| Background: The HFMD has break out in the world for many times Since 1957, when the HFMD caused by enterovirus has been reported. EV71 and CoxA16 are the most important pathogen of the outbreak of HFMD. Generally speaking, HFMD is a self-limiting disease, the prognosis of it is good, But in recent years, severe HFMD cases which wre infected by EV71 have appeared in some regions of China, these cases has rapid progression and poor prognosis, the treatment of them is very difficulty. Overall, severe HFMD cases with complications have high mortality rate, and the sequelae of survivors is very serious, especially those who have brain stem encephalitis and pulmonary edema. To reduce the incidence of mortality and complications of HFMD, clinicians should grasp the general laws of the epidemic of HFMD, judge the severe cases and block the progress of it .Objective: The epidemiological characteristics of HFMD in Jilin Province were analyzed to provide scientific basis for prevention and control measures of HFMD; the clinical characteristics of severe HFMD were analyzed to provide the basis for early diagnosis and treatment of it and reduce the incidence of mortality and complications.Methods: The epidemiological data between January 1, 2008 and August 6, 2009 were collected from the CDC(Centers for Disease Control and Prevention) of Jilin Province and the CDC of Changchun city, then descriptive epidemiological method were used to analyze the data .The First Hospital of Jilin University have admitted 924 cases of HFMD patients from May 2008 to November 2009. The clinical data of these 924 cases were collected, then retrospective analysis method were used to study the data. These cases were divided into mild group, severe group, critical group, and death group. The dividing were based on the the stages which is proposed by HFMD diagnosis and treatment guideline. Mild group are patients with fever and rash, severe group are patients with central nervous system symptoms, critical group and death group are patients with central nervous system symptoms and neurogenic pulmonary edema. Comparative analysis methods and statistical analysis methods were used to study the clinical manifestations, complications, laboratory Examinations, treatment and outcome of each group.Results: There are 9889 HFMD cases in 2008 and the incidence rate is 36.22/100,000, There are 12228 HFMD cases between January 1, 2009 and August 6, 2009 ,the incidence rate is 44.79/100,000. Most of them are sporadic cases, while some regions have outbreak. Changchun is the city with the most cases of HFMD, tatolly 2794 cases, Songyuan is the city with the highest incidence rate, and the incidence rate was 93.82/100,000.HFMD were appeard from April to December, the peak incidence occurred in July to August.Most of the HFMD cases were childrens under under 5 years old (86.50%), the percentage of patients under 3 years old is 56.25%, while the 3 years old cases constituted the majority. The ratio between male and female cases was 1.44:1, the incidence rate of male was significantly higher than the female. In the cases with laboratory diagnosis, EV71 accounted for 58.53%, CoxA16 accounted for 29.58%. But in severe cases, EV7l was the ascendant strain, and all deaths were infected by EV71.In clinical study, critical group and death group have persistent fever(72.73%,69.23%), atypical herpes (63.64%, 61.54%), disturbance of consciousnesss (100%, 100%), abnormal eye movement (36.36%, 23.08%), twitch(36.36%, 38.46%), positive pathologic reflex (27.27%, 81.54%), positive meningeal irritation (18.18%, 23.08%), changes in muscle tension (63.64%, 53.85%). The incidence rate of these symptoms and signs above are higher than severe group(the rate were 17.24%,24.79%,33.76%,0%,3.56%, 0%,1.71%,1.99%). The mean of duration in mild group is 6.66±1.30 days, the mean of duration in severe group is 8.44±2.36 days, the mean of duration in critical group is 16.55±6.56 days. the mean of duration in death group is 4.46±0.97 days. the comparison between the four groups was statistically significant difference (F=94.84, P<0.0001).The mean of leukocyte in mild group is 9.36±7.27×109/L, the mean of leukocyte in severe group is 10.29±3.76×109/L, the mean of leukocyte in critical group is 18.2±7.29×109/L,the mean of leukocyte in death group is 19.63±5.85×109/L, the comparison between mildl group, severe group and critical group, death group was statistically significant difference(F=19.45,P<0.0001). The mean of blood glucose in mild group is 5.26±1.04 mmol/L,the mean of blood glucose in severe group is 6.5±1.24 mmol/L, the mean of blood glucose in critical group is 16.82±3.22 mmol/L,the mean of blood glucose in death group is 19.72±6.72 mmol/L, the comparison between the four groups was statistically significant difference (F=542.21,P<0.0001). The mean of LDH in mild group is 251.35±81.69 U/L, the mean of LDH in severel group is 279.55±49.80 U/L, the mean of LDH in critical group is 312.92±132.11 U/L, the mean of LDH in death group is 320.73±123.71U/L, the comparison between normal group, severe group and critical group, death group was statistically significant difference(F=9.17,P<0.0001). The mean ofα-HBDH in mild group is 214.79±51.45 U/L, the mean ofα-HBDH in severel group is 226.47±71.47 U/L, the mean ofα-HBDH in critical group is 291.6±151.71 U/L, the mean ofα-HBDH in death group is 262.07±79.14U/L, the comparison between normal group, severe group and critical group was statistically significant difference (F=8.42,P<0.0001).Conclusion:1,Epidemiological characteristic:HFMD began to appear from April, the peak incidence occurred in July to August.The incidence rate of male was significantly higher than the female.Most of the cases were children less than 5 years,the age-specific peak incidence occurred in 3 years old. HFMD patients are widespread in Jilin Province, while Changchun is the city with the most cases , Songyuan is the city with the highest incidence rate.2,Etiological study shows that,the etiological agent of HFMD in Jilin Province are EV71 and CoxA16, but in severe cases,EV7l is the ascendant strain.3,Clinical characteristic:.some symptooms are identified as early clinical signs to help detecting children at risk of condition deteriorated. These symptoms include: (1)General situation: persistent fever,atypical rash; (2)Nervous system symptoms: disturbance of consciousness, abnormal eye movement twitch, positive pathologic reflex, positive meningeal irritation and changes in muscle tension; (3)Respiratory symptoms: Shortness of breath, irregular rhythm of breath; (4)Circulatory symptoms: Significantly increased heart rate, hypertension and poor peripheral circulation The level of leukocyte, blood glucose, LDH andα-HBDH was positively correlated with the stage of HFMD.
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