马鞍山市手足口病流行现状及其多次感染发病影响因素研究

发布时间：2018-04-25 19:06

本文选题：手足口病 + 流行病学　；参考：《安徽医科大学》2013年硕士论文

【摘要】：目的本研究的主要目的是通过分析马鞍山市2008～2011年手足口病疫情资料，描述手足口病流行病学特征，病原学构成及变迁情况。了解手足口病多次感染病例所占的比例，病例流行病学特征及多次感染时间间隔等。同时开展病例对照研究，探索手足口病多次感染病例发病主要危险因素，为手足口病防控工作提供依据。方法从《中国疾病监测信息报告管理系统》中导出马鞍山市2008～2011年手足口病个案信息，统计分析手足口病发病率、年龄别构成比、性别构成比、病原学构成比等描述性指标，描述马鞍山市手足口病的三间分布特征。多次感染病例采用按照预先设定多次感染条件，筛选多次感染病例，分析多次感染病例所占的比例及其特征。患者监测标本应用逆转录—聚合酶链反应（RT—PCR）进行肠道病毒核酸检测。发病危险因素病例对照研究，以多次感染病例所有病例为病例组，匹配年龄和性别因素，严格按照随机抽样方法调查同等数量的单次感染手足口病发病儿童和健康儿童，分别分析手足口病单次感染发病和多次感染发病的危险因素。采用非条件Logistic回归对变量进行分析，，应用SPSS11.5统计包进行统计分析。结果马鞍山2008～2011年共报告手足口病7583例，年平均发病率为129.46/10万，2010年手足口病发病率最高(262.23/10万)，2008年最低(56.97/10万)。发病主要集中在4～7月份，占总病例数的64.25%，病例主要集中在1～4岁年龄组，占82.76%，男女性别比为1.54:1。病原学监测结果显示，2009年阳性标本均为肠道病毒71型(Enterovirus71，EV71)，2010年以柯萨奇病毒A组16型(Coxsackievirus A16，CoxA16)为主，占阳性标本的60.71%，2011年以EV71为主，占阳性标本的69.71%。 2008年至2011年发生的7583例手足口病患儿中，有294例发生2次及以上感染，多次感染病例占总病例数的3.88%，其中有2例感染3次，其余均感染2次。多次感染人群中男女性别为1.75:l，发病年龄主要集中在l～4岁(占92.52%)，多次感染发病高峰期与全市总发病高峰期基本一致。有183例多次感染病例发生在距首次感染的12个月内，占62.24%，有99例发生在距首次感染13～24个月内，占33.68%，有12例发生在距首次感染24个月以上，占4.08%。在同一自然年内和第二年发生多次感染病例最多，分别有89例和158例，各占30.27%和53.74%。间隔时间最短13d，最长1283d(42M)，平均(11±7)个月。多次感染病例中实验室诊断病例占10.88%，型别主要以EV71为主，占59.38%。单因素分析结果显示，影响单次感染手足口病发病的因素有儿童类别、体质状况、家庭使用厕所类型、家庭住房类型；影响多次感染发病的因素有小孩是否偏食、家长是否带小孩在路边店吃零食的习惯以及家长有与小孩共用饮料和食物的习惯。多因素分析结果显示，居住条件是平房的儿童感染手足口病的风险更高，OR值为1.656（95%CI：1.081—2.539），以学生为对照，散居儿童与幼托儿童单次感染手足口病风险均增加，其OR值分别为6.729（95%CI：3.183—14.228）和1.851（95%CI：0.951—3.601）；小孩不偏食以及家长不与小孩共用饮料或食物是多次感染手足口病的保护因素，其OR值分别为0.604（95%CI：0.415—0.880）和0.545（95%CI：0.346—0.858）。结论马鞍山市手足口病发病率较高，农村病例居多，发病具有明显季节性和人群分布特点，主要集中在4～7月份和1～4岁儿童。各年流行的优势型别不同，2009和2011年主要为EV71，2010年主要为CoxA16。1～4岁儿童手足口病多次感染发生的比例较高，感染的肠道病毒以EV71为主。加强散居儿童和家庭居住条件相对较差的居住在平房的儿童手足口病的预防控制，开展健康教育，倡导儿童均衡饮食，建议儿童不要与大人共用食物和饮料，保持健康的生活方式和良好的行为习惯。
[Abstract]:Purpose

The main purpose of this study was to describe the epidemiological characteristics of hand - foot - mouth disease , the composition of etiology and the change of the hand - foot - mouth disease by analyzing the epidemiological characteristics of hand - foot - mouth disease in Ma On Shan city from 2008 to 2011 . The case - control study was carried out to explore the main risk factors of the cases of multiple infection of hand - foot - mouth disease , and to provide the basis for prevention and control of hand - foot - mouth disease .

method

In this paper , the information of hand - foot - mouth disease in Ma ' anshan city from 2008 to 2011 was derived from the report management system of Chinese disease surveillance information . The incidence of hand - foot - mouth disease , age - specific constitution ratio , sex ratio and etiology constitute the three distribution characteristics of hand - foot - mouth disease in Ma ' anshan city .

Results

In 2008 - 2011 , 7583 cases of hand - foot - mouth disease were reported . The annual average incidence rate was 129.46 / 100000 . In 2010 , the incidence of hand - foot - mouth disease was highest ( 262.23 / 100000 ) , the lowest in 2008 ( 56.97 / 100000 ) .

Among the 7583 cases of hand - foot - mouth disease occurred in 2008 - 2011 , 294 of them were infected with more than two or more infections . Among them , there were 2 cases infected 3 times and the rest were infected twice . There were 89 cases and 158 cases , accounting for 33.68 % . Among them , there were 89 cases and 158 cases , accounting for 30.27 % and 53.74 % .

The results of single factor analysis showed that the factors influencing the morbidity of single - order infected hand - foot - mouth disease include the category of children , the physical condition , the type of family use and the type of family housing ;
The factors that affect the incidence of multiple infections include whether a child is biased or not , whether a parent has a child ' s habit of eating snacks at a roadside store , and a habit of a parent having a beverage and food with the child .

The results of multi - factor analysis showed that the risk of hand - foot - mouth disease of children living in bungalow was higher , OR value was 1.656 ( 95 % CI : 1.081 - 2.539 ) . The risk of single - infection hand - foot - mouth disease of children and children was increased , with OR value of 6.729 ( 95 % CI : 3.183 - 14.228 ) and 1.851 ( 95 % CI : 0.951 - 3.601 ) , respectively .
The OR was 0.604 ( 95 % CI : 0.415 - 0.880 ) and 0.545 ( 95 % CI : 0.346 - 0.858 ) .

Conclusion

The incidence of hand - foot - mouth disease in Ma ' anshan city is higher , the rural cases are more , the morbidity has obvious seasonal and population distribution characteristics , mainly in April - July and children aged 1 - 4 years . In 2010 and 2011 , it is mainly EV71 . In 2010 , it is mainly CoxA16.1 ~ 4 - year - old children with hand - foot - mouth disease prevention and control , health education and child - balanced diet . It is recommended that children not share food and drink with adults , maintain healthy lifestyles and good behavior habits .

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.1

【参考文献】