Correlation analysis of EV71 detection and case severity in hand, foot, and mouth disease in the Hunan Province of China.

An increase in the incidence of hand, foot and mouth disease (HFMD) cases has been observed in the Hunan province of mainland China since 2009 with a particularly higher level of severe cases in 2010-2012. Intestinal viruses of the picornaviridae family are responsible for the human syndrome associated with HFMD with enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) being the most common causative strains. HFMD cases associated with EV71 are generally more severe with an increased association of morbidity and mortality. In this study, the etiology surveillance data of HFMD cases in Hunan province from March 2010 to October 2012 were analyzed to determine if there is a statistically relevant linear correlation exists between the detection rate of EV71 in mild cases and the proportion of severe cases among all HFMD patients. As the cases progressed from mild to severe to fatal, the likelihood of EV71 detection increased (25.78%, 52.20% and 84.18%, respectively). For all cases in the timeframe evaluated in this study, the presence of virus was detected in 63.21% of cases; among cases showing positivity for virus, EV71 infection accounted for 50.14%. These results provide evidence to support the observed higher morbidity and mortality associated with this outbreak and emphasizes the importance of early detection in order to implement necessary prevention measures to mitigate disease progression.

[The influence of familial factors on post rabies exposure vaccination in rural habitats].

OBJECTIVE: To understand the current situation of potential exposure to rabies among the rural habitats in Hunan province, and to study the impact related to familial factors on post rabies exposure vaccination. METHODS: In total, 40 villages from 20 townships of 4 counties were selected by multistage sampling method. Study samples were selected from these villagers and familial basic information and vaccination post rabies exposures were recorded through questionnaires. Data were statistically analyzed by SPSS 17.0. RESULTS: Among 3042 villagers from 864 households being surveyed, 124 person-time exposures were found from January, 2009 to October, 2010, with a total exposure rate as 4.08%, and the annual average exposure rate as 2.33%. Data from univariate analysis showed that the rates on post rabies exposure vaccination were statistically correlated with the following four factors:knowledge on the score of rabies prevention (χ(2) = 8.260, P = 0.042), whether being involved in the new type of rural cooperative medical care(P = 0.035), family disposable cash income in the year of 2009(χ(2) = 10.831, P = 0.031), distance between the households and the health facilities in towns and townships(χ(2) = 9.071, P = 0.033). Results from logistic regression analysis indicated that the score of knowledge on rabies prevention(O∧R = 1.420, 95% CI:1.055-1.905)and the annual disposable cash income of the family in 2009(O∧R = 1.480, 95% CI:1.044-2.098)were independent factors that influencing the rabies vaccination. CONCLUSION: Strengthening the education programs on rabies prevention in rural habitats and increasing family income were feasible way to increase the rate of rabies vaccination in rural areas of Hunan province.

[Analysis on the changing trend of mortality rate and spectrum regarding causes of death in the last recent 30 years in Hunan province].

OBJECTIVE: To investigate the changing trend of mortality and the spectrum regarding causes of death in the population of Hunan, and to analyze the health-related major diseases. METHODS: With retrospective study method, a sample survey on causes of death and the related information was carried out from 2004 to 2005 among the residents in Hunan province. Results were compared with the data from a retrospective survey on causes of death in Hunan during 1973-1975 and 1990-1992, respectively. RESULTS: The crude mortality rates and the standardized mortality ratios (SMR) of the residents in Hunan were 901.59/100 000 and 865.14/100 000 during the period of 1973-1975 while 588.64/100 000 and 537.42/100 000 during the period of 1990-1992, and 608.27/100 000 and 413.67/100 000 during the period of 2004-2005, respectively. During the past 30 years, the SMR of the residents in Hunan decreased by 52.18% and the descending range from the rural areas was more than that of the urban areas, and higher in females than in males. The death proportion of infectious diseases, maternal and perinatal diseases, nutritional deficiencies decreased significantly (P<0.01), but the death proportion of chronic non-communicable diseases increased significantly (P<0.01). The changing ranges of the former two proportions were both larger in the rural areas than those in the urban areas. The highest proportions of deaths due to injury and poisoning during the past 30 years were both seen in the 5 year olds, followed by the age groups of 25 year olds (P<0.01). During the period of 2004-2005, the death proportion of all the infectious diseases, maternal/perinatal diseases and nutritional deficiencies was 8.01% altogether, and those of chronic non-communicable diseases, injury and poisoning were 80.66% and 11.33%, respectively. During the past 30 years, the SMR of the three kinds of diseases all significantly decreased, more significantly seen in infectious diseases, maternal and perinatal diseases, and nutritional deficiencies but less in chronic non-communicable diseases. Among the death cases of chronic non-communicable diseases, the SMR of cerebrovascular disease, malignant tumor, and heart disease showed an increasing tendency and the sequences of them had been advanced to the first, the second, and the fourth in the death ranking during the period of 2004-2005, respectively. CONCLUSION: The SMRs of the residents in the urban and rural areas from Hunan province showed a declining tendency. Cardiovascular, cerebrovascular diseases and malignant tumors had become the important diseases affecting the health of the people, while injury and poisoning had otherwise topped the causes of death among children and adolescents in Hunan province.

[Risk factors of death cases of hand-foot-and-mouth disease in Hunan province].

OBJECTIVE: To study risk factors of death cases of hand foot and mouth diseases (HFMD) in Hunan province, so as to provide scientific evidence for further prevention and control. METHODS: The 105 death cases of HFMD between January and October, 2010 in Hunan Province were selected as case group; and the 210 survival cases of serious HFMD, which were matched by gender and resident places with a ratio at 2:1 in the same period in Hunan were selected as control group. The basic information, hospitalized experience and previous medical history had been surveyed and the relevant risk factors were analyzed by single factor and multi-factor logistic regression. RESULTS: In case group, 79.05% (83/105) of the cases lived in rural area and 9.52% (10/105) of the cases lived in urban-rural midst area. In control group, 87.62% (184/210) of the cases lived in rural area and 11.43% (24/210) of the cases lived in urban-rural midst area. In case group, 59.05% (62/105) of the patients first visited rural (private) clinics and 20.00% (21/105) first visited community hospitals in villages and towns; while in control group, 43.81% (92/210) and 13.33% (28/210) chose rural (private) clinics and community hospitals in villages and towns as the first choice respectively.22.86% (24/105) of the case group and 39.05% (82/210) of the control group were diagnosed as HFMD in their first visit to hospital.27.62% (29/105) of the case group and 7.14% (15/210) in control group were provided pyrazolone in the treatment. For glucocorticoid, 80.95% (85/105) and 5.71% (6/105) of the case group were given as treatment by rural (private) clinics and community hospitals in villages and towns separately; while the proportions in the control group were 41.43% (87/210) and 0.48% (1/210) respectively. For antibiotics, 35.24% (37/105) and 23.81% (25/105) of the case group were prescribed by rural (private) clinics and community hospitals in villages and towns separately; while the percentages in the control group were 15.71% (33/210) and 7.14% (15/210). 3.81% (4/105) of the case group and 11.90% (25/210) of the control group were vaccinated in one month before the onset. The results of single-factor logistic regression indicated that living in rural areas (OR = 0.075, 95%CI: 0.016 - 0.343) and in rural-urban midst areas (OR = 0.069, 95%CI: 0.013 - 0.368), diagnosis of HFMD in the first visit to hospital (OR = 0.463, 95%CI: 0.271 - 0.788) and vaccination one month before the onset (OR = 0.293, 95%CI: 0.099 - 0.866) were four protective factors; while rural (private) clinics as the first choice (OR = 4.717, 95%CI: 1.891 - 11.767), community hospital in villages and towns as the first choice (OR = 5.250, 95%CI: 1.883 - 14.641), medication of pyrazolone (OR = 4.961, 95%CI: 2.520 - 9.766), medication of glucocorticoid in rural (private) clinics (OR = 6.009, 95%CI: 3.435 - 10.510) and in community hospital in villages and towns (OR = 12.667, 95%CI: 1.505 - 106.638), medication of antibiotics in rural (private) clinics (OR = 2.918, 95%CI: 1.690 - 5.040) and in community hospital in villages and towns (OR = 4.062, 95%CI: 2.036 - 8.108) were seven risk factors. The results of multi-factors logistic regression showed that medication of pyrazolone (OR = 2.311, 95%CI: 1.062 - 5.030), medication of glucocorticoid in rural (private) clinics (OR = 5.480, 95%CI: 3.039 - 9.880), medication of antibiotics in rural (private) clinics (OR = 2.430, 95%CI: 1.301 - 4.538) and medication of antibiotics in community hospitals in villages and towns (OR = 3.344, 95%CI: 1.477 - 7.569) were the risk factors of death of HFMD. CONCLUSION: The risk factors of HFMD deaths include the medication of pyrazolone, glucocorticoid and antibiotics by rural (private) clinics and medical institutions in villages and towns. The department concerned should revise the technical manual to standardize the medication of the above drugs.

Development of real-time and nested RT-PCR to detect astrovirus and one-year survey of astrovirus in Jiangmen City, China.

Human astroviruses (HAstVs) are one of the major viral agents of acute gastroenteritis (AGE) in all age groups, especially in young children. In this study, new one-step real-time RT-PCR and nested RT-PCR assays were developed to detect HAstVs. HAstVs were identified in 46 (8.75%) of 526 stool samples in Jiangmen City over 1 year, including 43 (9.15%) of 470 children and 3 (5.4%) of 56 adults, and HAstV-1 was the most predominant strain. This finding suggests that HAstVs infections are common in Jiangmen City, China. Further detailed molecular epidemiological studies are required for understanding the prevalence of HAstVs infection and gaining knowledge about the circulating genotypes.