福建省4岁以下儿童手足口病再次罹患特征的队列分析

谢忠杭; 王灵岚; 严延生; 洪荣涛; 欧剑鸣; 黄文龙; 祝寒松; 陈光敏

Abstract

谢忠杭,王灵岚,严延生,洪荣涛,欧剑鸣,黄文龙,祝寒松,陈光敏.福建省4岁以下儿童手足口病再次罹患特征的队列分析[J].Chinese journal of Epidemiology,2014,35(10):1109-1114

福建省4岁以下儿童手足口病再次罹患特征的队列分析

A cohort study on the characteristics of the recurrent epidemics on hand,foot and mouth disease,in Fujian province

Received:June 11, 2014

DOI：10.3760/cma.j.issn.0254-6450.2014.10.007

KeyWord: 手足口病再次罹患队列研究流行病学

English Key Word: Hand,foot and mouth disease Recurrence Cohort study Epidemiology

FundProject:福建省卫生厅青年科研基金（2012-2-23）

Author Name	Affiliation	E-mail
Xie Zhonghang	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China Public Health College of Fujian Medical University
Wang Linglan	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China
Yan Yansheng	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China Public Health College of Fujian Medical University	yysh@fjcdc.com.cn
Hong Rongtao	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China Public Health College of Fujian Medical University
Ou Jianming	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China
Huang Wenlong	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China
Zhu Hansong	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China
Chen Guangmin	Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350001, China Public Health College of Fujian Medical University

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Abstract:

目的探讨福建省<4 岁儿童手足口病再次罹患特征，为制定防控策略提供依据。方法运用队列研究方法以福建省手足口病监测资料中<4 岁患儿为研究对象，以首次罹患时的特征作为其再次罹患的影响因素，采用SAS 9.0 软件的logistic 逐步回归法筛选。结果共纳入研究对象82 949 例，其中多次罹患者2 612 例（3.15%）。在多次罹患者中，累计罹患2 次者2 510 例，3 次者98 例，4 次者3 例，5 次者1 例。年龄<2 岁和2 岁者首次罹患时，其再次罹患风险分别是年龄为3 岁者的4.39（95%CI：3.80～5.07）倍和2.73（95%CI：2.35～3.18）倍；以居住地区<6 岁儿童手足口病患病率<2%为对照，患病率>4%、3%～4%和2%～3%的再次罹患风险分别为2.15（95%CI：1.88～2.45）倍、2.10（95%CI：1.85～2.38）倍和1.65（95%CI：1.44～1.89）倍；在妇幼保健机构就诊者再次罹患风险是在非妇幼保健机构就诊者的1.64（95%CI：1.51～1.78）倍；男性再次罹患风险是女性的1.34（95%CI：1.23～1.46）倍。引起再次罹患的主要病原是肠道病毒（EV）71 型（33/60），并进展为重症病例（8/2 612）；首次、再次罹患的致病病原有可能均为EV71 型毒株（3/6）。结论是否重复罹患与其再次接触病原体的机会密切相关，对首次罹患的低龄幼儿应及时采取干预措施。

English Abstract:

Objective To explore the recurrent epidemiological characteristics of hand,foot and mouth disease （HFMD） among children aged <4 years to provide evidence for HFMD prevention and control. Methods Principles on historical cohort study were followed when analyzing data related to HFMD surveillance in Fujian province. All the research objects were restricted to patients aged <4,with HFMD and who were permanent residents in Fujian province. Characteristics of the study objects were extracted as potential factors when the patients first showed symptoms of HFMD. These factors might cause the recurrence of HFMD and were filtered by the logistic stepwise regression with SAS 9.0. Results A total of 82 949 children were included. Among them,2 612 had repetitiously suffered from HFMD（occupied 3.15%）,including 2 510 who had the histories of suffering twice,98 suffering three times,3 suffering four times,and 1 even suffering five times. Comparing with the objects who had the first onset at the age of 3,also with the risk increased to 4.39 （95%CI：3.80-5.07）times,when compared to those who had the first onset at the age below 2. Again,the risk among children whose first onset was at the age of 2 had increased to 2.73 （95% CI：2.35-3.18）times. According to the current residents areas,the morbidities of patients under 6 years old were below 2% when the symptoms first started,but the risk of the objects whose morbidities were higher than 4% ,had increased 2.15（95% CI：1.88-2.45）times. Again,risk of the objects whose morbidities were between 3% and 4% had increased to 2.10（95%CI：1.85-2.38）times. Among those whose specific morbidities were between 2% and 3% ,the risk had increased to 1.65（95% CI：1.44-1.89） times. Comparing with the objects who never visited any maternal/child care settings when started the first onset,the risk among the ones who had been to the maternal/child care settings,had increased to 1.64（95% CI：1.51-1.78）times. Boys had the risk 1.34（95% CI：1.23-1.46）times increase than girls. The preponderant pathogen causing HFMD recurrence was EV71 （33/60）. Recurrence might cause more severe symptoms or signs （8/2 612）. Pathogens causing the initial infection and recurrence might both belonged to the same-EV71（3/6）. Conclusion Recurrence of the disease were closely related to the opportunities of contacting the pathogens. Interventions should be imposed on patients in time as soon as the disease initiated,especially at the younger age.

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