2009—2019年云南省手足口病重症病例流行病学特征及危险因素分析  

Epidemiological characteristics and risk factors of severe death cases of hand foot mouth disease in Yunnan, 2009—2019

作　　者：杨溪[1] 寸建萍[1] 曹亿会[1] 周晓芳[1] 李楠 姜黎黎[1] YANG Xi;CUN Jian-ping;CAO Yi-hui;ZHOU Xiao-fang;LI Nan;JIANG Li-li(Center for Disease Control and Prevention of Yunnan,Kunming,Yunnan 650022,China)

机构地区：[1]云南省疾病预防控制中心急传所,云南昆明650022

出　　处：《现代预防医学》2022年第15期2689-2693,共5页Modern Preventive Medicine

基　　金：“十三五”国家科技重大专项(2017ZX10103010)。

摘　　要：目的 了解云南省2009—2019年手足口病重症的流行分布特点、病原谱构成及变迁,探索重症病例的影响因素。方法 手足口病病例信息来源于“传染病报告信息管理系统”手足口个案,对重症病例的流行病学及病原学特征进行描述;采用多因素logistic回归分析重症病例的危险因素。结果 2009—2019年,云南省手足口病重症病例占报告手足口病例总数的1.37%,年均重症率1.97/10万;重症手足口发病呈现季节性,高峰时间为3—8月,5岁及以下儿童占全部重症的97.71%,散居儿童高于幼托儿童,男性多于女性。感染EV-A71的病例发展为重症的风险最高,自2013年起,其他肠道病毒的病原构成逐年持续增加。男性(OR=1.128,95%CI:1.083~1.175)、低年龄(0~12月龄,OR=2.279,95%CI:2.031~2.557;13~24月龄OR=2.326,95%CI:2.095~2.582)、EV-A71感染(OR=14.834,95%CI:14.122~15.583)、诊断时病程较长(1天OR=1.578,95%CI:1.459~-1.708;2天OR=2.709,95%CI:2.504~2.931;3天及以上OR=4.623,95%CI:4.294~4.978)与重症手足口病发病风险增加相关。结论 性别、年龄、病毒分型、诊断时病程是重症手足口病的影响因素,注重小年龄组儿童看护人的健康宣教,加大医护人员培训早期识别重症手足口病和EV-A71疫苗在偏远且病原流行州市的推广是防治重症手足口病的有力措施。Objective To collect and systematically analyze the surveillance data of severe cases of hand-foot-mouth disease(HFMD) in Yunnan Province from 2009 to 2019, so as to understand the epidemic distribution characteristics of severe cases of HFMD and the composition and changes of pathogen spectrum, and to explore the influencing factors of severe cases. Methods The epidemiological and etiological characteristics of the two groups were analyzed by SPSS 11.0. In univariate analysis, t-test and ANOVA were used to compare the measurement data, and chi-square test was used to compare the count data and classification data. In univariate analysis, the variables with P<0.05 were analyzed by multivariate logistic regression analysis, and the value and 95%CI of risk factors were calculated. Results From 2009 to 2019, 1.37% of the total reported cases were severe cases in Yunnan Province, with an average annual severe rate of 1.97/100 000;the incidence of severe HFMD was seasonal, with the peak time from March to August. The cases were concentrated in central and western Yunnan, and children under 5 years old accounted for 97.71% of all severe cases. Among them, children aged 1-2 had the heaviest burden of severe diseases, scattered children were higher than kindergarten children, and male were more than female. Since 2013, the pathogen composition of other enteroviruses has been increasing year by year. Male(OR=1.128, 95%CI: 1.083-1.175), low age(0-12 months old, OR=2.279, 95%CI: 2.031-2.557;13-24 months old, OR=2.326, 95%CI: 2.095-2.582), EV-A71 infection(OR=14.834, 95%CI: 14.122-15.583), and long course of disease at diagnosis(1-day OR=1.578, 95%CI: 1.459-1.708;2-day OR=2.709, 95%CI: 2.504-2.931;3-day OR=4.623, 95%CI: 4.294-4.978) were associated with increased risk of severe HFMD. Conclusion Gender, age, virus typing and course of disease during diagnosis are the influencing factors of severe hand, foot and mouth disease. Paying attention to the health education of child caregivers in young age group, increasing the train

关 键 词：重症手足口病 流行特征 病原学分析 影响因素 

分 类 号：R725.1[医药卫生—儿科] R181[医药卫生—临床医学]