| Objectives To invistigate the epidemic situation、pathogenic composition and the main factors that influence the incidence of hand, foot and mouth disease( HFMD) in Hebei province from 2011 to 2014,to timely know about the prevalent regularityof HFMD in Hebei province,the change of pathogenic spectrum and risk factors of the disease,so as to provide scientific basises for formulating control and prevention strategies.Methods 1 The epidemiological characteristics of HFMD: The data was collected from the National Disease Surveillance Information Management System and the laboratory data within the province of HFMD was analyzed by descriptive epidemiological method. 2 Pathogenic characteristics of HFMD: the HFMD network laboratory data of Hebei Province from2011 to 2014 were collected to analyze pathogen distribution of HFMD. 3 Study on risk factors of HFMD: using the 1:1 matched case-control study method, 204 cases were selected as case group from the selected countiy with a high incidence of HFMD in Handan with a stratified sampling. According to the matching factors, 204 cases of non-HFMD healthy children were selected as the control group. Data was collected with the unified questionnaires. Sample database was built through Epi Data3.1, and univariate and multivariate conditional logistic regression analyses were performed through the SPSS17.0 statistical software.Results 1 A total of 296689 cases of HFMD were reported in Hebei province from 2011 to 2014, the annual incidence rate was 100.03 per 100 thousand population, 114.23 per 100 thousand population, 77.98 per 100 thousand populations, 116.30 per 100 thousand populations respectively. The average incidence rate of HFMD was 102.15 per million population, 1853 cases of severe, annual severe rate was 0.63%, 73 cases of death, the annual mortality rate was 0.025 per 100 thousand population, the annual fatality rate was 24.6 per 100 thousand population. Four years, the fatality rate of HFMD was statistically significant(c2=10.397, P=0.016). 2 Seasonal distribution was clear for HFMD in Hebei provinc, Double peak distribution were obvious annually.January to March was the low period, and the main peak was from May to July, when number of cases proportion to the total incidence were 63.82%. After cases were decreased.The seasonal distribution characteristics of each year are basically the same. 3 The incidence of HFMD was concentrated in central of Hebei province, Cangzhou,Baoding and Shijiazhuang were the cities of more incidence number, and Cangzhou,Chengde,Baoding had the higher incidences,the incidence of Cangzhou was the highest,and the incidence of HFMD in Langfang increased rapidly from 2011 to 2014. In the county rankings, Renqiu had the highest incidence, the incidence of Luancheng County in the province￠s top ten from 2011 to 2014. 4 More than 90% cases of HFMD were children under the age of 5. The children 1 to 3 years old accounted for the largest proportion, accounting for 71.53%. The incidence rate was the highest in the 1~ age group, 2~year age group incidence rate was just lower than 1~year age group.HFMD male 182427 cases, female 114262 cases, male to female ratio was 1.60:1 in Hebei province from2011 to 2014. The male average annual incidence rate was 122.03 per 100 thousand population, the female average annual incidence rate was 81.07 per 100 thousand population, the incidence sex ratio of male to female was 1.51:1,and the annual incidence of male was higher than female(c2=11.11, P<0.05 in 2011; c2=10.58, P<0.05 in 2012; c2=5.43, P<0.05 in 2013, c2=6.59,P<0.05 in 2014), the incidence of male was also higher than female in each age group less than 5. Scattered children were the main suffering group, accounting for 78.62% in total cases. 5 A total of 18661 cases of laboratory confirmed cases were reported in Hebei province from 2011 to 2014, pathogen EV71 accounted for 53.49%, Cox A16 accounted for 24.11%, and other enterovirus accounted for 22.68%. EV71 infection positive ratio were higher in 2010, 2012 and 2014, all above 50%.The positive ratio of other intestinal virus are as high as 44.89% in 2013, more than 75% of severe cases and more than 85% of deaths were caused by infection of EV71. 6 Multivariate logistic regression analysis showed that low average family income(OR=1.570, P=0.009), at-will dumping domestic garbage(OR=4.734, P=0.002), scattered children(OR=3.254, P=0.002), breastfeed time was short(OR=1.692, P=0.030), having the history of case contact(OR=2.516, P<0.001), rarely change clothes every week(OR=1.986, P=0.004), caregivers often go shopping(OR=2.016, P=0.018) were the major risky factors of children suffering from HFMD, and children can provide for oneself(OR=0.354, P=0.009) was the main protection of children suffering from HFMD.Conclusions 1 The annual incidence rate of HFMD is from 77.89 to 116.30 per 100 thousand populations respectively. The severe incidence rate is from 0.03% to 0.11%. The fatality rate of severe cases is from 1.98% to 11.16%. The overall epidemic situation of HFMD is severe in Hebei province, and showed a more intensity, longer duration broader distribution epidemic characteristics. and the main peak is from May to July. Mid-Hebei is the main prevalent area of HFMD, Children under 5 years old is the main HFMD group,within which the incidence rate in 1?2 years age group was the highest. The Incidence of males was higher than that of females. Scattered children were as the main suffering group. 2 EV71 and Cox A16 are the main pathogens of HFMD in Hebei Province, the proportion of other enteric viruses shows a slow upward trend, EV71 is the main pathogen both of severe and fatal HFMD cases. In the future, we should pay much attention to monitoring the variation of the dominant pathogen and the change of the pathogen spectrum of HFMD. 3 Low average family income, at-will dumping domestic garbage, scattered children, and breastfeed time is short, having the history of case contact, rarely change clothes every week, caregivers often go shopping with child are the major risky factors of children suffering from HFMD, whether children can treat defecation by oneself or not is the main protective factor in children suffering from HFMD. |
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