手足口病流行特征及其影响因素研究

发布时间：2018-05-08 03:30

  本文选题：手足口病 + 流行特征　； 参考：《中国科学技术大学》2017年硕士论文

【摘要】：手足口病作为一种常见儿童传染病,是如今造成中国儿童死亡的一个重要原因。鉴于该疾病的重要影响,本文将阜阳市手足口病监测资料作为样本,对2009-2013年阜阳地区手足口病的流行特征及影响因素进行了讨论,包括重症危险因素以及该病与气候因素的关系。2009-2013年阜阳市一共报告了 95 937例手足口病病例,包括95 417例普通病例和520例重症病例。本研究首先对手足口病的流行情况进行了描述性分析,分析了发病的时间、地区、人群、病毒类型、月龄、出生月份和发病月份分布。研究发现,阜阳地区手足口病高发期为4-6月。颍上县和临泉县是手足口病的高发地区,颍州区的发病率最高,太和县的重症病例数最多。报告病例中有63.61%男性患者和36.39%女性患者,平均男女比为1.75:1。散居儿童占报告病例主体(96.8%)。在1 000例实验室诊断病例中,59%是enterovirus 71(EV 71)感染者,7.2%是coxsackie A16(Cox A16)感染者,33.8%是其他肠道病毒感染者。手足口病发病与患者年龄有关,以12个月为周期,12,24,36,48,60个月的儿童发病数最多。在60个月以下儿童这个群体中,与出生在1月的儿童相比,出生在5月的儿童的患病相对危险度增加8倍以上(relative risk = 8.88,RR)。本研究利用Logistic回归模型探索重症手足口病的危险因素。单因素Logistic回归模型研究表明,患者年龄、居住地区、出生月份以及发病前7天平均气温、最高气温、最低气温和气压的均值是重症手足口病的危险因素。多因素Logistic回归模型表明,相对于居住在临泉县,居住在太和县和颍上县是危险因素(odds ratio分别为2.68和1.99,OR),而居住在颍州区则是保护因素(OR=0.56)。与出生在1月相比,出生在3-12月的病人有2倍以上风险发展成为重症病例。特别地,与在1月出生相比,在8月出生的患者有5倍多的风险成为重症病人。低龄患者更易发展成为重症病例,发病前7天平均气温也是重症的危险因素(OR=1.02)。本研究利用广义相加模型研究气候因素和手足口病发病数之间的关系。在控制了时间的长期趋势和季节性之后,我们发现平均气温和相对湿度与每周发病数有关。在线性影响假设下,气温每升高1℃,手足口病发病的相对危险度增加2.79%;相对湿度每增加1%,发病相对危险度下降0.32%。在非线性影响假设下,气温大于13℃时、相对湿度高于70%时是手足口病的危险因素。本文的研究结果可帮助制定手足口病管理措施。例如对高危群体实施定向疫苗接种措施,可提高疫苗接种效率。相关管理机构也可以根据研究结果在适当的时候发出预警,以减少可能发生的损失。
[Abstract]:Hand, foot and mouth disease (HFMD), as a common infectious disease in children, is an important cause of death in China. In view of the important influence of this disease, the epidemic characteristics and influencing factors of hand, foot and mouth disease in Fuyang from 2009 to 2013 were discussed by using the surveillance data of hand, foot and mouth disease in Fuyang as a sample. 95,937 hand-foot-mouth disease cases were reported in Fuyang city from 2009 to 2013, including 95,417 common cases and 520 severe cases. In this study, the epidemic situation of HFMD was analyzed, and the time, region, population, virus type, age of month, month of birth and month of onset were analyzed. It was found that the high incidence of HFMD in Fuyang area was from April to June. Yingshang County and Linquan County are the high incidence areas of HFMD, Yingzhou District has the highest incidence, Taihe County has the most severe cases. Of the reported cases, 63.61% were male and 36.39% female, with an average male to female ratio of 1.75: 1. Scattered children accounted for 96. 8% of the reported cases. Among the 1 000 laboratory diagnosed cases, 59% were enterovirus 71(EV 71) and 7.2% were coxsackie A16(Cox A16) and 33.8% were other enterovirus infections. The incidence of HFMD was related to the age of the patients. In the group of children under 60 months, the relative risk of disease in children born in May was more than eight times higher than that in children born in January, and the relative risk was more than eight times higher than that in children born in January. In this study, Logistic regression model was used to explore the risk factors of severe hand, foot and mouth disease. Univariate Logistic regression model showed that the mean values of mean air temperature, maximum temperature, minimum temperature and air pressure in patients' age, living area, month of birth and 7 days before onset were risk factors of severe HFMD. The multivariate Logistic regression model showed that compared with living in Linquan County, the odds ratio of living in Taihe County and Yingshang County were 2.68 and 1.99 respectively, while those living in Yingzhou District were the protective factors. Patients born between March and December were more than twice as likely to develop severe cases as they were born in January. In particular, patients born in August were more than five times more at risk of becoming severe than those born in January. Young patients were more likely to develop into severe cases, and the mean temperature 7 days before onset was also a risk factor for severe disease. A generalized additive model was used to study the relationship between climate factors and the incidence of hand, foot and mouth disease (HFMD). After controlling the long-term trend and seasonality of time, we found that the average temperature and relative humidity were related to the number of cases per week. Under the assumption of linear influence, the relative risk of HFMD increased by 2.79 for each temperature rise of 1 鈩，

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