2007～2011年山东省手足口病流行特征及死亡危险因素分析

发布时间：2018-04-11 11:12

本文选题：手足口病 + 流行病学　；参考：《山东大学》2012年硕士论文

【摘要】：[研究背景] 手足口病是一种由肠道病毒引起的急性病毒性传染病。我国是手足口病的高发国家,白1981年在上海发现首例手足口病患者后,全国十多个省(市)相继出现手足口病流行。到目前为止,全国各省、自治区、直辖市均有手足口病病例报告。近年来,我国部分地区陆续出现了手足口病的大规模暴发流行,尤以广州、安徽、山东、河南、江苏等省份疫情最为严重。全国手足口发病和死亡人数也呈逐年上升趋势,2010年我国大陆地区共报告手足口病病例177.35万,较2009年的115.38万例病例同比增长53.71%,其中2010年死亡904人,死亡病例数与2009年相比增长了155.37%。手足口病对儿童青少年的健康已构成严重危害,加强手足口病的规范化预防控制刻不容缓。 [研究目的] 1.分析2007～2011年山东省手足口病的流行特征、人群发病特征、时间分布特征,为手足口的防控提供科学依据。 2.分析山东省手足口病的病原学构成特征。 3.建立新型肠道病毒71型(enterovirus71, EV71)山东地方株VP1编码区全基因序列数据库,分析EV71山东地方株基因进化特征。 4.建立柯萨奇病毒A组16型(coxsackievirus A16, CoxA16)山东地方株VPl编码区全基因序列数据库,分析CoxA16山东地方株基因进化特征。 5.分析手足口病死亡病例的临床特征及死亡危险因素。 [研究方法] 1.描述性研究：根据中国疾病预防控制信息系统手足口病发病报告信息,统计分析2007-2011年山东省手足口病发病率、年龄别构成比、性别构成比、病原学构成比等描述性指标,应用流行病学原理描述山东省手足口病的三间分布特征。根据手足口病个案调查结果,对手足口病死亡病例的临床特征进行描述分析。 2.病原学特征研究：随机抽取各地市送检手足口病患者粪便、咽拭子标本,经病毒分离、核酸提取、RT-PCR、序列测定等步骤,分析2007～2011年山东省手足口病病原EV71和CoxA16的基因进化特征。 3.死亡危险因素分析：以手足口病死亡病例为病例组,重症病例为对照组,采用1：3匹配的病例对照研究分析手足口病的死亡危险因素。研究采用条件Logistic回归对变量进行分析,应用SAS9.1软件进行统计分析。 [研究结果] 1.2007～2011年山东省各年手足口病总发病人数分别为38267例、32434例、138227例、141744例、95796例,累积发病率分别为4.09/万、3.46/万、14.76/万、15.13/万和10.01/万。 2.山东省手足口病患者以5岁以下儿童为主。2007～2011年,5岁以下病例占当年总病例数的比例分别为88.57%、91.28%、91.89%、91.21%、89.00%。重症病例多集中于3岁以下年龄组。2009～2011年,3岁以下重症病例占当年重症病例总数的比例分别为84.08%、77.94%、73.01%。手足口病病例男性多于女性,2007-2011年手足口病病例男女性别比波动在1.66-1.80之间；5-8月是手足口病高发期,2007-2011年中,各年5-8月手足口病发病人数占当年总发病人数的比例分别为81.38%、77.73%、64.10%、74.72%、73.60%。 3.EV71和CoxA16是引起山东省手足口病暴发流行的主要病原体。2008～2011年各年EV71所致手足口病病例数占当年总病例数的比例分别为60.53%、67.02%、34.69%、50.57%；2008～2011年各年CoxA16所致手足口病病例数占当年总病例数的比例分别为27.63%、3.64%、37.08%、29.78%。 4.2007～2011年67株EV71山东地方株均为EV71C4a亚型。2011年EV71山东地方株与CoxA16原型株之间的核苷酸同源性为62.1%-63.4%,与EV71原型株之间的核苷酸同源性为80.5%～82.9%,与EV71B型代表株之间的核苷酸同源性为83.0%～85.4%,与EV71C1代表株之间的核苷酸同源性为85.6%-88.5%,与EV71C2代表株之间的核苷酸同源性为87.4%～90.3%,与EV71C3代表株之间的核苷酸同源性为86.7%～88.7%,与EV71C4a代表株之间的核苷酸同源性为93.3%～96.6%,与EV71C4b代表株之间的核苷酸同源性为90.1%～93.1%。 5.2007～2011年38株CoxA16山东地方株全属于B1亚型。2011年CoxA16山东地方株与CoxA16原型株之间的核苷酸同源性为75.1%～77.3%,与B2原型株之间的核苷酸同源性为89.0%～９0.0%,与2007年7株山东地方株之间的核苷酸同源性为90.9%-95.3%。 6.死亡病例总病程平均时间为82.40±5.39小时,发热最高体温平均值为39.08±0.15℃。咳嗽(OR=16.16，P=0.0398)、颈抵抗(OR=189.50,P=0.0072)、呕吐(OR=16.16,P=0.0398)是手足口病重症病例死亡的危险因素,年龄增加(OR=8.04,P=0.0131)是病例死亡的保护因素。 [结论与建议] 1.山东省手足口病发病率高,重症发生率高,危害严重,应加强防控。 2.5岁以下儿童为手足口病高发人群,其中3岁以下儿童是手足口病重症及死亡的高危人群,应加强对3岁以下手足口病患儿的临床监护,防治患儿发生重症或死亡。 3.5～8月是手足口病的高发时期,卫生部门应在该时间内加强对儿童青少年的卫生宣传教育,做好托幼机构、小学等儿童聚集地的消毒,防止手足口病暴发流行。 4.EV71是山东省手足口病的最主要优势病原体,EV71感染是重症发生的危险因素。 5.EV71和CoxA16处于不断地基因突变过程当中且病毒变异速度较快,应加强对EV71和CoxA16流行的监测,防止新型毒株的出现并造成流行。 6.咳嗽、颈抵抗、呕吐是手足口病病例死亡的危险因素,年龄增加是病例死亡的保护因素。应加强出现咳嗽、颈抵抗、呕吐症状的低龄手足口病重症患儿的临床监护,防止死亡发生。
[Abstract]:[research background]
Foot and mouth disease is an acute infectious disease caused by enterovirus. China is a country with high incidence of HFMD in 1981, found that patients with first hand foot and mouth disease in Shanghai, the country's more than 10 provinces (city) have HFMD epidemic. So far, the provinces, autonomous regions, have foot and mouth disease case report of municipalities directly under the central government. In recent years, some regions of China emerged HFMD pandemic, especially in Guangzhou, Anhui, Shandong, Henan, Jiangsu and other provinces. The most serious outbreak of HFMD cases and deaths also increased year by year, in 2010, China reported a total 1 million 773 thousand and 500 HFMD cases were 1 million 153 thousand and 800 cases, an increase of 53.71% in 2009 2010, which killed 904 people, the number of deaths compared with 2009 growth of healthy 155.37%. HFMD on children and adolescents has posed a serious hazard, It is urgent to strengthen the standardized prevention and control of hand foot and foot disease.
[research purposes]
1. the epidemiological characteristics of hand foot and mouth disease (HFMD) in Shandong province in the past 2007~2011 years, the characteristics of the population and the characteristics of the time distribution were analyzed to provide scientific basis for the prevention and control of hand, foot and mouth.
2. the characteristics of the etiology of hand foot and mouth disease in Shandong province were analyzed.
3. the whole gene sequence database of the VP1 coding region of Shandong local strain 71 (enterovirus71, EV71) was set up to analyze the evolution characteristics of the local strain of EV71 in Shandong.
4. establish coxsackievirus A group 16 type (coxsackievirus A16, CoxA16) Shandong native strain VPl coding region full gene sequence database, analyze CoxA16 Shandong local plant gene evolution characteristics.
5. analysis of the clinical characteristics and death risk factors of the death cases of hand foot and mouth disease.
[research methods]
1. descriptive study: according to disease reporting information and control information system of hand foot and mouth disease prevention China, statistical analysis of 2007-2011 years of Shandong province and the incidence rate of HFMD, age composition, sex ratio, pathogen proportion and other descriptive indicators, using epidemiological principle in Shandong province HFMD three distribution according to the case. Foot and mouth disease survey, a descriptive analysis of the clinical features of hand foot and mouth disease deaths.
2. etiology characteristics: random sampling of stools, throat swabs, hand foot and mouth disease specimens, virus isolation, nucleic acid extraction, RT-PCR sequencing and other steps were carried out to analyze the gene evolution characteristics of EV71 and CoxA16 of HFMD pathogens in Shandong province in 2007~2011 years.
3. death risk factors of HFMD deaths: the case group of severe cases as control group, using 1:3 matched case-control study of HFMD death risk factors. Studies using conditional Logistic regression analysis on the variables, using SAS9.1 software for statistical analysis.
[results]
From 1.2007 to 2011, the total incidence of hand foot mouth disease in Shandong province was 38267 cases, 32434 cases, 138227 cases, 141744 cases, 95796 cases, the cumulative incidence rate was 4.09/ ten thousand, 3.46/ 10000, 14.76/ 10000, 15.13/ Vanward 10.01/ ten thousand.
Shandong Province in 2. ~ 2011 foot and mouth.2007 disease in children under the age of 5, were under the age of 5 accounting for the proportion of the total number of cases were 88.57%, 91.28%, 91.89%, 91.21%, severe cases of 89.00%. are more concentrated in the 3 age groups of.2009 to 2011, under the age of 3, accounting for the proportion of severe cases of severe cases were 84.08%, 77.94%, 73.01%. HFMD cases in men than in women, 2007-2011 years of HFMD cases sex ratio fluctuated between 1.66-1.80; 5-8 month is the high incidence of HFMD, 2007-2011 years, each year 5-8 month HFMD incidence accounted for the proportion of the total number of patients were 81.38%, 77.73%, 64.10%, 74.72%, 73.60%.
3.EV71 and CoxA16 are the main pathogens of.2008 in Shandong province to cause HFMD outbreak in 2011 of each year by EV71 the number of HFMD cases accounted for the proportion of the total number of cases were 60.53%, 67.02%, 34.69%, 50.57%; 2008~2011 years of CoxA16 each year due to the number of HFMD cases accounted for the proportion of the total number of cases respectively. 27.63%, 3.64%, 37.08%, 29.78%.
From 4.2007 to 2011, 67 strains of EV71 isolates from Shandong were EV71C4a subtype.2011 EV71 isolates from Shandong and nucleotide CoxA16 prototype strain homology between 62.1%-63.4%, EV71 and the nucleotide homology between prototype strains ranged from 80.5% to 82.9%, and EV71B represents the nucleotide homology between 83% ~ 85.4%, and EV71C1 nucleotide homology between 85.6%-88.5% and EV71C2, represent the nucleotide homology between 87.4% ~ 90.3%, and EV71C3 represents the nucleotide homology between 86.7% ~ 88.7%, and EV71C4a represents the nucleotide homology between 93.3% ~ 96.6%, and EV71C4b represents the nucleotide homology between 90.1% ~ 93.1%.
From 5.2007 to 2011, 38 strains of CoxA16 isolates from Shandong belong to B1 subtype.2011 CoxA16 isolates from Shandong and nucleotide CoxA16 prototype strain homology between 75.1% ~ 77.3%, and the nucleotide homology between B2 prototype strains ranged from 89% to 90%, and in 2007 7 strains of isolates from Shandong between the nucleotide homology was 90.9%-95.3%.
6. death cases of total average time duration of 82.40 - 5.39 hours, heating the highest temperature average value is 39.08 + 0.15. C (OR=16.16, P=0.0398), cough (OR=189.50, P=0.0072) neck resistance, vomiting (OR=16.16, P=0.0398) were risk factors of death in severe cases with hand foot mouth disease, increased age (OR=8.04, P=0.0131) is the protection factors of death cases.
[conclusions and recommendations]
1. the incidence of hand foot and mouth disease (HFMD) in Shandong province is high, the incidence of severe disease is high and the harm is serious, and prevention and control should be strengthened.
Children under 2.5 years old are high incidence of hand foot mouth disease. Among them, children under 3 years old are high-risk groups of severe hand, foot and mouth disease and death. We should strengthen clinical monitoring for children under 3 years of age, and prevent and cure children's severe or death.
From 3.5 to August is a period of high incidence of HFMD, health departments should strengthen the health education for children and adolescents at the time, good kindergartens, primary school children gathered in the disinfection, to prevent HFMD outbreaks.
4.EV71 is the most dominant pathogen of hand foot and mouth disease in Shandong Province, and EV71 infection is a risk factor for severe occurrence.
5.EV71 and CoxA16 are in the process of continuous gene mutation, and the speed of virus mutation is fast. We should strengthen the monitoring of the prevalence of EV71 and CoxA16, prevent the emergence of new strains and cause epidemic.
6., cough, neck resistance and vomiting are risk factors for the death of hand, foot and mouth disease. Age increase is a protective factor for death. We should strengthen the clinical care of children with severe HFMD, who have cough, neck resistance and vomiting symptoms, so as to prevent death.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

【参考文献】