无锡市托幼机构手足口病聚集性疫情发生影响因素

Influencing factors of clustering epidemic situation of hand-foot-mouth disease in kindergartens in Wuxi City

目的探讨无锡市托幼机构手足口病(HFMD)聚集性疫情发生的危险因素,为制定托幼机构HFMD防控措施提供科学依据。方法在无锡市469所幼儿园中选择2012—2014年连续发生聚集疫情或暴发疫情(3年内发生频次≥3次)的31所幼儿园作为研究组,按照街道、幼儿园性质、1∶2频数匹配原则,选择同时期同一街道未发生聚集疫情的68家托幼机构作为对照组。采用条件logistic回归分析探讨其危险因素。结果研究组和对照组托幼机构的机构性质、生源、校医基本情况及幼师基本情况差异均无统计学意义(均P>0.05)。多因素分析表明,1~10人使用1个水龙头(OR=0.150,95%CI=0.028~0.789)、缺勤追踪到位(OR=0.071,95%CI=0.011~0.470)及正确处理出现HFMD患儿的教室和午休室(OR=0.029,95%CI=0.001~0.638)是托幼机构HFMD聚集疫情发生的保护因素;和学生数≤349人相比,学生数350~499人(OR=9.622,95%CI=1.374~67.365)和学生数≥500人(OR=19.288,95%CI=2.787~133.477)是托幼机构HFMD流行的危险因素。结论建议托幼机构应根据园内面积控制招收规模,增加人均水龙头设备,做到缺勤追踪到位,正确处理出现HFMD疫情的教室和午休室,以降低托幼机构发生HFMD聚集疫情的风险。

[Objective]To explore the risk factors of clustering epidemic situation of hand-foot-mouth disease（HFMD）in kindergartens in Wuxi city,and provide scientific basis for formulating the prevention and control strategies and measures of HFMD.[Methods]31 kindergartens which the occurrence frequency of HFMD outbreak or clustering epidemic situation were ≥3 from2012-2014 were selected from 469 kindergartens in Wuxi city as study group. According to the principle of street,kindergarten nature and 1 ∶ 2 frequency matching,68 kindergartens which were in the same street and didn＇t have clustering epidemic situation were selected as control group. Conditional logistical regression analysis was used to explore the risk factors.[Results]The differences of kindergarten nature,source of students and basic situation of school doctors and teachers in study and control groups were not statistically significant（all P〉0.05）. Multiple factors analysis showed that 1-10 students using a faucet（OR=0.150,95%CI：0.028-0.789）,tracking absentee（OR=0.071,95%CI：0.011-0.470）and correctly dealing with the classroom and lunchroom where appeared HFMD cases（OR=0.029,95%CI：0.001-0.638） were the protective factors of HFMD clustering epidemic situation in kindergartens. Compared with kindergartens having ≤349 students,having 350~499 students（OR=9.622,95%CI：1.374-67.365）and ≥500 students（OR=19.288,95%CI：2.787-133.477）were the risk factors of HFMD.[Conclusion]The kindergartens should control the scale of enrollment according to kindergarten acreage,increase the number of faucets,timely track absentee,and correctly deal with the classroom and lunchroom where once appeared HFMD,in order to prevent the occurrence of HFMD clustering epidemic situation.