2008-2018年中国5岁及以下儿童手足口病死亡病例流行病学特征

崔金朝; 聂陶然; 任敏睿; 刘凤凤; 李昱; 王丽萍; 谭吉宾; 常昭瑞; 李中杰

Abstract

崔金朝,聂陶然,任敏睿,刘凤凤,李昱,王丽萍,谭吉宾,常昭瑞,李中杰.2008-2018年中国5岁及以下儿童手足口病死亡病例流行病学特征[J].Chinese journal of Epidemiology,2020,41(7):1041-1046

2008-2018年中国5岁及以下儿童手足口病死亡病例流行病学特征

Epidemiological characteristics of fatal cases of hand, foot, and mouth disease in children under 5 years old in China, 2008-2018

Received:January 14, 2020

DOI：10.3760/cma.j.cn112338-20200114-00031

KeyWord: 手足口病死亡流行病学

English Key Word: Hand,foot,and mouth disease Mortality Epidemiology

FundProject:肠道病毒71型灭活疫苗Ⅳ期临床应用研究（2016ZX09101120-004）；国家科技重大专项（2018ZX10713001）

Author Name	Affiliation	E-mail
Cui Jinzhao	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Nie Taoran	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China Miyun District Center for Disease Control and Prevention, Beijing 101500, China
Ren Minrui	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Liu Fengfeng	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Li Yu	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Wang Liping	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Tan Jibin	Regular Operations Management Center, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Chang Zhaorui	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China	changzr@chinacdc.cn
Li Zhongjie	Division of Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

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Abstract:

目的分析2008-2018年我国≤5岁儿童手足口病死亡病例的特征，为制定针对性措施，减少死亡病例发生提供依据。方法从全国疾病监测信息报告管理系统中收集2008-2018年手足口病监测数据，采用描述性分析方法分析手足口病死亡病例的人群特征、空间分布、诊断和报告情况及病原构成变化，采用logistic回归模型分析导致死亡的危险因素。结果 2008-2018年全国共报告手足口病≤5岁儿童死亡病例3 646例，男性多于女性（1.82：1），以≤2岁儿童为主（87.71%）。2010年之后全国≤5岁儿童报告手足口病调整后的死亡率由0.87/10万下降至2018年的0.11/10万（APC=-23.20%）。2 523例实验室确诊的死亡病例中，2 323例（92.07%）为肠道病毒71型（EV-A71）感染，但柯萨奇病毒A组16型（CV-A16）和其他肠道病毒构成呈现增加趋势。死亡病例发病至诊断时间间隔M=2（P₂₅～P₇₅：2～4）d，发病至死亡时间间隔M=3（P₂₅～P₇₅：2～4）d。0～1岁、EV-A71感染、发病诊断时间间隔较长和居住地为农村是手足口病死亡的危险因素。结论 2010年后，我国手足口病死亡水平呈下降趋势；死亡病例中优势病原仍为EV-A71，应加强死亡病例中非EV-A71和非CV-A16肠道病毒基因分型；西部省份、农村地区和小年龄组病例应当加强EV 71灭活疫苗接种宣传，提高诊断、救治及时性，降低死亡风险。

English Abstract:

Objective To understand the epidemiological characteristics and risk factors of fatal cases of hand, foot, and mouth disease (HFMD) in children under 5 years old in China from 2008 to 2018, and provide evidence for the development of targeted prevention and control measures and reduction of the incidence of fatal HFMD cases. Methods The incidence data of reported HFMD cases in China during 2008-2018 were collected from the National Notifiable Disease Surveillance Reporting System of China for the analyses on the demographic characteristics, spatial distribution, diagnosis or reporting and pathogen spectrum of the HFMD cases. Then the risk factors causing deaths were analyzed by using logistic regression model. Results From 2008 to 2018, a total of 3 646 fatal cases of HFMD in children under 5 years old were reported in China. There were more fatal HFMD cases in boys than in girls (1.82:1), the death mainly occurred in age group 0 to 2 years (87.71%). Adjusted mortality rate of HFMD in children under 5 years old in China declined from 0.87 per 100 000 in 2010 to 0.11 per 100 000 in 2018 (APC=-23.20%). In the 2 523 laboratory-confirmed deaths, 2 323 (92.07%) were EV-A71 infections, but the constituents of CV-A16 and other enterovirus infections increased. The interval from onset to diagnosis M=2(P₂₅-P₇₅:2-4)d. The interval from onset to death M=3(P₂₅-P₇₅:2-4)d. Age between 0 and 1 years, EV-A71 infection, longer interval between onset and diagnosis, and living in rural area were the risk factors causing fatal HFMD cases. Conclusions The number of the fatal cases, the rate of mortality and case fatality HFMD in China had shown downward trends since 2010. EV-A71 is still the main pathogen causing fatal cases, but we should pay more attention to gene pattern of the other enteroviruses except EV-A71 and CV-A16. To reduce the risk of the fatal cases we should strengthen the health education about the immunization of EV-A71 inactivated vaccines and reduce the interval from onset to diagnosis in young children in western provinces and rural areas.

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