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目的探讨海口市2009～2010年重症手足口病的流行病学和临床特征,为有效预防和控制重症手足口病提供科学依据。方法对海口市2009～2010年报告的重症手足口病病例进行个案调查和样本采集,实验室采用RT-PCR法检测患者样本的肠道病毒类型(EV71、CoxA16及其他),对各病例基本信息、临床表现特点及实验室检查结果等进行分析。结果 2009、2010年海口市手足口病重症率分别为1.49%、0.48%,病死率分别为5.88%、0%。2009年发病时间集中于9～11月,2010年集中于4～8月。3岁以下儿童发病占84.88%,散居儿童占76.74%。城市高于农村。临床表现以持续发热伴皮疹为主,合并症以神经系统受累为主,占94.12%。病例从发病到诊断为重症间隔时间为0～7d。重症患者EV71检出率为23.53%,CoxA16为1.17%,其他肠道病毒为8.24%。结论 2009～2010年海口市重症手足口病主要发生于3岁以下散居儿童,病原构成以EV71为主,病例病情进展迅速。在没有有效疫苗预防及足够病原检测条件下,应加强对3岁以下手足口病患儿随访管理,早期识别重症病例并及时干预和治疗是降低病死率的关键。
Objective To explore the epidemiological and clinical features of severe hand-foot-mouth disease in Haikou from 2009 to 2010 and provide a scientific basis for effective prevention and control of severe hand-foot-mouth disease. Methods The cases of severe HFMD reported in 2009-2010 in Haikou City were collected and the samples were collected. The types of enterovirus (EV71, CoxA16 and others) were detected by RT-PCR in the laboratory. The basic information of each case , Clinical features and laboratory test results were analyzed. Results The rates of HFMD in Haikou City in 2009 and 2010 were 1.49% and 0.48%, respectively. The case fatality rates were 5.88% and 0% respectively. In 2009 the onset time concentrated in 9 to November, 2010 focus on 4 to August. The incidence of children under 3 years of age accounted for 84.88%, scattered children accounted for 76.74%. The city is higher than the countryside. Clinical manifestations with persistent fever with rash-based comorbid nervous system involvement, accounting for 94.12%. Case from the onset to diagnosis of severe interval for 0 ~ 7d. Severe patients EV71 detection rate was 23.53%, CoxA16 was 1.17%, other enterovirus 8.24%. Conclusion Severe hand-foot-mouth disease in Haikou from 2009 to 2010 mainly occurred in scattered children under 3 years of age. The pathogen was mainly EV71, and the disease progressed rapidly. In the absence of effective vaccine prophylaxis and adequate pathogen detection, follow-up management of HFMD children under 3 years of age should be strengthened. Early identification of severe cases and timely intervention and treatment are the keys to reducing mortality.