| Objectives:1.To explore the hand-foot-mouth disease(HFMD)epidemiological present status,therefore,it provides a basis for designating prevention and control measures,as well as epidemic trend assessment and immunization strategy formulation.2.To understand infection status and infection rates of the HFMD patients and their close contacts within the family,and provide an evidence for recessive patients in terms of HFMD epidemic and as aspects of infection source,as well as in the cause of sustained high incidence of referenceMethods:HFMD epidemiological characteristics analyzed by descriptive epidemiology.Cross-sectional study in the hospital,and follow-up studied in the family,June to September in 2016,Mile County People's Hospital with non-randomized method selected 102 cases of confirmed hand,foot and mouth cases,homemade questionnaire was used to investigate the intimate contact with 203 households and fecal specimens.A total of 216 intimate contacts of 98 confirmed cases were studied and collected in 7 cities.The fecal samples were detected by R-T PCR method.The product was amplified by the specific primers of enterovirus.The DNA sequence was first edited with the SeqMan module of DNASTAR software.BLAST alignment was performed in the NCBI GenBank database for molecular modeling,and the gene phylogenetic tree was mapped with MEGA7.0 software.The Epidata 3.0 software was used to establish the database,and SPSS 23.0 statistical software was used to examine the data.The datum was analyzed by ?2 test.The nonunormal distribution data was analyzed by rank sum test.Spearman correlation coefficient,multivariate analysis using Logistic regression analysis.[Result]1.The HFMD case report incidence of HFMD is between 25.17 to 192.47/ten thousands in Yunnan province during 2008 and 2016 and,which indicated that the overall status of HFMD were increasing,incidence intensity exceeds the national average2.The HFMD in Yunnan province there are cases reports all year round and there a double peak,the main peak is from April to July and the secondary peak is from October to December.3.All of the 129 counties(cities and distributes)of Yunnan province had cases reports and differences in the intensity of the disease:Yuxi City,Kunming City,Dehong States,Xishuangbanna states and Lijiang City.4.Yunnan was pointed out that the proportion of male and female with HFMD was 1.43:1,which focused on the children of 5 years of age or younger,and there was a difference among all age groups(?2=34674.132,p<0.001)0 years of age group presented the least incidence rate and the 1 years of age group presented the highest incidence rate from 2011 to 2016.Therefore,with the gradual increase in age,the incidence gradually decreased and in different occupational distribution the scattered children were the highest number of cases.5.Over the past 9 years,all of the 8600 severe cases were reported which account for 1.7%of all cases reported.Kunming,Qujing and Honghe are the top places according to the report of severe cases.Analysis of unconditioned binary logistic regression shows that the risk factors of the HFMD according to:male infection(OR= 1.085,CI:1.025-1.140)and children in low age group[younger than one year old(ORF=2.095,CI:1.759-2.496),one year of age group(OR=2.086,CI:1.759-2.446),two years of age group(ORF=1.885,CI:1.602-2.218).)].98%of deaths were caused by EV-A71 infection,The risk factors of conformed severe case of HFMD are as follows:infection of EV-A71(OR=2.581,CI:2.471-3.557)and children in low age group[younger than one year old(OR=2.965,CI:2.471-3.557),one year of age group(OR=2.200,CI:1.885-1.568),two years of age group(OR=2.100,CI:1.788-2.467).The following risk factors were probably the death reasons of the HFMD patients:EV-A71(OR=8.041,CI:7.174-9.013)and children in low age group[younger than one year old(OR=2.242,CI:1.901-2.645),one year of age group(OR=2.242,CI:1.901-2.645),two years of age group(OR=2.098,CI:1.767-2.490).three to four years of age group(OR=1.615,CI:1.345-1.490].6.Laboratory monitoring data showed,among which EV-A71 was accounted for 40.43%,CV-A16 was occupied 37.86%,in Yunnan province.EV-A71 and CV-A16 were main HFMD pathogens in Yunnan.At this time,other enteroviruses were raised gradually,from 3%in 2008 to 41%in 2016.7.In Mile country,102 cases of confirmed hand,foot and mouth disease(HFMD)and 203 close contacts family members have coverage initiated into the research on family infection of HFMD,cases of male to female ratio is 1.49:1,the average age is 2.16±1.51years(0-7years),mainly scattered children(68.6%),childcare children for 32(31.4%)that households are dominated by local accounts(87.3%).All cases had typical clinical manifestations of hand,foot and mouth disease,drinking unboiled water(p=0.003<0.05)and eating cold food(p=0.020<0.05)are main risk factors.In 203 close contacts,male to female ratio is 0.69:1,the average age is 31.50±13.92 years(0-82 years old)and the occupation is mainly farmers(75.9%).In relationships with patients most are the parents(73.9%,150/203),followed are the grandparents(14.8%,30/203).Brothers and sisters and other else is less(11.3%,23/203).Investigation of the factors including the time of contact with the patients every day that the majority is more than 12 h(82.2%),family members contact one kid accounted for the highest(41.2%),followed is two or three kids(82.2%),the average living area of the family is 196.79±143.05m2.On average,a family has five members that mainly drinking bottled water(42.4%)and drinking unbolt or boiled water accounted for 48.1%and 51.3%.In research the toilets in the family are given priority to pit latrines and plunge down type(accounted for 32.4%and 57%respectively),54.4%and 47.3%contactors don't wash their hands before they touching and feeding kids.In the 102 cases,the family infection rate is 22.55%(23/102),consistent with the prototype at a rate of 79.31%,close contacts in the family infection rate is 15.27%(31/203)which consistent with the prototype at a rate of 83.16%.There is no difference in virus positive rate between how long the family members contact with the patients(?2=3.894,p=0.221>0.05)and also no difference enterovirus positive rate and concordance rate between the close contacts in different families(p>0.05).8.A total of 98 cases of hand-foot-mouth confirmed cases and 216 cases of intimate contact with the family were included in the survey.Seven cities(Chuxiong,Qujing,Kunming,Zhaotong,Yuxi,Xishuangbanna and Dehong)were incorporated into the survey.98 cases of confirmed cases,male to female sex ratio of 1.72:1,the average age of 2.64±1.64 years(0-10 years).The average age of men and women was 0.76:1,with an average age of 32.55±15.62 years(1-74 years).The number of parents in family members was 140(64.81%),and grandparents People(21.30%),brothers and sisters 30(13.89%).The infection rate was 51.02%,among which the coincidence rate was 51.02%.The infection rate of accurate contact was 38.92%,among which the pathogenicity was 83.16%.(?2 = 6.364,p = 0.041<0.05).The positive rate of the virus was significantly higher than that of the other patients(?2 =6.364,p = 0.041<0.05).The positive rate of the virus was significantly different among the different family members Analysis,the number of members of the family,the sampling interval,the number of children exposed to,housing construction area,whether the child after the wash with soap or hand sanitizer,the last two weeks whether to bring their children to public places and close contact with the family infection;Analysis results Investigate possible risk factors(including contact time,family members,the average household area,drinking water,toilets,lifestyle,etc.)to provide a reference for the study of intra-family infection.9.The positive rate of virus exposure in the family is related to the time(?2=11.732,p=0.008<0.05)interval between the sampling and the distance from the patient.The time of sampling is shorter and the positive rate of the specimen is higher.10.The result of gene sequence analysis showed that the patients were closely homologous(95.6%-100%)to the closely linked virus gene sequences in the family.Evolutionary analysis of the isolates in the same family was self-contained and the three families formed three small clusters.Conclusions:1.The prevalence of hand,foot and mouth disease in Yunnan Province is similar to that in other parts of China.The incidence of hand,foot and mouth disease and the occurrence of severe cases in Yunnan Province are increasing year by year.Although some conventional public health prevention and control measures have been undertaken in recent years,suggesting that the effect of reducing morbidity is not obvious.Infants with EV-A71 virus were right on elevated risk factors for severe cases and deaths.2.The study shows that hand-foot-and-mouth disease cases of family infection rate and close contact within the family infection rate is high,forming a large number of hidden infection,hidden infection as a source of infection is difficult to control,may be in hand,foot and mouth disease Communication plays an important role,it may be difficult to control hand,foot and mouth disease,sustained widespread,high incidence of one of the reasons.People are the only host of human enteroviruses,and vaccine immunization is the most economical,effective and convenient means of controlling hand,foot and mouth disease.Should be in school-age children to promote EV-A71 vaccine and new hand,foot and mouth disease vaccine vaccination. |
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