2014-2016年南充市儿童手足口病重症流行病学调查及危险因素分析

摘要 目的：了解南充市儿童重症手足口病流行病学特征及其相关危险因素,为降低儿童重症手足口病发病率提供依据。方法：对中国"疾病监测信息报告管理系统"中确诊的南充市（顺庆区、高坪区、嘉陵区、阆中市）2014-2016年儿童手足口病的病例信息进行研究,分析该市儿童手足口病疫情、时间分布、地区分布和人群分布特征,并应用单因素和多因素Logistic回归分析儿童重症手足口病危险因素。结果：2014-2016年顺庆区、高坪区、嘉陵区、阆中市共报告儿童手足口病8068例,其中重症病例426例,占5.28%。全年均有手足口病发生,4~7月为手足口病发病高峰期,2014年峰值明显高于2015年、2016年,重症手足口病时间分布和发病高峰期与以上相同。顺庆区、高坪区、嘉陵区、阆中市均有手足口病发生,阆中市重症病例比例均高于其他辖区,差异有统计学意义（P<0.05）。男性患儿重症病例构成比较高,不同性别患儿重症病例构成比比较差异有统计学意义（P<0.05）;重症病例主要集中在1~3岁儿童,不同年龄段重症病例构成比比较差异有统计学意义（P<0.05）,重症病例主要分布在散居儿童和农村儿童,不同生活方式、不同家庭住址重症病例构成比比较差异有统计学意义（P<0.05）;重症病例主要分布在3~6天时间间隔的就诊患儿,不同就诊时间间隔重症病例构成比比较差异有统计学意义（P<0.05）。多因素Logistic分析显示：年龄为1-3岁、散居、家庭住址为农村是重症手足口病的危险因素（P<0.05）。结论：年龄为1-3岁、散居、家庭住址为农村是重症手足口病的危险因素,应在流动人口集中、生活条件较差的地区开展手足口病的宣传教育,提高人们对手足口病防治的认知,对于1-3岁儿童应作为疾病重点防控对象,提高家长疾病防控意识,以降低重症手足口病的发病率。

Children with Hand Foot and Mouth Disease: Epidemiological Investigation and Risk Factors Analysis in Nanchong From 2014 to 2016

ABSTRACT Objective: To understand the epidemiological characteristics and risk factors of severe hand foot mouth disease in chil- dren in Nanchong, and to provide evidence for reducing the incidence of severe hand foot mouth disease. Methods: The case information of hand foot mouth disease in children in Nanchong(Shunqing District, Gaoping District, Jialing District, Langzhong District), which was confirmed in China''s disease surveillance report management system from 2014 to 2016, was studied. The epidemic situation, time distri- bution, regional distribution and population distribution of hand foot mouth disease in children in the city were analyzed. The univariate and multivariate Logistic regression was used to analyze the risk factors of severe hand foot mouth disease in children. Results: From 2014 to 2016, a total of 8068 children with hand foot mouth disease were reported from Shunqing District, Gaoping District, Jialing Dis- trict, Langzhong District. Among them, there were 426 severe cases,accounting for 5.28%. Hand foot and mouth disease occurred throughout the year, and the peak of hand foot and mouth disease occurred during April to July. The peak value in 2014 was significantly higher than that in 2015 and in 2016. The time distribution and peak incidence of severe hand foot and mouth disease were the same as the above. Hand foot mouth disease occurred in Shunqing District, Gaoping District, Jialing District, Langzhong District, and the propor- tion of severe cases in Langzhong District was higher than that in other districts, and the difference was statistically significant (P<0.05). The proportion of severe male patients was relatively higher, and the difference in the ratio of severe cases between different genders was statistically significant (P<0.05). Severe cases mainly concentrated in the 1~3-year-old children, there were significant differences in the proportion of severe cases between different age groups(P<0.05). Severe cases mainly distributed in scattering children and rural chil-dren, severe cases with different occupation lifestyle, family address were statistically significant difference(P<0.05). Severe cases mainly distributed in children with 3~6 days of interval of visiting,there were significant differences in the ratio of severe cases between different visits at intervals (P<0.05). Logistic multivariate analysis showed that the risk factors of severe hand foot mouth disease were children with 1-3 years of age, scattering children and rural children (P<0.05). Conclusion: 1-3 years of age, scattering children and rural children are risk factors of severe hand foot mouth disease.So the propaganda and education of hand foot and mouth disease should be carried out in the areas with poor floating population and poor living conditions to raise awareness of the prevention and treatment of hand foot mouth disease. 1-3-year-old children should be taken as the focus of disease prevention and control, and should improve the awareness of disease prevention and control of children''s parents in order to reduce the incidence of severe hand foot mouth disease.