【作者】 张庆；

【导师】 尹平； 程锦泉；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2012， 硕士

【摘要】 目的1.分析深圳市2010-2012年手足口病的流行病学特征，了解手足口病流行的时间、空间和人群分布，以及主要的致病病毒类型；2.探讨重症手足口病发生的危险因素，提出综合性的预防控制措施，有效降低深圳市手足口病的重症发生率和死亡率。方法1.利用深圳市疾病预防控制信息系统，整理分析2010-2012年上报的手足口病病例资料，采用描述性流行病学方法，分析手足口病的季节、地区流行趋势，以及年龄、性别和人群类型的分布情况；2.采用整群抽样，对深圳市儿童医院、宝安区人民医院和龙岗区中心医院前来就诊的326例手足口病患儿进行问卷调查，收集调查对象基本情况、就诊行为和患儿照看人对手足口病的知晓情况，按照重轻症分组后，对调查数据采用单因素和多因素logistic回归分析，确定重症手足口病的危险因素以及关联强度。结果1.2010年深圳市共发生23289例手足口病病例，发病率为299.56/10万，出现92例重症病例和6例死亡病例；2011年发生病例24827例，发病率为239.80/10万，重症病例151例，死亡6例；2012年发生病例30021例，发病率为289.97/10万，重症病例56例，死亡2例；2.2010-2012年深圳市手足口病发病人数从1月份开始持续增加，5、6月份达到高峰，9、10月份又出现第二期高峰，然后不断减少。每年第一期高峰的发病人数分别为4267、4615和5684，第二期高峰的发病人数分别为2264、2801和5547；3.2010-2012年深圳市手足口病及重症的高发区均为宝安区和龙岗区，其中以2012年的龙岗区手足口病发病人数最多，为14011,2011年的龙岗区重症发病人数最多，为55；4.2010-2012年深圳市手足口病人群分布中，性别方面，均是男性多于女性，但三年的性别分布无统计学意义（χ~2=0.1027；P=0.7486）。年龄方面均以1～2岁发病人数最多，每年分别为6635、7645和9219。人群类型方面，每年散居儿童的发病人数分别为17147、18985和22343；5.深圳市手足口病实验室检测的病毒类型中，2010-2012年EV71的阳性率分别为65.29%、72.12%和69.09%，COXA16的阳性率为33.53%、15.15%和9.09%；6. Logistic回归结果显示：接种疫苗和发病前一月得过传染病可降低重症手足口病发生的风险，而EV71病毒类型等则更易导致重症的发生。结论深圳市手足口病高发期一般在5-7月和9-10月，高发地区为宝安区和龙岗区；发病人群中，男性多于女性，1-2岁年龄段高发，且以散居儿童和幼托儿童为主；主要致病病毒为EV71和COXA16，其中EV71更易导致重症的发生；接种疫苗能够有效地降低重症手足口病的发生风险。更多还原

【Abstract】 Objective1. To assess the epidemiology of hand foot and mouth disease (HFMD) in Shenzhenfrom2010to2012, and understand the time distribution, space distribution,population distribution, and major pathogenic virus type.2. To investigate risk factors associated with severe hand foot and mouth disease, andpropose comprehensive prevention and control measures, in order to reduce incidenceand mortality for severe hand foot and mouth disease in Shenzhen.Methods1. We report the surveillance finds of hand foot and mouth disease (HFMD) collectedfrom Shenzhen information system for disease prevention and control between2010and2012, and the method of descriptive epidemiological analysis was adopted tounderstand epidemic trends on season, district and population for hand foot andmouth disease, including age, sex and classification.2. A total of326cases of HFMD were investigated by questionnaire from Shenzhenchildren’s hospital, the people’s hospital of BaoAn district in Shenzhen and the centralhospital of LongGang district in Shenzhen, in order to collect basic situation, medical treatment behavior of study objects, and knowledge for hand foot and mouth diseaseof caretakers. After cases were divided into severe and mild cases, univariate andmultivariate logistic regression analysis was conducted to determine risk factors ofsevere cases and strength of the association.Results1. There were23289cases of HFMD patients in2010in Shenzhen, the incidence ratewas299.56per100thousand, along with92cases of severe HFMD patients and6deaths. There were24827cases of HFMD patients in2011, the incidence rate was239.80per100thousand, along with151cases of severe HFMD patients and6deaths.There were30021cases of HFMD patients in2012, the incidence rate was289.97per100thousand along with56cases of severe HFMD patients and2deaths.2. During3-year study period, it increased in the number of HFMD patients inShenzhen from the January each year, and a seasonal peak was detected in the warmermonths (May-June), along with a smaller winter peak (September-October). Afterthat time, it decreased constantly. The number of the first peak was4267,4615and5684. The second one was2264,2801and5547.3. BaoAn and LongGang district have a high incidence number of HFMD and severecases from2010to2012. Among of them, the number of HFMD in2012inLongGang district, which was the most, was14011. The number of severe HFMD in2011in LongGang district,which was the most, was55.4. Among the population distribution of HFMD patients in Shenzhen from2010to2012, males are more than females. However, it has no significance statistically (χ2：0.1027；P：0.7486). Age group between1and2year has the largest number of cases,which is6635,7645and9219respectively. Scattered children has the largest numberof cases, which is17147,18985and22343respectively. 5. Among the types of virus in Shenzhen, being detected by laboratory, the positiverate of the EV71from2010to2012is65.29%,72.12%and69.09%respectively, thepositive rate of COXA16is33.53%,15.15%and9.09%respectively.6. The logistic regression results show that vaccination and having infectious diseasesone month before the onset of incidence can reduce the risk of severe HFMD, andEV71can cause more severe HFMD cases than other types of enteroviruses.ConclusionHFMD has a high incidence during the summer period (May-July) and winter period(September-October), there is the largest number of cases in BaoAn and LongGangdistrict.Among the HFMD patients in Shenzhen, males are more than females, thenumber of the patient is the largest in the age group between1and2year, scatteredchildren and kindergarten children are observed frequently.The major pathogenicviruses are EV71and COXA16, among of them, EV71is more likely to cause severecases.It can reduce the risk of the severe HFMD by vaccination, even other vaccines.更多还原