海南省手足口病重症病例危险因素的1:1匹配病例对照研究

A 1 ∶ 1 matched case-control study on risk factors of severe hand-foot-mouth disease in Hainan

目的探讨手足口病重症病例发病的危险因素,为重症病例的防控提供科学依据。方法按手足口病重症病例比例将海南省各县分为"高、中、低"三层,每层随机选取2个县,共对6个县的125例手足口病重症病例和125例普通病例进行现场调查,采用1∶1配对的病例对照方法进行危险因素分析。结果单因素条件Logistic回归分析发现初诊在村卫生室或私人诊所、非母乳喂养、肠道病毒71(enteroviruses 71,EV71)感染、就诊前最高体温高于39℃、发病到确诊时间≥2 d等5个因素在两组病例间分布存在差异。多因素条件Logistic回归发现EV71感染,初诊在村卫生室或私人诊所,非母乳喂养及发病到确诊时间≥2 d为重症病例发病的危险因素。结论加强病原学监测,根据EV71比例变化及时发布预警;提倡母乳喂养,禁止乡村医生、个体诊所接诊5岁以下发热儿童;加强培训,提高各级医疗机构手足口病诊断水平,有助于降低手足口病重症的发生危险。

Objective To explore risk factors for severe hand-foot-mouth disease（ HFMD） in Hainan and provide scientific basis for severe HFMD prevention and control. Methods Counties were stratified into three layers according to the proportion of severe HFMD. Two counties were selected in each layer. A total of 125 severe HFMD cases and 125 mild cases were investigated in 6 counties. A 1 ∶ 1 matched case-control study was conducted to explore risk factors for severe HFMD. Results Univariate analysis showed that following factors were distributed differently between two groups： village/private clinic as first diagnosis hospital,not breastfed,infected with enteroviruses 71（ EV71）,a peak body temperature〉39 ℃,period from onset to diagnosis ≥2 days. Conclusions Strengthening etiology surveillance,releasing the early warning according the variation of EV71 proportion,advocating breastfeeding,prohibiting village/private clinic receiving fever children under 5 years old and strengthening training to improve the diagnosis level might contribute to decrease risk for severe HFMD.