| PurposeThe study is designed to characterize the epidemiological feature,distribution,of hand-foot-mouth disease(HFMD).Meteorological factors correlation,pathogen composition characteristics,early clinical manifestations of severe cases,and main risk factors of severe HFMD from 2009 to 2019 in Fengxian District,Shanghai,we also investigate to provide an epidemiological basis for the prevention and control of HFMD in the suburbs of the metropolis.Method1.Descriptive epidemiology was used to analyze the three distribution characteristics of HFMD,and X~2test was utilized to compare the rates.P<0.05 is defined as the significant level.Data collection and statistical analysis are performed using Epi Data3.0,excels and SPSS 20.0 The epidemic information comes from the China Disease Prevention and Control Information System.The team of the District Center for Disease Control and Prevention is responsible for data collection and sorting.After the annual cleaning by the Shanghai Municipal Center for Disease Control and Prevention,the team collected and sorted all data of HFMD in the system that come from Fengxian District with the onset date from January 1,2009 to December 31,2019.The etiology data was derived from 2sentinel medical institutions of HFMD in this district,and anal swabs that randomly collected from more than 5 cases of common HFMD were sent to our team at the District Center for Disease Control and Prevention for pathogenic identification.2.We summarizes the monthly incidence of HFMD and the main indicators of meteorological factors in Fengxian District from 2011 to 2018,including monthly average temperature,monthly average maximum temperature,monthly average minimum temperature,monthly average relative humidity,and monthly precipitation.index.One-sample K-S test of non-parametric test in spss software package is used for coefficient test of meteorological factor index and monthly incidence rate of HFMD.If the data conforms to the bivariate normal distribution,Pearson correlation analysis was applied for univariate correlation analysis;if not,uses Spearman correlation analysis is used.The significance levelα=0.05.The meteorological data comes from the Meteorological Bureau of Fengxian District,Shanghai.3.The logistic regression model is used to analyze the severe risk factors of HFMD:the case group comes from January 1,2009 to December 31,2019,shich was input by our team and polisher of levels report directly through the China Disease Prevention and Control Information System network.There are 160 severe cases with the current address from Fengxian district.The control group was common cases of HFMD that were directly reported by medical institutions above level II in Fengxian District through the Internet.Compared with severe cases in case group,common cases with the difference of onset time and age are less than 2 weeks and 1 year respectively are used as a control group.And a1:2 match number was used to conduct a retrospective questionnaire survey,which content contains the general situation of the case,the onset of treatment,clinical symptoms and signs,epidemiology,birth status,caregiver status and so on.Risk factor analysis of Severe HFMD were initially assessed using univariate Logistic analysis to determine the independent factors that affect the severity of HFMD,and then the variables with P≤0.1 in the univariate analysis are included in the multivariate logistic regression,To eharacterize the independent rise factor and the significance level of the included and excluded variables is 0.10.Result1.Epidemiological characteristicsThe incidence of HFMD showed an upward trend every other year,and the incidence of severe cases has shown a downward trend.From 2009 to 2019,a total of 25,575 cases of HFMD were reported in Fengxian District,with an incidence rate of114.66/100,000-328.04/100,000,which is slightly higher than the same period of reported incidence rate of HFMD in Shanghai(99.64/100,000-269.21/10)with basically same incidence trends;severe cases were reported every year during 2009-2017,and no severe cases were reported in this district from 2018 to 2019.A total of 160 cases were reported from 2009 to 2019,of which the most reported in 2010(46 cases)and the least reported in2017(1 case),and the number of severe cases accounted for 0.80%-2.06%of the total number of cases,which was slightly higher than the same period in Shanghai(0.07%-1.02%).For time distribution,the incidence of HFMD showed obvious seasonal characteristics,beginning to increase in early April,peaking from April to July,and a slight rebound from October to December with a secondary peak.The incidence increased every other year,with a high incidence in even years and a low incidence in odd years.From the perspective of the main peak of the epidemic,the peak in even-numbered years was steep,and the trend in odd-numbered years was flat.The incidence trend of the registered perminant residents cases and was basically the same as temporaily.Before 2017,there were more cases in the migrant population in this district than in the local population;from2018 to 2019,the number of cases in the local population was higher than that in the migrant population.The time distribution of severe cases was basically the same as that of the overall epidemic,and the peak onset was one month later.The difference in the incidence of severe cases in different years was statistically significant(χ2=116.520,P<0.05).For population distribution,the predominant population of HFMD was children of under 5 years old,accounting for 87.04%-94.00%of the reported cases.The age composition of HFMD from 2009 to 2019 was statistically different(χ2=186.389,P<0.05).Severe cases were mainly scattered children under 3 years old,accounting for 72.32%.The age composition of severe cases and mild cases was statistically significant(χ2=19.069,P<0.05).There were more male cases than females in each year,with a male-to-female ratio of 1.63:1.There were 97 severe cases of males and 63 females.There was no statistically significant difference in the rate of severe cases between males and females(χ2=0.157,P>0.05).The city’s household registration is dominated by scattered children and children in kindergartens,accounting for 45.74%and 47.06%,respectively.The foreign household registration cases ware mainly scattered children,accounting for 59.83%.The occupational composition of the registered perminant residents cases and was basically the same as temporaily registration was different from,and the difference was statistically significant(χ2=563.593,P<0.05).For regional distribution,there are cases of HFMD in all towns(including sub-districts and communities)in the whole district,and the number of cases is higher in the towns with concentrated population,mainly in Nanqiao,Fengcheng and Jinhui.Among them,the three towns with the highest incidence of severe cases are Nanqiao,Fengcheng and Zhuangxing.Meteorological factor correlation analysis,showed that monthly average temperature,monthly average maximum temperature,monthly average minimum temperature,monthly average relative humidity are normally distributed,monthly precipitation,monthly incidence of HFMD are non-normally distributed.And Spearman correlation analysis was applied to single factor correlation analysis for monthly incidence of HFMD and the above meteorological factors.Among them,monthly average temperature,monthly average maximum temperature,monthly average minimum temperature and monthly average relative humidity are all positively correlated(P<0.05);Monthly average temperature,monthly average maximum temperature,monthly average minimum temperature are moderately correlated with corresponding month incidence of HFMD(r/rs value was between 0.460-0.468);monthly average relative humidity had a low degree of correlation with the monthly incidence of HFMD(r/rs=0.242).2.Etiological characteristicsFrom 2009 to 2019,we carried out virul nucleic acid testing of anal swab samples from common HFMD cases sent by sentinel hospitals in this district.A total of 992 cases were tested,including EV71,Cox A16,Cox A6,Cox A10.There were 879 cases of other enteroviruses,with a virus detection rate of 88.61%;the detection rate of EV71 had a significant downward trend,and Cox A16 and Cox A6 viruses gradually became dominant.From 2009 to 2012,EV71 was the dominant strain.In 2013,other viruses accounted for the highest proportion.In 2014,Cox A16 virus co-led the epidemic.After 2017,Cox A16virus and Cox A6 virus gradually became dominant.In 2019,Cox A10 virus has Rising trend.In seasonal distribution,EV71 virus and Cox A16 virus have a high incidence from April to September,and Cox A6 virus has a high incidence from November to January.In the 160 severe cases of HFMD,the virus nucleic acid test for severe cases revealed that EV71 was the main strain,accounting for 94.96%.The detection rate of EV71 in severe and mild cases was compared,and the difference was statistically significant(χ2=141.618,P<0.05).3.Analysis of risk factors for severe casesA total of 160 severe cases were investigated in this study.157 cases(98.10%)had fever before admission,and 65 cases(40.80%)had a maximum body temperature of>39°C.Among them,152 cases(95.60%)had skin rashes,mainly macula,papules and herpes;the rashes were mainly on the hands,feet,mouth,and buttocks;73 cases had vomiting symptoms before admission,accounting for 45.91%;73 cases had tremor,accounted for 45.91%;58 cases had panic symptoms,accounted for 36.48%.There were 97 males and 63 females in the severe case group;198 males and 122females in the control group,which has no statistically significance in male and female(χ2=0.119,P=0.730);the average age of the severe case group was 3.19±1.88 years old,and the average age of the control group was 2.89±1.58 years old,showing no statistically significance(t=1.652,P=0.099).The univariate logistic regression analysis of the influencing factors of severe HFMD found that the risk of the onset of children living with multiple children(OR=2.079,95%CI=1.417-3.615),the risk of the onset of children whose caregivers with a primary school education or less(OR=2.310,95%CI=1.274-4.186),the risk of onset to treatment for more than 1 day(OR=3.242,95%CI=2.114-4.974),and the risk of having a history of respiratory tract infection before 1 month(OR=2.133,95%CI=1.037-4.240).Furthormore high fever clinical signs(OR=2.182,95%CI=1.270-3.749),poor spirits(OR=2.994,95%CI=1.621-5.532),easily startled(OR=3.974,95%CI=1.873-8.433),hand and foot shaking(OR=43.310,95%CI=13.252-141.549),vomiting(OR=3.532,95%CI=2.140-5.828)and EV71 infection(OR=23.176,95%CI=9.805-54.784)were also significant associated with severe.Multivariate logistic regression analysis of the influencing factors of severe HFMD found that multiple children living in the same household(OR=3.248,95%CI:1.566-6.734),the time interval between onset and treatment(OR=4.060,95%CI:1.934)-8.521),and EV71 infection(OR=19.134,95%CI:6.780-54.001)are risk factors for severe of HFMD.Conclusion1.The occurrence of HFMD has obvious seasonality.Even-numbered years have a high incidence with steep peaks,suggesting that prevention and control should be strengthened;the peaks of odd-numbered years are flat,and the peaks of epidemics in autumn and winter are gradually higher than the peaks in summer,suggesting that odd years should guard against the rebound of HFMD in autumn and winter.2.The onset age of HFMD is mainly children under 5 years old,and the onset age of severe cases is mainly under 3 years old,and scattered children are the focus of severe occurrence population.3.The incidence of HFMD has a certain correlation with certain meteorological factors,and the prevention and control of HFMD should be carried out scientifically in accordance with the above rules.4.EV71,Cox A16,Cox A6 and other enteroviruses are in the process of dynamic changes.And,EV71 is the dominant strain in severe cases of HFMD in this region.The Cox A16 virus has a high incidence from April to September,and the Cox A6 virus has a high incidence from November to January of the following year,which should be strengthened monitoring and key responding.5.Multiple children in one family,patient delay and EV71 infection are serious risk factors of HFMD.Health education should be carried out to improve the awareness of medical treatment. |
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