| Hand, foot, and mouth disease (HFMD), a common illness in children by species human enteroviruses, particularly human enterovirus 71(EV71) and coxsackievirus A16 (Cox A16), EV71 and Cox A16 infections manifesting as HFMD and herpangina are clinically indistinguishable, but EV71 infection is more frequently associated with serious neurological complication and fatalities. Most of the cases were children less than 5 years, and the age-specific peak incidence occurred less than 3 years. Febrile, the skin rash, which may be maculopapular or vesicular, typically occurs on the palms and soles but can also involve the buttocks, elbows, and knees. But some patients have herpangina and others have no oral lesions. Some cases cough, cry and diarrhea. EV71 has also been associated with several clinical syndromes:acute flaccid paralysis mimicking paralytic poliomyelitis, bulbar and brainstem encephalitis, and rapidly fatal pulmonary edema and hemorrhage.ObjectivesBy analyzing, the epidemiology and clinic characters of HFMD data from China Information System for Disease Control and Prevention, to investigate the risk factor of severe clinic by comparing features of the clinic and laboratory of severe and mild cases.Materials and methods1. All the data of HFMD epidemic situation in 2009 were collected by China Information System for Disease Control and Prevention. Case investigations were collected, and samples of stool from cases were tested on the methods of RT-PCR technology by Zhengzhou Center for Disease Control and prevention.2. The data were analyzed by using EPI DATA5.0 and SPSS 12.0.Results1. A total of 670 HFMD cases were reported in huiji district. The reported morbidity was 338.09 per one hundred thousand, including 26 severe cases. The peak incidence occurred in April and May. Male were more than female, sex ratio was 1.39:1. There were 619 children younger than five years old attacked by HFMD; the attack rate was 92.39%. All cases were distributed wide over 8 towns of huiji district. The incidence of each town was different, and Changxing, Liuzhai, Xincheng were the three highest counties, and the number of cases were 193,151,95. The rates were 28.72%,22.54% and 14.18%.2. There were 149 cases suffered febrile of mild HFMD, and the percent was 36.08%. The temperature was between on 37.5～39.0℃. The typical erthras in hand, foot, mouth and so on were the predominant clinical manifestations, and the rate was 94.92%. Some (32.3%) children were suffered Oral Herpes. The other clinical symptoms were Cough, runny nose, sore throat, vomiting, abdominal pain, nausea and diarrhea.3. There were 26 severe cases, a total of 3.88%. The highest incidence counties were Liuzhai, Xincheng and Dahe. The rates were 26.92%,19.23%,15.38% respectively.A total of 24 severe cases suffered febrile, and percent was 92.3%. The temperature was between 38℃and 42℃. The rash was mainly found on hand, foot, bottock. The 24 (92.3%) severe cases suffered mouth ulcer. The other clinical symptoms were cough, runny nose, throat, convulsions, and the neurological complications.Total 13 severe HFM were tested by X-ray, and 7 cases were lung texture,2 cases pulmonary edema.4. The clinical manifestations of mild and severe cases were different in fever, cough, oral herpes, nausea, vomiting. The white blood cell count of severe cases was more than mild cases, but the number of neutrophil was reduced. In addition the severe cases had the following symptoms myoclonus, irritability, somnolence, convulsions, arrhythmia, stiff neck characteristic, etc.5. Ninety-nine specimens from clinically diagnosis cases with HFMD were detected, of which 67 EV71 positive detection rate 67.68%., the Cox A16 positive four, other positive 12. The EV71 positive of mild children present in 64.94%, and the severe cases infected 77.27%. The EV71 positive of severe cases was more than mild cases.Conclusions1. There was an HFMD epidemic in Huiji district, and the incidence was higher than the average level of Chinese. The EV71 was the preponderant strain. The incidence of each town was different, and was higher in the densely inhabited district.2. In this study we identified and validated that history of high temperature, nausea, vomit and convulsion predicted clinical risk factor. Those risk factors may serve as a guide to clinicians to decide the need for hospitalization and further investigation, and close monitoring for disease progression in children with HFMD.3. Children in 3 years old group were the major infection target of EV71. |
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