陕西省2009－2013年手足口病疫情时空流行特征分析

白尧; 刘昆; 谷旭; 张康军; 袁筱婕; 邵中军

Abstract

白尧,刘昆,谷旭,张康军,袁筱婕,邵中军.陕西省2009－2013年手足口病疫情时空流行特征分析[J].Chinese journal of Epidemiology,2018,39(9):1152-1158

陕西省2009－2013年手足口病疫情时空流行特征分析

Analysis on the spatial-temporal characteristics of hand-foot-mouth disease in Shaanxi province, 2009-2013

Received:November 16, 2017

DOI：10.3760/cma.j.issn.0254-6450.2018.09.003

KeyWord: 手足口病时空分布规律 Power-law算法

English Key Word: Hand-foot-mouth disease Spatial-temporal epidemiological characteristics Power-law method

FundProject:国家传染病防治科技重大专项（2017ZX10105011）；国家自然科学基金面上项目（81373058）；陕西省自然科学基础研究计划项目（2017JQ8015）；陕西省卫生计生科研基金项目（2016A002）

Author Name	Affiliation	E-mail
Bai Yao	Department of Epidemiology, School of Military Preventive Medicine, The Fourth Military Medical University, Xi'an 710032, China Department of Infection Disease Control and Prevention, Xi'an Center for Disease Prevention and Control, Xi'an 710054, China
Liu Kun	Department of Epidemiology, School of Military Preventive Medicine, The Fourth Military Medical University, Xi'an 710032, China
Gu Xu	Department of Epidemiology and Health Statistics, School of Public Health and Management, Weifang Medical College, Weifang 261021, China
Zhang Kangjun	Department of Epidemiology, School of Military Preventive Medicine, The Fourth Military Medical University, Xi'an 710032, China
Yuan Xiaojie	Department of Epidemiology, School of Military Preventive Medicine, The Fourth Military Medical University, Xi'an 710032, China
Shao Zhongjun	Department of Epidemiology, School of Military Preventive Medicine, The Fourth Military Medical University, Xi'an 710032, China	13759981783@163.com

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Abstract:

目的探讨陕西省手足口病疫情的时空演变规律，为优化手足口病的防控策略提供科学依据。方法 2009－2013年手足口病疫情个案数据来源于中国疾病预防控制信息系统，同期人口数据和国内生产总值（GDP）数据来源于陕西省统计年鉴，采用R3.4.1、ArcGIS 10.2和SaTScan 9.2软件进行时空流行病学分析，采用基于Power-law算法的时空多成分模型分析手足口病的时空演变特征。结果 2009－2013年陕西省累计报告手足口病229 904例，年均发病率122.50/10万；手足口病季节性明显，4－7月病例数占总病例数的71.71%，高发病率县（区）主要分布在关中地区的中东部区域；时空扫描分析显示，2009－2013年陕西省疫情的一类聚集区固定在以西安市为中心的陕西省中部和东南部，RR=2.24（95% CI：2.18～3.08）；基于Power-law算法的时空多成分模型结果显示：陕西省手足口病疫情受先前时段疫情影响较大的县（区）主要有渭南市潼关县和蒲城县、西安市未央区（时间自相关成分值分别为1.14、0.97和0.89）；本地发病风险较大的县（区）主要有渭南市华阴市、西安市长安区和雁塔区（局部特性成分值分别为5.08、4.12和4.08）；疫情受临近区域影响较大的县（区）主要是西安市莲湖区和高陵县、咸阳市武功县（空间流行成分值分别为2.12、2.08和1.77）。2009－2012年陕西省的优势循环血清型为肠道病毒71型，2013年则变迁为其他肠道病毒。结论陕西省手足口病疫情存在显著的时空异质性，疾病高发区采取针对性措施利于控制手足口病疫情。

English Abstract:

Objective To study the spatial-temporal dynamical features of hand-foot-mouth disease (HFMD) in Shaanxi Province, so as to provide evidence for the development of relative prevention and control programs on HFMD. Methods Surveillance data of HFMD was collected from the China Information System for Diseases Control and Prevention from 2009 to 2013. Related data on population and gross domestic product (GDP) was obtained from Shaanxi Statistical Yearbook. Statistical tools as R3.4.1, ArcGIS 10.2 and SaTScan 9.2 software were used to describe the spatial-temporal distribution of the disease. Power-law method on spatial-temporal-multicomponent model was used to analyze the spatial-temporal evolution of the HFMD epidemics in Shaanxi Province. Results A total of 229 904 cases of HFMD were reported in Shaanxi Province from 2009 to 2013, with an average annual incidence as 122.50 per 100 000. Obvious seasonal characteristics were noticed, with 71.71% of the total cases identified between April and July. Counties with high incidence were mainly distributed in the mid-and east parts of Guanzhong area. Through temporal and spatial scan statistics, we identified that Class Ⅰ clustering area was fixed to the central and southeast regions of Shaanxi province which were around Xi'an City between 2009 and 2013, with the relative risk (RR) as 2.24, ranging from 2.18 to 3.08. Results from Power-law analysis showed that the continuous follow-up impact from the previous HFMD epidemics appeared strong in Tongguan, Pucheng districts of Weinan City and Weiyang district of Xi'an, with autoregressive components as 1.14, 0.97 and 0.89, respectively. The risk of HFMD seemed high in Huayin city, Changan and Yanta districts and with the endemic components as 5.08, 4.12 and 4.08, respectively. Impact of the epidemics on nearby districts was largely seen in Lianhu district of Xi'an, Wugong district of Xianyang and Gaoling district of Xi'an with epidemic components as 2.12, 2.08 and 1.77, respectively. The etiological constituents of HFMD were mainly Enterovirus 71 between 2009 and 2012, while HFMD was mainly caused by other entero-viruses, in 2013. Conclusion Significant spatial-temporal heterogeneity of HFMD was seen in Shaanxi province, which called for specific strategies to be developed in the highly endemic areas.

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