2012-2020年重庆市大足区手足口病时空聚集性及趋势分析

Analysis on spatial-temporal clustering and trend of hand-foot-mouth disease in Dazu District of Chongqing municipality from 2012 to 2020

目的 分析2012—2020 年重庆市大足区手足口病(hand-foot-mouh disease,HFMD)时空聚集性,建立时间序列(ETS)模型预测其未来发展趋势,为制定防控策略提供理论依据。方法 采用描述性流行病学方法,对2012—2020年重庆市大足区手足口病监测资料和病原学检测结果进行统计分析,利用Excel 2016、ArcGIS 10.2和SPSS 19.0软件进行数据处理,计数资料采用卡方检验。结果 2012—2020 年重庆市大足区 HFMD 累计报告 5 324 例,年均发病率为 77.12/10万,重症病例10例占0.19%,死亡3例,病死率为0.06%。发病率最高的是2018年(211.84/10万),其次是2016年,2018年以后HFMD发病率有下降的趋势。9-11月为发病高峰期。交通发达、人口密集的龙岗镇(包括龙岗街道和棠香街道)发病率最高(156.83/10万)。发病人群5岁以下婴幼儿高发611例(95.6%)。男女性别比例为1.57∶1,散居儿童为主(82.32%)。病原学检测EV 71共62例(9.70%),CVA 16共124例(19.41%),其他肠道病例453例(70.89%)。不同年份病原学构成差异有统计学意义(χ^(2)=168.998,P<0.001)。不同年龄组人群的病原构成差异有统计学意义(χ^(2)=19.849,P=0.031)。以2012—2020 年每月发病数据为基础,建立时间序列(ETS)模型预测,2021 年、2022 年大足区 HFMD 的发病数约为 755 例和813 例。结论 2012—2020 年重庆市大足区 HFMD 发病存在一定的时空聚集性,时间序列(ETS)预测模型对实际值具有很好的拟合和跟踪,为HFMD前期预警工作提供了数据支撑。加强重点地区、重点人群疫情监测及预警工作,明确病原学诊断、流行病学特征,对于EV相关疾病的治疗与控制、多价疫苗的研发具有重要的意义。

Objective To analyze the spatial and temporal clustering of hand- foot- mouth disease(HFMD) in Dazu District,Chongqing,from 2012 to 2020;to establish a time series (ETS)model to predict its future development trend,and to provide a theoretical basis for the development of prevention and control strategies.Methods Descriptive epidemiological methods were used to statistically analyze the surveillance data and etiological detection results of HFMD in Dazu District of Chongqing from 2012 to 2020.Excel 2016,ArcGIS 10.2 and SPSS 19.0 software were used for data processing,and Chi- square test was used for counting data.Results From 2012 to2020,a total of 5 324 cases of HFMD were cumulatively reported in Dazu District,Chongqing,with an average annual incidence rate of 77.12/10~5.There were 10 severe cases,accounting for0.19%,and 3 deaths,with a mortality rate of 0.06%.The highest incidence rate was in 2018(211.84/10~5),followed by 2016.The incidence rate of HFMD showed a decreasing trend after2018.The peak period of incidence was from September to November.The highest incidence rate was found in Longgang Town (156.83/10~5,including Longgang Street and Tangxiang Street),a densely populated street with developed transportation.Most cases were children under 5 years old(611 cases,95.6%).The sex ratio of male to female was 1.57∶ 1,and scattered children predominated,accounting for 82.32%.There were 62 cases of enterovirus 71 (9.70% ),124Coxsackievirus group A type 16 (19.41% ),and 453 other enteric cases (70.89% ) detected pathogenically.The difference in pathogenic composition of different years was statistically significant(χ^(2)=168.998,P<0.001).The difference in the pathogenic composition of different age groups was also statistically significant (χ^(2)=19.849,P=0.031).Based on the monthly incidence data from2012 to 2020,ETS model was established,which predicted that the number of HFMD cases in Dazu District would be about 755 and 813 in 2021 and 2022,respectively.Conclusions There was a certain spatial- temporal clustering in the incidence of HFMD in Dazu District,Chongqing,from2012 to 2020.The ETS prediction model fit and tracked the actual values well,which provides data support for early warning of HFMD.Epidemic surveillance and early warning should be strengthened in key areas and groups.In addition,it is of vital significance to clarify the etiological diagnosis and epidemiological characteristics for the treatment and control of EV- related diseases and the research and development of polyvalent vaccines.