kindergartens. Multivariate analysis revealed that healthy children carrying entero virus （OR=8.77, 95~CI： 2. 59~29. 76） was a risk factor for HFMD, while, separated bed （OR=0.10, 95%CI： 0.01~0.88） and proper method of washing hands （OR=0.24, 95%CI： 0.08~0.72） were pro tective factors for HFMD in kindergartens. Conclusions Healthy virus carriers, separated bed and proper hand washing are factor of HFMD in kindergartens. Therefore, management of cases with HFMD and self pro- tection are important for HFMD prevention in kindergartens.