| BackgroundChina is one country with many patient infected by hand, foot and mouth disease (HFMD). HFMD was first reported in Shanghai in 1981. The disease was reported in Beijing. Hebei, Tianjing, Shandong, Henan, Guangdong and other provinces since then. Up to now, HFMD has spread to all the provinces. Hand, foot and mouth disease outbreak in Xintai City of Shandong Province in 2003. Over eighty thousand cases of HFMD were reported in China, among which over thirty thousand cases reported in Shandong province and seventeen cases were dead in 2007.Ministry of Health take hand, foot and mouth disease into, "People's Republic of Infectious Diseases Prevention Law" under the management of infectious diseases in class C, May 2,2008. The monitoring of HFMD were strengthened in everythere.Information of hand, foot and mouth disease was report through national disease surveillance and reporting system.The number of HFMD cases were reported up to 130,000, hand, foot and mouth disease epidemic was a very grim situation.Objective1. To analyze the prevalence of hand, foot and mouth disease characteristics in Shandong Province from 2007 to 2010, provide the basis for the development of prevention and control measures;2. To compare the incidence of hand, foot and mouth disease in different cities;3. To analyze the spatial and temporal characteristics of hand,foot and mouth disease in Shandong Province.4. To analyze the risk factors that lead to severe cases.Methods1. The study of temporal and spatial characteristics In this study, we collect data of Shandong Province from the China Disease Prevention and Control information system from 2007 to 2010, and describe the distribution of the disease. we use Geographic information system (ArcGIS software) to analyze the onset date and incidence at the township. Inverse Distance Weighted and Kriging Interpolation methods are used to predict the onset date of villages and towns.2. Study on risk factors of severe HFMD cases In this study, we used Uniform questionnaire to gather information from patients infected by HFMD from April,1,2009 to August,31,2009. Those patients who's frist diagnosis were normal HFMD cases were investigated carefully and their final diagnosis were found in their medical records. Non-condition Logistic regression analysis was selected to analyze risk factors of severe cases.Results1. In 2007,the total number of hand,foot and mouth disease cases was 38 267 in Shandong Province. The overall incidence was 4.09 per 10 000 with 14 patients died. In 2008, the total number of hand,foot and mouth disease cases was 32 434 in Shandong Province. The overall incidence was 3.46 per 10 000 with no dead patients. In 2009, the total number of hand,foot and mouth disease cases was 138 227 in Shandong Province. The overall incidence was 14.76 per 10 000 with 45 patients died. In 2010, the total number of hand,foot and mouth disease cases was 141,744 in Shandong Province. The overall incidence was 15.13 per 10,000 with 8 patients died. 2. From 2007 to 2010, a upward trend can be seen at the number of cases. HFMD has its peak in May and June. The largest number of severe cases occur in June and July. The ratio of incidence between men and women was 1.68. Male had higher incidence than female (χ2=2435.84,P<0.05). The smallest patient aged 1 month and the oldest patient was 75 years old. Age group 1-2 years has the largest number of cases. Most of HFMD patients were scattered children or preschool children. Other cases were students, farmers, workers and so on.3. Entervirus test results are mainly EV71 in 2008 and 2009, account for 60.53% and 67.67% respectively. In the year 2010, EV71 and Cox A16 account for 38.78% and 37.85% respectively. We detected 577 severe cases and found 404 cases were infected by EV71,account for 70.02%.4. The year 2007 was the first year that hand, foot and mouth disease began to outbreak and became pandemic. Where the epidemic first appeared were Jinan and tai'an city. We can see the details in page 36-37.5. Based on multivariate non-conditional logistic regression analysis, the related risk factors of fatal cases were Patient delay (OR=1.101, P<0.05), fever (OR=2.021, P<0.05), higher peak white blood cell count (OR=1.058, P<0.05) and higher peak lymphocyte count (OR=1.008, P<0.05). Older age (OR=0.577,P<0.05) is a protective factor.Conclusion1. Hand, foot and mouth disease start at urban areas, then spread to areas around. It had a fast spread speed, with its peak time in May and June.2 Cases with hand, foot and mouth disease distribute and local epidemic during year 2007 and 2008. The disease became widespread in the next two years. It had two sources of infection, Jinan and Linyi city.3. Scattered children are most likely to be infected by entervirus, then come the preschool children.4. Age group 1-2 years has the largest number of cases. It has a highest incidence of severe case in this age group. With the increase of age group, the incidence of severe case continue to reduce.5. Those cases who were young, hospital delay, fever, higher peak white blood cell count and higher peak lymphocyte count were most likely to become severe cases. 6. Etiological agent that cause hand,foot and mouth disease in Shandong Province were mainly EV71 and Cox A16 in 2009,and EV71 was the ascendant strain. EV71 can easily lead to severe cases. In 2010, Major epidemic entervirus were EV71 and Cox A16,which had different Epidemiological characteristics in different area. |
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