Study On Epidemiology And Economic Burden Of Hand-foot-mouth Disease In Yantai City

Objectives To analyze epidemiological characters and trend in hand-foot-mouth disease between 2007 and 2008,to research the ascendant strain and economical burden in 2008 through retrospective investigation,evaluate all the preventive methods,to carry out the preliminary assessment and provide scientific basement to the following work.Methods China Information System For Disease Control And Prevention was used to collect the epidemic situation data and describe the epidemiological characters for 2007 and 2008;To collect the clinical epidemiological characters by the established case investigation database for deal of typical cases;To research the etiological grouping by feces samples harvested from hospitalized cases;According to simple random sampling to draw 1398 cases in Yantai in 2008 to carry out economical burden investigation by designed questionnaire.Results There are 3644 hand-foot-mouth disease cases in 2007 and the incidence rate is 53.80/100,000,Laiyang city,Zhifu district and Haiyang city were the three highest cities in Yantai,totally 2165 cases(59.41%),and the incidence rate were 106.99/100,000,98.52/100,000 and 73.37/100,000 respectively,on the contrary,the three lowest cities in Yantai were Changdao county,Laizhou city and Muping district, totally 131 cases(3.59%),and the incidence rate were 0,3.81/100,000 and 18.50/100,000.The number of cases was 2713 in 2008 and the incidence rate was 39.91/100,000,significantly decreased 25.55%by 2007.Laishan district,Fushan district and Kaifa district were the three highest cities in Yantai,totally 690 cases (25.43%),and the incidence rate were 124.59/100,000,98.60/100,000 and 96.77/100,000 respectively,and the lowest cities in Yantai were Laizhou city,Qixia city and Muping district,totally 220 cases(8.11%),the incidence rate were 8.07/100,000,11.86/100,000 and 13.22/100,000.Most of cases were located in south and north of Yantai in 2007,however,it changed to some of the northeast counties in 2008.Sex ratios in 2007 and 2008 were 1.59:1 and 1.70:1.The peak age of all over the hand-foot-mouth disease cases were from age 3 to 4 in 2007,and were from age 2 to 3 in 2008,but the most part of cases were the scattered children and the children from nurseries and kindergartens in 2007 and 2008.The peak time was in June 2007,and in May 2008.Most of the cases in 2007 and 2008 were sporadic cases.All the cases distributed in 139 villages and towns(93.92%of all villages and towns) in 2007,and in 141 villages and towns(95.27%of all villages and towns) in 2008.There were 161 incidents of clustered cases referring 818 cases(22.45%of all cases) in 2007,and 131 incidents of clustered cases referring 650 cases(23.96%of all cases) in 2008.The incidents of clustered cases happened in nurseries and kindergartens in 2008 was less than that in 2007.The median of course of disease was 7 days in hospitalized cases,53.6%of cases with the symptom of fever,low fever and high fever were the main symptoms of all the cases.Rashes presented on hand,foot, mouth and haunch were 86.60%,82.94%,58.71%and 36.92%respectively.The rash was usually present in some parts together,not only in hand or foot.The etiological agent was EV71 and Cox A16,and EV71 was the ascendant strain.Economical burden investigation showed that the average cost was 566.12±167.92 Yuan in outpatient cases,while it was 1807.02±815.38 Yuan in hospitalized cases;the two severe cases in Yantai cost 25880 and 54400 Yuan respectively.In hospitalized patients,71.54%went to outpatient service for one time,25.40%for twice,3.06%for three or more than three times.Cases first went to private clinic,rural area hospitals, and county hospitals was 6.54%,43.59%and 49.87%,62.5%cases went to rural area hospitals before May 23rd while 64.91%cases went to county hospitals after that time.After hand-foot-mouth disease was internalized as legal communicable disease in May 2nd in 2008,we paid much more attention to hand-foot-mouth disease control and prevention,the measures we carried out were more specificate and more targeting, it showed that the number of cases and incidence rate both were significant decreased in 2008,and the concentrate cases clustered cases in 2008 obviously reduced by 2007,it showed that our comprehend measures were effective.Conclusions The disease radius was extended but severe level descended in 2008.The region for high incidence rate in 2008 was changed from 2007.The highest risk crowd is scattered children and then children in schools nurseries and kindergartens.Prevalence peak is in summer and autumn;Peak time was one month earlier than 2007 and more mild.The ascendant strain was EV71,it remind us the emphasis in 2009 is to pay close attention to Longkou and Qixia scattered children. Through the economical burden investigation to evaluate that the whole economical burden in Yantai is 2792.6 thousand Yuan,and hospitalized patients were higher than outpatient,once it developed to severe patients,the burden is more heavy.Patients in city paid more than in rural area,and children under 3 years old more than others. Designated hospitals were one of the key methods to circumvent severe cases and death,health education and other comprehend measures were effective in Yantai.