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@#Objective To analyze the epidemiological and etiological characteristics of hand,foot and mouth disease(HFMD)in Honghe Prefecture,Yunnan Province from 2013 to 2021,and provide basis for the development of prevention and control strategies for HFMD. Methods The case data of HFMD in Honghe Prefecture,Yunnan Province from 2013 to2021 were extracted from the“China Disease Prevention and Control Information System”. Descriptive epidemiological analysis method was used to analyze the incidence rate,severe rate,mortality rate. The nucleic acids of enterovirus-A71(EV-A71)and Coxsackievirus-A16(CV-A16)were detected by Real-time PCR in throat swabs,anal swabs or stool samples from 16 586 cases of HFMD,and the etiological characteristics were analyzed. Results A total of 78 356 cases of HFMD were reported from 2013 to 2021 in Honghe Prefecture,Yunnan Province,with 354 severe cases and 11 deaths. The average annual incidence rate of HFMD was 187. 47/100 000,with an upward trend from 2013 to 2015,and reached the first peak in 2015,which showed a downward trend from 2016 to 2017,while increased,reached the second peak,and then gradually decreased and tended to be flat in 2018. The severe and death rates have been declining since 2015. The age group of 0～7 years old showed high incidence,which accounted for 97. 85%(76 670/78 356)of the total incidence,and the average annual incidence of 1～2 years old group was the highest(4 397. 98/100 000). Generally,the time distribution showed a bimodal distribution,which were from April to July(summer peak)and from October to December(autumn peak),and the peak in summer was higher than that in autumn. The number of cases and severe cases in males were significantly higher than those in females（χ~2= 1 154. 436 and 5. 183,respectively,each P < 0. 05）. The average annual incidence and severe rate in the northern part of Honghe Prefecture were significantly higher than those in the southern part（χ~2= 18 573. 742 and 11. 036,respectively,each P < 0. 05）. Among 16 586 HFMD cases,EV-A71,CV-A16 and other enteroviruses accounted for 18. 71%,20. 38% and 60. 91% of cases,respectively,with significant difference（χ~2= 5 426. 965,P < 0. 05）. The dominant pathogen was EV-A71 in 2013 and 2015,while CV-A16 in 2014,and other enteroviruses became the dominant pathogens in 2016 — 2021. Conclusion The epidemic trend of HFMD in Honghe Prefecture,Yunnan Province from 2013 to 2021 was seasonal and regional,with children under the age of 7 being the key population,and other enteroviruses have become the dominant pathogens after 2016. HFMD prevention and control knowledge publicity should be strengthened,good hygiene habits should be advocated,and parents' awareness of disease prevention should be raised. EV-A71 vaccination should be strengthened to reduce EV-A71 infection and effectively prevent severe cases and deaths.
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Objective@#To evaluate the effect of daily temperature on hand-foot-mouth disease (HFMD) in children under 5 years old in Jingzhou city.@*Methods@#HFMD incidence data and meteorological data in Jingzhou city were obtained during 2010 and 2017. Distributed lag non-linear model (DLNM) was utilized to investigate the impact of daily temperature on HFMD incidence among children under 5 years old adjusting for potential confounders of other meteorological factors, secular trend, weekdays and holidays.@*Results@#A total of 47 525 cases were reported during 2010 to 2017, of which the ratio of male to female was 1.52. Children under 1 year old, 1-<3 years old, 3-5 years old accounted for 9.72%, 62.10%, and 28.18% of the total cases, respectively. Children cared at home and children care in kindergarten accounted for 73.29% and 26.71% of the total cases, respectively. The relationship between the temperature and the daily cases of HFMD in children under five years old was a ‘M’ pattern. Compared with a reference temperature (the 50 th percentile of average temperature during the study period, P 50), the maximum value of effect at 8.21 ℃ and 25.81 ℃ were 1.53(95%CI=1.33-1.76) and 1.47(95%CI=1.31-1.65). Higher temperatures (such as 25.81 ℃ in this paper) showed a long lag effect on the HFMD incidence compared with lower temperatures (such as 8.21 ℃). Subgroup analyses indicated that children aged 3-5 years (children who attended daycare) were more vulnerable to the effects of temperature changes on HFMD than those under 1 year old and 1-<3-year-old (cared at home).@*Conclusion@#The temperature has a significant impact on the HFMD incidence among children under five years old in Jingzhou. Daycare centers is the key place for prevention and control of HFMD.
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Objective To investigate the risk factors of severe hand,foot and mouth disease (HFMD).Methods 175 severe cases of HFMD and 183 mild cases of HFMD in the same period were randomly selected.Single factor analysis was first performed between severe and mild cases on age,gender,residence,symptoms,signs and laboratory examinations,etc,to screen out the related risk factors which P value ＜ 0.05.Then,binary logistic regression analysis was carried out to determine risk factors most related to severe HFMD.Finally,receiver operating characteristic curve (ROC) analysis was performed on severe HFMD related risk factors.Results Single factor analysis showed that there were obvious differences between children with mild HFMD and those with severe HFMD in the factors like difficulty in breathing,walking instability,vomiting,limb shaking,disturbance of consciousness,convulsions,cold sweat and weakness,thermal process,the degree of fever,pulmonary rales,heart rate,serum EV71 antibody,circulatory failure,leukocyte count,platelet count,neutrophil ratio,CRP,blood glucose,etc (x2 =15.236,19.819,33.823,52.670,12.984,10.180,29.318,52.932,34.544,14.615,46.633,31.407 and 5.303,t =3.184,3.144,2.256,2.244 and 2.828,,all P ＜0.05).Binary logistic regression analysis showed that the thermal process,startle tremor or limb jitter,serum EV71 antibody,vomiting,fever,neutrophil ratio were the related risk factors of severe HFMD (B value =2.605,2.129,1.409,1.185,0.841 and 0.103,all P ＜ 0.05).ROC analysis showed that the areas under the curve of the predicted probability and thermal process were larger than any other risk factors [(95％ CI (0.888 ～ 0.961) and (0.818 ～ 0.920)],and thus had better diagnostic values.Conclusion Children under 3 years old were the high risk population of HFMD.Such clinical symptoms as persistent high fever,vomiting,startle tremor orlimb jitter,EV71 antibody in serum and increasing neutrophil ratio were risk factors for severe HFMD.The predicted probability had more diagnostic value than any other risk factors.
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Objective To summarize the prevention and treatment of hand food and mouth disease (HFMD),especially the severe cases.Methods We analyzed the data including gender,age,time of onset,place of residence,contact history,clinical manifestation,accessory examinations and clinical outcome of 266 HFMD cases hospitalized in our department from Apr to Oct 2009,and identified the clinical and epidemiologic features associated with HFMD.Results Age group ranged from 4 months to 11 years with 87.6％(233/266) of the cases≤5 years.Most cases were resident in rural or suburban area,the number of which was 3 times as much as urban.Neurological complications were more common,especially in the cases with increases of white blood cell and neutrophil number in peripheral blood.There were 40 cases with etiological examination results.Twelve cases were infected with enterovirus 71 ( EV71 ) and the others were infected with Coxsackievirus A16.Twelve cases with EV71 infection were complicated with meningoencephalitis,encephalitis,encephalomyelitis,one of whom was brain stem encephalitis.Conclusion The high-risk group of HFMD are the children less than 5 years.The suburban and rural are the key areas of prevention and control.The neurological complications are common,especially in the case with EV71 infection and significant increases of white blood cell and neutrophil number in peripheral blood.