Surveillance And Analysis Of The Clusters And Outbreaks Of Hand-Foot-Mouth Disease In Shandong,China,2012～2018

ObjectiveTo analyze the epidemic feature of hand-foot-mouth disease(HFMD)clusters and outbreaks in Shandong Province from 2012 to 2018,to explore the rule of occurrence,and to provide rationalization suggestions for the control and prevention of the disease,so as to reduce the occurrence of HFMD clusters and outbreaks and control the occurrence of the epidemic scale.MethodRelevant data on HFMD clusters and outbreaks in Shandong Province were collected and reported on the Public Health Incident Information Management System(PHIIMS).The obtained information is built into a database for data storage and management,and some of the unfilled information is completed after checking the associated uploaded attachments.Analytical epidemiological methods were used for analysis.Mainly using quartiles,constitute ratios,rates and other indicators.When analyzing the correlation between the two variables,the Pearson correlation coefficient is used for exploration.Statistical analysis was performed using SPSS 22.0 software(IBM SPSS Inc.,Chicago,IL,USA)with P values < 0.05(bilateral significance test)considered statistically significant.ResultFrom 2012 to 2018,a total of and 367 events in Shandong Province reached the standards of HFMD cluster and outbreak respectively.A total of 5460 cases of HFMD were reported,with no deaths.The number of reported cases in 2014 has risen sharply,much higher than the average of 2012～2018.The time from April to July had the high incidence of HFMD clusters and outbreaks in Shandong Province,and the number of HFMD clusters and outbreaks and the number of cases reported in some years from October to November increased slightly.From2012 to 2018,kindergartens and families are the main occurrence places for the HFMD clusters and outbreaks.The proportion of HFMD clusters and outbreaks happened in community is also high in the total reported HFMD events,and the majority of the affected population are scattered children.Except Heze and Linyi,there are 15 districts reporting HFMD outbreaks,and the average number of cases of per HFMD outbreak in districts of Shandong Province during 2012～2018 was 5～25 cases.The outbreaks were mainly concentrated in coastal areas and some inland areas.The average number of cases of per HFMD outbreak in the coastal areas was generally higher than that in the inland areas except the cities in the center of the province,such as Jinan,Zibo,Tai’an and so on.The number of HFMD outbreaks reported in economically developed areas is higher than that in economically underdeveloped areas.The time from discovery to report of HFMD outbreaks reported during 2012～2018 in Shandong Province was 7(6～8)days,and the duration was 12(7～20)days.Pearson correlation analysis was carried out on the time from discovery to report of HFMD outbreaks and the duration of the corresponding HFMD outbreak.The standard of p<0.05,then we found that the relationship between the time from discovery to report of HFMD outbreaks and the duration of the corresponding HFMD outbreak was extremely weakly correlated(r=0.161).From 2012 to 2018,although the number of HFMD outbreaks happened in urban areas was more than that in rural areas early in Shandong Province,there was slight difference between them in morbidity level.ConclusionThe HFMD clusters and outbreaks in Shandong Province are still seasonally high in2012～2018.The epidemic mainly occurs in coastal areas and some inland areas which located in the center of the province.The scale of the epidemic in coastal areas is higher than that in the inland areas,this may be related to factors such as climate characteristics,economic development,population density,differences in diagnosis and treatment levels in different districts.The family is the main occurrence place for the HFMD clusters.The kindergarten is still a high～risk place for the HFMD outbreaks.The community events take the high proportion deserving attention.Although most of the patients were scattered children,their close contacts were mostly children with kindergarten history in the community,so it was impossible to determine whether the source of the epidemic was community or kindergarten.Except in 2014,the number of HFMD outbreaks reported by rural areas in other years and the number of cases involved in each epidemic have been similar to those reported by urban areas,slightly higher or slightly lower than the level of urban areas.The gap in the level of HFMD outbreaks in urban areas and rural areas is decreasing year by year.The time from CDCs found out the HFMD outbreaks to report had no effect on the duration of the corresponding epidemic,which reflects that the current monitoring system is not obvious for the early detection,early warning and emergency treatment of HFMD clusters and outbreaks,but it has a very high reference value in analyzing the characteristics of the epidemic situation.