| BackgroundHand,foot and mouth disease (HFMD) was a common infectious disease caused by a variety of enteric viruses. National HFMD outbreak more and more seriously and threat to children's health and safety, according to recent reports. Shandong had many HFMD cases, HFMD first outbreak in Zaozhuang in 1984, Zhaoyuan in 2000, Tai'an in 2003 also have occurred in the prevalence of hand, foot and mouth disease. In recent years, HFMD epidemic in Shandong Province rapidly increased, and showed a growth trend year by year. In Liaocheng city, incident cases and the rate of severe cases increased year by year and caused serious social harm, which caused the party and government and community attention. Therefore, we should clarify the local epidemiological characteristics and the pathogen characteristics of HFMD, summarize experience and lessons in prevention and control, study on severe risk factors, discuss prevention and control measures to prevent spread of HFMD and reduce morbidity and mortality.ObjectiveTo analyze the prevalence of hand, foot and mouth disease characteristics and trends in Liaocheng City from 2007 to 2010 and study on epidemic strain. To analyze risk factors in severe children with HFMD, explore prevention and control measures, evaluate the effect of prevention and control preliminarily, and provide a scientific basis for prevention and control work for future.MethodsIn this study, we collect data of Liaocheng City from the China Disease Prevention and Control information system for four years, we use descriptive epidemiological method and Geographic information system (ArcGIS software) to analyze epidemic characteristics of HFMD. We observed the occurrence of cases of severe disease which come from the monitoring queue of mild cases in the peak of 2009, established mild cases, severe cases case study databases, collected the clinical diagnosis and treatment, epidemiological informations and stool samples in some cases to make etiological classification and investigate infected time.We trained the investigators and unified the investigation method. In the data collection process, the staffs were sent to be responsible for site guide by Liaocheng Center for Disease Control and Prevention and check the data in question, after that enter the finishing questionnaires by hand, create Excel database, proof and analyze dataResults1.In terms of the four-year Incidence data, HFMD epidemic was in an upward trend in Liaocheng city from 2007 to 2009,2010 declined a little. In 2007,474 HFMD cases were reported, the annual incidence rate was 8.37/10 million; in 2008, the total number of HFMD cases was 2 026, the annual incidence rate was 35.42/10 million; in 2009, the total number of HFMD cases was 16 018, including 641 severe cases,3 died cases(two from Yanggu couty, one from Guan couty), the reported incidence rate was 277.60/10 million; incidence of severe cases was 4.00%, mortality rate was 0.02%. In 2010, the total number of HFMD cases was 11 730 the reported incidence rate was 201.44/10 million, Epidemic wes spread rapidly from late March, the incidence rate was high from April to July, and mainly infected scattered children. The incidence ratio between male and female was 1.96:1, the cases were mainly infants and young children, of which 5 year age group accounted for 96% or more of reported incidence.2. In terms of geographical epidemic features, in 2007, prone areas were Chiping couty and Dong'a couty, the first case was in Gaotang couty, and the epidemic was spread towards East, and gradually covered all the couties, but the incidence rate declined in Chiping couty and Dong'a couty. HFMD outbreak in the whole Liaocheng city, the overall trend is gradually spreading towards South and West in 2009 and 2010. The incidence rate of severe cases and the major epidemic Pathogenic types was EV 71. From the time of distribution, onset time was ahead from 2007 to 2009, the overall epidemic in 2010 was gently compared with 2009.3. According to epidemiological features and risk factors of severe cases, from regional distribution, there was statistical difference between the incidence of severe cases in different areas of the same year, there was no statistical difference only in Guan couty, there was statistical difference between 2009 and 2010 in the other couties.We found the statistical difference in the incidence of severe cases between high and low incidence month in 2009. Based on multivariate non-conditional logistic regression analysis:the related risk factors of fatal cases were Patient delay, fever and rash, older age and higher Unit level in newly diagnosed is a protective factor.4. Pathogen monitoring results showed that the major strains type in 2010 were EV 71, which caused the higher incidence rate of severe cases.5. During the high incidence of disease, we should take strict measures including isolate and control infection sources and protect susceptible populations, whose effect was significant in short time.But the most important measure to prevent and control HFMD was to strengthen the health education and publicity. Conclusion1. HFMD epidemic spread from several towns to all between 2007 to 2010, the speed was faster, high incidenced seasons focused on April to July, the cases occurred throughout the whole year in 2009 and 2010.2. HFMD input our city in 2007, partly epidemic in 2008 and pandemic began in 2009.One of the early HFMD spread came from Jinan and Tai'an city, spread westward from Chiping and Gaotang couty, the other came from Hebei, spread northward from Yanggu and Shen couty.3. The risk occupational groups of HFMD were the scattered children, followed by preschool children.4. The largest incidence number was the group for 1 to 2 years, in which the incidence rate of severe cases was highest. The incidence rate of severe cases reduced with age increasing.5. HFMD cases such as younger age, medical treatment is not timely, fever and rash and first diagnosed units was in low level were easy to become severe cases.6. Our dominant strain was EV 71 in 2010, Cox A16 virus and other enteric viruses also existed. All kinds of viruses in different counties haad been found.Strategies and Recommendations1.We should strengthen the construction of laboratory personnel and configure equipment scientificly. The future work focus on improving the ability of pathogen monitoring.2.Under the government leadership and participation of the whole society, jointing prevention and control, we would made significant effect when epidemic occure. During the epidemic, Medical institutions should control nosocomial infection, we should take positive measures in the focus and key areas to prevent spread of the disease. 3.Strengthening health education and publicity to improve people's health behavior and form long-lasting effective measures. |
PDF Full Text Request