2009-2015年湖南省手足口病死亡病例临床与流行病学特征分析

Clinical and epidemiological characteristics of death cases of hand,foot and mouth disease in Hunan Province,2009-2015

目的分析湖南省手足口病死亡病例临床与流行病学特点,为防制手足口病、减少手足口病死亡提供科学依据。方法收集2009-2015年湖南省手足口病死亡病例个案信息,采用描述性、分析性流行病学方法分析病例三间分布、临床诊疗特征和病原学特征。结果 2009-2015年,湖南省报告手足口病病死率为0.039%。死亡病例集中出现在4-6月,以农村(77.8%)5岁及以下(99.3%)的散居儿童(87.3%)为主。病例发病到死亡的时间中位数为3 d,初诊为手足口病的正确率为24.3%,主要临床表现为发热(97.1%)、皮疹(83.0%)以及精神差(81.7%),肺水肿为主要并发症(69.6%)。EV71感染占89.8%,不同标本之间肠道病毒阳性率差异无统计学意义(P>0.05)。结论 2009-2015年湖南省手足口病病死率水平较高,死亡病例以农村地区散居儿童为主要人群,病例病情进展迅速,需同时加强乡村医师培训和农村地区家长健康宣传教育以降低病死率。

Objective To analyze the clinical and epidemiological features of death cases of hand, foot, and mouth disease [HFMD] in Hunan Province from 2009 to 2015 so as to provide scientific evidence for preventing and controlling HFMD and re- ducing its deaths. Methods We collected the information of death cases of HFMD in Hunan Province during 2009-2015. De- scriptive and analytic epidemiological methods were used to analyze its distribution with respect to time, region, population, as well as its clinical and etiological features. Results The reported mortality rate of HFMD in Hunan Province during 2009-2015 was 0. 039%. Most of the death cases occurred during April and June, and were rural [77.8%） scattered [87.3%） children aged 5 years and below （ 99.3% }. The median of interval between onset and death was 3 days. The accuracy of first diagnosis was 24.3%, and the most common clinical symptoms were fever （ 97.1% ） , rash （ 83.0% ） and fatiguc （ 81.7% ）. Pulmonary edema （ 69.6% ） was the major complication. EVT1 infection occupied 89.8% of all the deaths. No statistically significant difference was found in the positive rate of intestinal virus among different specimens （ P〉0.05）. Conclusions The mortality of HFMD in Hunan Province during 2009-2015 is at a high level. Most of the deaths are scattered children in rural areas. HFMD progresses quickly; and hence, it is necessary to simultaneously intensify the training of village doctors and health education of parents in rural areas so as to lower the mortality.