2009-2016年上海市奉贤区重症手足口病流行特征分析

Epidemiological characteristics of severe hand-foot-mouth disease in Fengxian,Shanghai,2009-2016

目的分析2009-2016年上海市奉贤区重症手足口病病原学和流行特征,为采取有效防控措施提供科学依据。方法收集、整理并分析本区2009-2016年全部重症病例的相关资料,探讨相关防控措施。结果 2009-2016年本区共报告和调查手足口病重症病例159例,占发病总数的0.80%。男性96例,重症率7.79‰;女性63例,重症率8.37‰,性别差异无统计学意义(P>0.05)。职业以散居儿童为主,占77.36%。最小年龄为6个月龄,最大为9岁,3岁以下年龄组占发病总数的72.33%,0~岁和≥3岁年龄组差异有统计学意义(χ~2=30.777,P<0.05)。5-7月为发病高峰;2010年之后疫情呈下降趋势。农村重症比例高于城镇,差异有统计学意义(χ~2=5.779,P<0.05)。实验室确诊重症病例119例,EV71阳性占94.96%,与普通病例EV71的检出率相比,差异有统计学意义(χ~2=141.618,P<0.05),表明EV71为重症病例的优势毒株。入院前临床体征方面,40.88%的病例最高体温≥39℃,45.91%的病例出现呕吐症状,45.91%的出现手足抖动,36.48%的病例出现易惊症状,提示出现这些症状应及时住院治疗。结论奉贤区重症手足口病发病呈下降趋势,3岁以下儿童为重症病例的主要发病人群,应提高警惕,加强健康宣教,落实综合性防控措施是做好重症手足口病防控工作的关键。

Objective To analyze the etiology and epidemiological characteristics of severe hand,foot and mouth disease in Fengxian District of Shanghai from 2009 to 2016,and provide scientific evidence for effective prevention and control measures.Methods A case study of all severe cases in this district from 2009 to 2016 was conducted.Real-time fluorescent RT-PCR was used to detect enterovirus,and relevant data were collected,collated and analyzed to explore related influencing factors and prevention and control measures.Results In 2009-2016,159 cases of severe cases of hand,foot and mouth disease were reported and investigated in this district,accounting for 0.80%of the total number of cases,96 males,accounting for 7.79‰,63 females,accounting for 8.37‰;the difference was not statistically significant(P>0.05).Among the occupational distribution,scattered children accounted for 77.36%.The minimum age was 6 months,the maximum was 9 years old,and the age group under 3 years old accounted for 72.33%of the total number of cases,compared with the 0-3 years old and≥3 years old age group in mild cases,The difference was statistically significant(χ~2=30.777,P<0.05).The incidence showed a single peak distribution,and the peak incidence of severe disease occurred from May to July;the epidemic situation showed a downward trend after 2010.Compared with urban areas,the proportion of rural severe cases was higher than that of urban areas,and the difference was statistically significant(χ~2=5.779,P<0.05).119 cases of severe cases were confirmed in the laboratory,113 cases were EV71 positive,accounting for 94.96%.Compared with the detection rate of EV71 in common cases,the difference was statistically significant(χ~2=141.618,P<0.05),indicating that EV71 was the dominant strain in severe cases.In terms of clinical signs,severe cases have fever before admission,and 40.88%of cases had a maximum body temperature≥39℃.45.91%of the cases had vomiting symptoms before admission,and 45.91%of the hands and feet were shaking.36.48%of the cases showed suspicion.Prompt for these symptoms should be promptly hospitalized.Conclusion The incidence of severe hand,foot and mouth disease in Fengxian District was decreasing.Children under 3 years old were the main morbidity of severe cases.They should be vigilant,strengthen health education,and implement comprehensive prevention and control measures to ensure the prevention and control of severe hand,foot and mouth disease.