Study On Epidemiology And The Content Of Epinephrine In Serum Of Hand-foot-mouth Disease

Objective: The data of hand-foot-mouth disease (HFMD) epidemic situation and the deaths of Hebei province in 2008 were searched for analyzing their epidemiological characters,exploring key risk factors and providing scientific basement for prevention and control; The content of epinephrine in blood serum was detected to research whether it will be an early signal of severe cases.Method:1 We studied the children diagnosed with HFMD from January to December in 2008 .There were 29499 cases in the study. The criteria for HFMD was based on "Hand, Foot and Mouth Disease Control and Prevention Guide" formulated by the Ministry of Health.All the data of HFMD epidemic situation of Hebei province in 2008 were exported from China Disease Reporting Information System Databases. Information about etiology was provided by Center for Disease Control and Prevention in Hebei Province.Population information was obtained from Hebei province statistics bureau. Information about weather was provided by Hebei Province Bureau of Meteorology. Descriptive epidemiological method was used for analyzing HFMD epidemic situation and the deaths.2 Not only children admitted to Maternal and Child Health Hospital of Handan City , diagnosed with HFMD, in 2009, but also healthy children were included in this study.The objects were divided into three groups:common HFMD group (n=20),severe HFMD group (n=40),healthy children group (n=20). All the children were less than 5 years old, and sex ratio was 3:2 in every group. The criteria for HFMD was based on "Hand, Foot and Mouth Disease Control and Prevention Guide" formulated by the Ministry of Health. Venous blood samples were collected after the patients were admitted to the hospital. The blood samples, which was at least 3ml,were obtained and immediately sent to the laboratory. Serum was separated from the blood and then was stored at -20 Degrees until it was processed. The Human Adrenaline (E) ELISA Kit was used to assay the content of Adrenaline (E) in serum of the objects.3 All the data were analyzed by SPSS13.0 . Categorical data was analyaed by Chi-square test. The relationship between morbidity and factors was analyzed by multiple linear regression. Results of quantitative data were expressed as mean + standard deviation. The difference among the three groups was analyzed by ANOVA.The value of p<0.05 was regarded as statistical significance.Result:1 In Hebei province, 29499 HFMD cases were reported in 2008, there were 135 severe cases and 10 deaths during the 2008 epidemic.2 Cases were reported in every month in 2008, but the peak incidence occurred in May to July, 23542 cases were reported during the three months.There were 18596 boys and 10903 girls during the 2008 epidemic .The infected children were predominantly male (63.04%),sex ratio was 1.71:1. The children less than 3 years old were 20850 and they accounted for 70.68% of the objects, the HFMD cases under 5 years old were 26728 and they accounted for 90.61% of the total cases, and the age-specific peak incidence occurred from 1 to 2 years old, There were 9308 cases reported from 1 to 2 years old. The infected children were predominantly scattered inhabiting children (79.01%) while the children in kindergarten accounted for 16.03%of the objects. All cases were distributed widely over 11 cities,172 counties and 2002 towns(90.83%) of Hebei province, and they were dispersed predominantly. The incidence of each city was different and morbidity increases with the dropping of temperature but the increasing of humidity.The incidence between urban area and county was differern too.3 The proportion of severe cases in Enterovirus 71(EV71) infected children was 8.2%, while it was 3.6% in Non-EV71(CoxA16 and other enterovirus) infected children.There is significant difference between them (χ2 =4.296,P=0.038<0.05). It is showed that severe cases were caused by EV71 with a higher possibility.4 The relationship between morbidity and factors was Y=1.236 X1-4.379 X2+15.485 (X1 stands for precipitation,Pregression coefficient =0.001<0.05;X2 stands for temperature, Pregression coefficient=0.001 < 0.05).It shows that morbidity increases with the dropping of temperature but the increasing of precipitation.5 EV71 was the main causative agent of deaths in young children.The age of the deaths is from six month to four years old.It was an average of 13.8 hours that the children died after hospitalization. The deaths had been diagnosed with HFMD associated with central nervous system involvement when alive and they died of neurogenic pulmonary edema.6 The content of epinephrine was 69.705±31.086 in common HFMD group ,85.162±34.226 in severe HFMD group and 67.873±27.728 in healthy children group. There was no significant difference among the content of epinephrine of the three groups (p>0.05).Conclusion:1 HFMD is a common infectious illness in young children, particularly those less than 5 years old.And the risk crowd is scattered children and children in kindergarten.Prevalence peak is in May to July. The cases of HFMD were widespread in hebei province in 2008 ,and they were dispersed predominantly.The incidence of each city was different and morbidity increases with the dropping of temperature but the increasing of precipitation . The incidence between urban area and county was differern too.2 Severe cases were caused by EV 71 with a higher possibility .So we should give more intensive care to children infected by EV 71.3 Enterovirus 71 (EV71) was the main causative agent of deaths in young children.The deaths had been diagnosed with HFMD associated with central nervous system involvement when alive and they died of neurogenic pulmonary edema.4 To prevent and control HFMD, we should not only devote ourself to educating the children less than 5 years old but also give effective prevention and control measures to kindergartens .To develop EV71 vaccine is also an very important thing we will do.Going to designated hospitals is the key method to circumvet severe cases and deaths.5 There is no enough reason to confirm the content of epinephrine to be an early signal of severe cases.