Analysis Of Clinical Characteristics And Risk Factors Of Severe Cases Of Hand-Foot-Mouth Disease In Baise Area

Objective:To analyze the clinical characteristics and main risk factors of different types of hand-foot-mouth disease(HFMD)in Baise area from 2015 to 2022,so as to provide scientific basis for clinicians to identify critical cases early,improve the treatment level of critical HFMD,and provide reference for the prevention and treatment of HFMD in this area.Methods:(1)The data of reported cases of HFMD were collected from January 1,2015to December 31,2022 on the national epidemic reporting management system of infectious diseases,and the place where the disease occurred was in the counties(cities,districts)of Baise.Risk factor analysis case data were collected from the hospital medical record information system,including age,sex,HFMD vaccination history,birth history,clinical manifestations,etiological examination results,etc.(2)The etiological data came from the etiological surveillance carried out by the designated treatment hospitals of HFMD in Baise area and the detection results of pathogenic nucleic acid of all hospitalized severe and dead cases.(3)Logistic regression model was used to analyze the risk factors of severe HFMD.Single factor analysis was used to determine the possible influencing factors of severe HFMD,and then multi-factor Logistic regression analysis was carried out.Results:(1)A total of 140883 cases of hand,foot and mouth disease were reported in Baise area from 2015 to 2022,with an annual incidence of 12.03/10~4and 76.75/10~4,with the highest incidence of 76.75/10~4in 2015 and a significant downward trend since 2018.(2)HFMD is mainly common cases,with severe cases accounting for 3.05/10~4-44.04/10~4of the total annual cases each year.260 severe cases and 7 deaths are reported,and severe cases account for 0.18%of the total cases.Deaths account for 0.5/10~4of the total cases.The peak of serious cases was 44.04/10~4in 2016 and 38.79/10~4in 2017.there were no severe cases in2022.The highest mortality rate was 18.05/10~5in 2016,and there were no deaths from 2018to 2022.(3)With the increase of EV71 vaccination rate of hand-foot-mouth disease cases,the serious disease rate and mortality rate of hand-foot-mouth disease decreased significantly from 2015 to 2022.(4)The age of onset of HFMD is mainly children under 5 years old,especially infants under 3 years old.There are 98195 cases under 3 years old,accounting for69.70%of the total cases.Severe cases are mainly concentrated in the age group under 3years old,accounting for 83.46%of the number of severe cases.(5)There were 83353 male HFMD cases,accounting for 59.16%of the total cases;57530 female HFMD cases,accounting for 40.84%of the total cases;and 260 severe cases,including 162 male severe cases and 98 female severe cases,with a male-to-female ratio of 1.65:1.(6)The number of cases from April to July in 2015-2022 accounted for 60.12%,57.05%,53.22%,56.75%,57.14%,52.59%,56.42%and 48.35%,respectively.The seasonal distribution of severe cases is mainly in summer,with a total of 201 severe cases reported from April to August,accounting for 77.3%of the total.(7)From 2015 to 2022,the counties,cities and districts reported the largest number of cases in Tiandong County and Pingguo City,with a cumulative number of reported cases of 20583 and 20405 respectively,accounting for 14.61%and14.48%of the total cases in this region.The total number of reported cases was the lowest in Xilin County,with a cumulative number of 2972 cases,accounting for 2.11%of the total cases in this area.(8)Etiological surveillance showed that the combined proportion of Cox A16,Cox A6 and other enteroviruses in 2015 was 93.32%,and Cox A10 was at a low level.The proportion of EV71 virus was relatively high in 2016 and 2017,accounting for 31.52%and 21.15%respectively.In 2018-2022,the proportion of EV71 virus decreased significantly,and no EV71 virus was detected in 2020 and 2022.The positive rates of EV71 in severe case group and mild case group were 83.08%and 16.21%respectively,and all the dead cases were EV71 positive.(9)Multivariate Logistic regression analysis showed that 8 risk factors of severe HFMD were not vaccinated with EV71 vaccine(OR=9.312),EV71 infection(OR=28.591),fever≥3 days(OR=15.934),vomiting(OR=19.628),lethargy(OR=27.442),prone to convulsion(OR=28.454),limb tremor(OR=28.684)and convulsion(OR=11.463).Conclusion:(1)HFMD has the characteristics of intermittent outbreak epidemic,and the incidence of HFMD in Baise area is relatively high in recent years.After extensive vaccination with EV71 vaccine and preventive and control measures such as strengthening hygiene propaganda and keeping social distance,the incidence of HFMD,the rate of serious illness and mortality in this area have decreased significantly,which proves that vaccination and hygiene prevention can effectively control the occurrence of HFMD and serious illness cases.(2)The epidemic of HFMD has obvious seasonality,with peak incidence in summer and secondary peak in autumn and winter;it occurs in children of all ages,with the highest incidence in children under 5 years of age,and critical cases and deaths mainly occur in infants and children under 3 years of age.(3)The types of viruses causing HFMD are in the process of dynamic change,among which EV71 is still the dominant strain for severe HFMD and fatal cases in the region.(4)Non-vaccination against EV71,EV71 infection,fever≥3days,vomiting,lethargy,easily startled,shaking limbs and convulsions are the main risk factors for severe HFMD.