2009年临沂市手足口病流行特征及重症病例危险因素分析

目的了解2009年山东省临沂市手足口病流行病学特征。方法应用描述流行病学方法对临沂市2009年手足口病患者的三间分布进行分析,并运用Logistic回归分析方法研究手足口病重症病例的流行特征及危险因素。结果临沂市手足口病以4~7月份为发病高峰期,发病率以人口密度最高的临沂市市区最高,男、女重症发病率分别为1.54/万和1.01/万;3岁以下儿童占重症发病总数的比例为86.99%;散居儿童占重症发病人数比例为95.91%。多因素非条件Logistic回归分析结果显示,手足口病患者出现以下几种情况则提示其可能发展为重症患者的风险增加：患者就医时间的延长（OR=1.101,P=0.005）,出现发热（OR=2.021,P=0.025）,外周血白细胞计数增高（OR=1.058,P〈0.01）和淋巴细胞比例增高（OR=1.008,P=0.019）;患者年龄越大则发生重症的风险越小（OR=0.841,P〈0.01）。结论重症病例发生的危险人群主要为1~2岁的散居儿童;发热、外周血白细胞水平升高和淋巴细胞比例增高等症状和体征是重症发生前期症状;及时就医对于防止重症的发生有重要意义。

Epidemiological characteristics of hand,foot,and mouth disease in the City of Linyi,in 2009

Objectives To ascertain the epidemiological characteristics of and the risk factors for hand,foot,and mouth disease（HFMD） in the City of Linyi,Shandong Province,and to provide evidence for HFMD control strategies.Methods Data on HFMD cases in 2009 were collected from surveillance sites.Related risk factors were identified using correlation and logistic regression analyses.Results The number of HFMD cases increased starting in April,with a peak incidence from May to July.The highest incidence occurred in areas of the City of Linyi with the highest population density.Severe cases occurred in 1.54 males/10,000 population and in 1.01 females/10 000 population.Children residing separately from their parents accounted for 95.91% of severe cases,and children under 3 years of age accounted for 86.99% of severe cases.Based on multivariate non-conditional logistic regression analysis,risk factors associated with a severe case of HFMD were patient delay（OR=1.101,P=0.005）,fever（OR=2.021,P=0.025）,an increased white blood cell count（OR=1.058,P0.01）,and an increased proportion of lymphocytes（OR=1.008,P=0.019）.Severe cases were less likely at an older age（OR=0.577）.Conclusion At risk of HFMD were mostly children 1 to 2 years of age residing separately from their parents.Symptoms and characteristics such as patient delay,fever,an increased white blood cell count,a greater proportion of lymphocytes,and young age were early signs of a severe case of HFMD.A timely visit to a physician is critical to preventing severe cases of HFMD.