| Hand-foot-mouth disease (HFMD) is an acute infectious diseases chiefly which affects preschool children, caused by the intestinal virus (RNA virus), Coxsackie (COX), A6and A5A10, A9, B5, B2, ECHO virus, EV71(A, B, and C-type) virus and other enterovirus infection and characterized by skin lesions, especially on oral mucosa, hands and feet, the most infected occurs in the group aged below3. The disease was first described the by Seddon in1957. The following year, Coxsackie virus CoxA16was isolated from stool and throat swab by Robbinson. Growth of antibodies in the serum was found at a speed of4times, and CoxA16was identified as the initialpathogen. In1959, the disease was named Hand-Foot-Mouth Disease (HFMD) when patients’are found to have blisters and rashes on the hands, feet and mouth if infected. The pathogens of the early reports of hand, foot and mouth disease is Cox A16. However since the1970s, there has been some reports of the disease which relates with EV71infection. In1972, for the first time, United States confirmed that EV71can also be pathogenic. Since then the two kinds of pathogens, CoxA16and EV71which dominate the treatment of HFMD alternatively, of which AEV71virus takes more propotion.HFMD patients and latent infection are main sources of infection, which mainly transmit through the digestive tract, respiratory tract and by close contact means. The speedy propagation can spread the disease shortly at densely populated places, such as kindergartens, schools, and crowds. Normally the prognosis of HFMD cases is good, but central nervous system involvement of children can be left with varying degrees of sequelae, if combined with pulmonary edema, pulmonary hemorrhage, even can cause death.In recent years, in some areas in China appear HFMD cases, in which some deaths have been reported, HFMD now has been designated as a Class C infectious diseases by the Ministry of Health. From April to October in2009, HFMD broke out in the Henan, especially in Shangqiu city-east of Henan.A large number of children were infected. During this breaking out,not only the general cases increased, but it has seen more severely infected cases than before.Worse still, a few deaths were reported. Henan province government, State health department and the news media, attached great attention and strengthened the supervision to the prevention and control measures.Shangqiu’s geographic location is very special, and it is at the junction of Henan, Shandong, Jiangsu and Anhui provinces. The convenient transportation brought mass flows of people and more complexities to the disease. In April2009, Health Minister Chen Zhu visited Shang qiu city in Henan Province to inspect the hand-foot-mouth disease epidemic situation and gave directions and guidance. Based on this background, this article reviews a large number of clinical data of children in observing rooms infected with hand, foot and mouth disease. The authors used the epidemiology and clinical data statistics, research and analysis1200cases of HFMD, so as to prevent and control the disease and to provide basic data for diagnosis and treatment, is reported as follows:ObjectiveTo explore and research the clinical and epidemic characteristics, diagnosis, treatment, clinical prevention of1200cases of the hand-foot-and-mouth disease in the East Henan Province in2009; to provide reliable scientific basis for epidemic characteristics, clinical characteristics, diagnosis,treatment,prevention and prognosis of HFMD. Materials and Methods1. Object1200cases of hand-foot-and-mouth disease in Henan Province Shangqiu People’s Hospital from April to October2009. Observing room of the First People’s Hospital of Shangqiu782cases, the First People’s Hospital of Yongcheng106cases, the Zhecheng First People’s Hospital,105cases, NingLing First People’s Hospital100cases accounting for, the MinQuan First People’s Hospital,107cases accounting for. Shangqiu411cases, which was accounted for34.3percent, the suburbs outside of the suburbs in789cases, accounting for65.7%. Male665cases, female535cases, male to female ratio of1.24:1.The youngest of three months,the biggest16-year-old, the average (3.1±1.2) years of age, duration of4to15d, the average (7±2.3) days.2. MethodsThis group of childrens diagnosis and treatment was conducted by the Department of Infectious Diseases physicians. It was made the diagnosis according to the "Practical Pediatrics" hand-foot-and-mouth disease diagnostic criteria. Clinical classification and treatment was in accordance with the standards of hand-foot-and-mouth disease prevention and control guidelines promulgated by the Ministry of Health,2008.3. Statistical analysisAll cases according to patients’ age, gender, the onset time, population distribution, clinical manifestations and prognosis classified research respectively. The statistical analysis was conducted by means of SPSS10.0software. Measurement data are expressed as mean±standard deviation (x±s), using test, count data using chi-square test of a=0.05.Results1. Epidemiological survey1.1GenderMale-665cases, female-535cases, male to female ratio of1.24:1. 1.2Duration of disease and age distribution.The youngest is three months, the biggest is16-year-old, the average (3.1±1.2) years old, duration of4to15days, the average (7±2.3) days.April224cases of children of18.7%, May256cases of21.3%, June270cases of22.5%, July185cases of15.4%, August120cases of10.0%, September84cases of7.0%, October61cases of5.1%.1.3Population DistributionObserving room of the First People’s Hospital of Shangqiu782cases (65.2%), the First People’s Hospital of Yongcheng106cases (8.8%), the Zhecheng First People’s Hospital,105cases (8.8%), NingLing First People’s Hospital100cases accounting for8.3%, the MinQuan First People’s Hospital,107cases accounting for8.9%. Shangqiu411cases, which was accounted for34.3percent, the suburbs outside of the suburbs in789cases, accounting for65.7%. Preschools and elementary school students have480cases, accounting for40.0%; live scattered of720cases, accounting for60.0%. Have clear exposure history in510cases, accounting for42.5%.2. Clinical manifestation2.1Ordinary cases1200cases of hand-foot-and-mouth disease, fever in968cases, accounting for80.67%, temperature≤38℃in690cases, accounting for57.5%,38℃～39℃in188cases, accounting for15.67%,>39℃in90cases, accounting for7.5%; duration of fever last time1～5d, an average of2～3d heat-type variable. The majority of the temperature dropped to normal shortly after antiviral therapy.2.2Severe casesIn115cases, accounting for9.6%, which were accompanied with continuing high fever in85cases, accounting for7.1%. Dysphoria, lethargy, convulsions, vomit, unconsciousness,30cases of concurrent encephalitis and pneumonia accounted for2.5%, which were transferred to the imergency ward for further treatment.2.3RashNucous Herpes appear on oral cavity, as needlepoint to the green beans-sized, number unequal. The typical rash of hand and foot were blisters or pustules. Its size is of a grain of rice to soybean. Pygal rash in children less than3years of age is common, in which a few of them may also appear below the knee, mainly erythema and papules. The serious patients were with sparse rash, not typical. Rash mainly by hand in433cases, accounting for36.1%,374cases of foot-based, accounting for31.2%, the main425cases of oral lesions, accounting for35.4%,122cases of pygal-based, accounting for10.2%, in knee andelbow, the chest and abdomen,in60cases, accounting for0.5%.2.4Laboratory testsThe total number of white blood cells increased in370cases, accounting for30.8%, and the total number of white blood cells reduced in240cases, accounting for20.0%, normal WBC count was590cases, accounting for49.2%.56cases of electrocardiogram have ST change,32cases cardiac enzyme increases,35patients were moderately elevated liver function, and high blood sugar27cases. Chest X-ray thick lung markings of260cases.15lumbar puncture for cerebrospinal fluid examination, cerebrospinal fluid pressure increases, biochemical and cell count, accord with viral encephalitis change.3. Pathogen typeAll115cases of severe person were taken the blood centrifugal serum to detect pathogens, the results is that93cases infected enterovirus (EV),71positive in infection. The rate was80.9%.4. Course and prognosticDrug treatment is accompanied by anti-virus and supportive treatment. The average duration lasts (7±3.5) days. At the end of observing the1085cases recovered.111of115hospitalization cases in severe finally clinically cured,4cases with the brain sequelae had to take a follow-up treatment.Conclusion:1. In this group of patients, morbidity in males was more than than females, male to female ratio1.24:1.1～3years old children have the highest incidence among below7-years-old group.2. The population distribution situation, scattered children accounted for60.0%of the cases, The suburb is higher than urban areas.3. The onset time to peak is in May and June, Spring and summeris high-risk period.4. ordinary cases are of high cured rate, accouting for90.4%with no relevant sequelae.5. Severe cases test resulting from positive infection EV71as the main pathogens account for80.9%. Among the cured cases the brain sequelae is still following-up. |
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