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目的探讨河南省2009年手足口病(hand-foot-mouth disease,HFMD)死亡病例的临床特点和流行病学特征,为预防控制手足口病提供科学依据。方法依据卫生部《手足口病预防控制指南(2009版)》,填写《手足口病死亡病例个案调查表》,统计分析调查结果。结果 2009年河南省共报告手足口病101 672例,死亡46例,病死率为0.45‰,其中男性34例(73.91%),女性12例(26.09%);死亡病例的死亡时间多在3月和4月,占总数的71.74%(33/46);29例在入院后24 h内死亡;死亡病例年龄在6~64个月之间,平均年龄(18.37±10.75)个月;实验室确诊病例32例,其中肠道病毒71型(enterovirus 71,EV71)阳性31例,占96.88%;其他肠道病毒阳性1例。手足口病死亡病例的临床特点是有发热、皮疹等典型症状,多因神经、呼吸和循环系统并发症和多器官衰竭死亡,病情变化较快,病程较短。结论死亡病例多发生在疫情高发区和疫情高峰时期,以3岁以下EV71感染的重症病例为主。重症病例入院早期是临床救治的关键时期,开展重症病例的实验室病原学检测对指导预防控制和临床救治工作至关重要。
Objective To investigate the clinical characteristics and epidemiological characteristics of death from hand-foot-mouth disease (HFMD) in 2009 in Henan province and provide a scientific basis for the prevention and control of HFMD. Methods According to the Ministry of Public Health Handbook for the Prevention and Control of Hand-Foot-Mouth Disease (Version 2009), fill out the “Case-List of Death Cases of Hand-Foot-Mouth Disease” and make statistical analysis of the survey results. Results A total of 101 672 hand-foot-mouth disease cases were reported in 2009 in Henan province, with 46 deaths, with a case fatality rate of 0.45 ‰, including 34 males (73.91%) and 12 females (26.09%); the deaths were mostly in March And April, accounting for 71.74% (33/46) of the total; 29 patients died within 24 hours after admission; the deaths were between 6 and 64 months (mean age, 18.37 ± 10.75 months); laboratory diagnosis Among 32 cases, 31 cases were positive for enterovirus 71 (EV71), accounting for 96.88%, and 1 was positive for other enteroviruses. Hand, foot and mouth disease deaths are clinically characterized by fever, rash and other typical symptoms, mostly due to nerve, respiratory and circulatory complications and death of multiple organ failure, rapid changes in the disease, shorter duration. Conclusions Most deaths occurred in the high incidence area and the peak period of the outbreak, with the severe cases of EV71 infection under 3 years old as the mainstay. Severe cases of early admission is a critical period of clinical treatment, to carry out laboratory tests of critically ill cases of pathology to guide the prevention and control and clinical treatment is essential.