| [Object]To analyze the hand-foot-and-mouth disease (HFMD) diseases during2005to2011and clusters during2009to2011in Changning District, described their epidemiological characteristics. To research economic burden in2010through retrospective investigation, evaluate effects of interventions in order to provide more evidence for improving the prevention and control measures.[Methods]It collected the disease information of HFMD through China Information System for Diseases Control and Prevention to describe its epidemiological characteristics; It gathered clustered cases and swab specimens of clinically diagnosed cases in monitoring hospitals to undertake etiological classification and describe its pathogenic characteristics; After being accepted, a designed study on economic burden in the form of questionnaire was undertaken on the HFMD cases managed by Changning in2010.[Results]1. There were2575hand-foot-mouth disease cases during2005to2011and the average incidence rate is59.7/100,000, Xinjin sub district (184.7/100,000), Zhouqiao sub district (64.3/100,000) and Chengqiao sub district (60.9/100,000) were the three highest sub districts in Changning district, on the contrary, the three lowest sub districts were Tianshan sub districts (23.6/100,000), Xinhua sub district (25.7/100,000) and Huayang sub district.(31.8/100,000). The case reports throughout the year show a significant trend of seasonal incidence. Late spring and early summer (from May to July) as well as late autumn and early winter (from October to December) are two peak periods of HFMD, whose ratio account for50.6%and24.8%, respectively. HFMD mainly occurs in man, and the incidence ratio of men to women was1.5:1; HFMD mainly also occurs in the children aged from0to6years, whose incidence ratio in the total number of patients is up to92.7%(2387/2575); And most patients are preschool children (54.1%) and children lived in scattered communities (37.5%). In the pathogenic surveillance of the clinical diagnosis of406HFMD cases in2009to2011, the positive rate is74.1%, the virus type is mainly EV71(34%) and CoxA16(22%), and there are also some enteroviruses (14%) and mixed infections (0.2%). The proportions of pathogen in different years were different significantly (p<0.05) and the proportion of EV71was rising.2.2009to2011,117events were reported which affected3,422children. Among them, there were491HFMD patients and the mean attack rate of the events was14%(range:4.7%-100%). Two severe cases were reported and no death was involved. The events happened in all of the ten communities in Changning District, and85%(100/117) of them occurred in preschools. However, the incidences in family and community were rising. The peaks of the reports were April to June and October to December accounting for34%(40/117) and41%(48/117), respectively. About57%(67/117) of the events were identified by the active surveillance in CDC. Days from the cluster report to onset of last case and the peak of the cluster were within1day in51%(60/117) and95%(111/117) events, respectively. There were significant differences in report resource and attack rate between different places (p<0.05). Among the93events with positive results from laboratory,35and24events were caused by single pathogen as EV71and Cox A16, respectively. There were4events due to combination infection with EV71and Cox A16. EV71was the pathogen for the two severe cases. The proportions of pathogen in different years were no different significantly (p>0.05) and the proportion of EV71was rising. The median duration of the events was4days (range:0-17d). Type of pathogen, and whether to close the class or not, did not have significant effect in the duration of epidemic (p>0.05).3.Economic burden investigation showed that the average cost wes396.3±153.4Yuan (range:134.0-804.0Yuan) in outpatient cases, while it was2905.9±741.2Yuan (range:1880.0-6300.0Yuan) in hospitalized cases. As for the influencing factor of the total expenses for outpatients, the difference between children under3years old and those over3years old is small, and that of the children with fever is higher than that of the children without fever. As for the influencing factor of the total hospitalization expenses, there is no significant difference in sex, age and fever. For the direct medical costs of the outpatients with fever, patients with fever is higher than those without fever; For the indirect medical costs of outpatients (including transportation fees, nutrition costs, etc.), women spend more than men, and patients with fever spend more than those without fever; For the indirect losses, children under 3years lose more than those over3years old. The direct and indirect medical costs of the patients with fever are higher than those without fever.4. HFMD mainly happens sporadically. For sporadic cases, health education, home visits, guidance of disinfection and isolation and other measures can be used. Once there is a clustered event, we should verify the epidemic timely, implement disinfection and isolation dismiss classes/close kindergartens and take other prevention and control measures. There are only2cases caused outbreak among the117clustered cases, it can be seen that isolating the patients, retrieving the pathogen, dismissing classes/closing kindergartens, undertaking prevention and control measures with home visit and health education as its representatives is effective.[Conclusions]1. The incidence rate of HFMD is increasing year by year, which is with no significant regional features, but with a seasonal incidence trend.2. Preschool is the key place for HFMD prevention and control, and the critical periods are April-July and October-December, and the high-risk population is0and6-years old preschool children.3. The economic burden of inpatients is higher than that of outpatients, and the patients with fever have heavier burdens of disease. Early detection, early diagnosis and early treatment can prevent the occurrence of hospitalized cases and severe cases, which is a key factor to reduce the burden of disease.4. The timeliness of the report for HFMD clusters should be improved to prevent the spread of the disease.5. Pathogen detection helps us to prevent severe cases.6. Integrated interventions, such as disinfection and isolation, pathogen detection and health education, were effective in changning district. |
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