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目的分析河北省2008年儿童手足口病(HFMD)的流行病学特征及死亡病例特点,探讨HFMD的主要危险因素,为HFMD的预防和控制提供理论和实践依据。方法使用国家疾病监测信息报告管理系统开展HFMD监测,以河北省2008年1月1日-12月31日诊断为HFMD的29 499例患儿为研究对象。采用描述性流行病学方法对此次疫情的流行特征及死亡病例进行分析。结果 29 499例HFMD患儿中,重症病例135例,其中死亡10例。发病时间主要集中在5-7月份,发病例数占全年疫情总数的79.81%;男:女为1.71:1;≤3岁发病20 850例(占70.68%),≤5岁发病26 728例(占90.61%);其中1~2岁年龄组发病数最多(9 308例,占31.55%);散居和幼托儿童多见,分别占79.01%和16.03%。不同地区HFMD发病率差异有统计学意义,发病率随气温的升高而降低,随降水量的增加而升高。EV71感染较非EV71(柯萨奇病毒A16型和其他肠道病毒)感染更易引起重症病例。死亡病例以EV71感染为主,年龄6个月~4岁;患儿从开始发病至到达死亡所在医院的时间(院前时间)平均为3.1 d;到达死亡所在医院平均13.8 h死亡;大都诊断为HFMD并脑炎;死亡原因均为神经源性肺水肿、肺出血。结论河北省2008年手足口病好发人群主要为≤5岁儿童,以散居儿童和幼托儿童多见;发病时间主要集中在5-7月份;发病率随气温升高而降低,随降水量增加而升高。在临床工作中对EV71感染患儿更要加强监护。对≤5岁儿童进行健康教育和管理、落实好对托幼机构的防控措施,并研发能有效控制EV71流行的疫苗是预防本病的关键。到定点医院接受规范诊疗是防止发生重症和死亡病例的关键。
Objective To analyze the epidemiological characteristics and mortality of childhood HFMD in Hebei province in 2008 and to explore the main risk factors of HFMD so as to provide theoretical and practical basis for the prevention and control of HFMD. Methods HFMD surveillance was conducted using the National Disease Surveillance Information Reporting Management System. A total of 29 499 children diagnosed with HFMD from January 1 to December 31, 2008 in Hebei Province were enrolled in this study. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of the epidemic and the deaths. Results Among 29 499 children with HFMD, 135 cases were severe and 10 died. The onset time mainly concentrated in May-July, the incidence of cases accounted for 79.81% of the total number of the outbreak; male: female 1.71: 1; 20 850 cases (70.68%) ≤ 3 years old, ≤ 72 years old (90.61%). The highest incidence was found in the age group of 1-2 years (9 308 cases, accounting for 31.55%). Diaspora and preschool child were more common, accounting for 79.01% and 16.03% respectively. The incidence of HFMD in different areas was significantly different, the incidence decreased with the increase of temperature, increased with the increase of precipitation. EV71 infection is more likely to cause severe cases than non-EV71 (coxsackievirus A16 and other enteroviruses) infections. The deaths were mainly EV71 infection, ranging in age from 6 months to 4 years. The average time from premature onset to the hospital where the deceased was (prehospital time) was 3.1 days and the average death rate was 13.8 hours at the hospital where the deceased was. Most of the deaths were diagnosed as HFMD and encephalitis; causes of death were neurogenic pulmonary edema, pulmonary hemorrhage. Conclusion The population of HFMD in Hebei Province in 2008 was mainly ≤5 years of age, mostly in scattered children and preschool children. The onset time was mainly in May-July. The incidence of HFMD decreased with the increase of precipitation Increase and increase. In clinical work in children with EV71 infection should be more intensive care. Health education and management of children ≤5 years of age, implementation of prevention and control measures for nurseries and childbirth, and to develop vaccines that can effectively control the epidemic of EV71 are the key to prevent this disease. To the designated hospitals to receive standardized treatment is to prevent the occurrence of severe and fatal cases of the key.