韦氏智力量表

Original article

Clinical characteristics of hand, foot and mouth disease in Harbin and the prediction of severe cases

ZHOU Hong, GUO Shu-zhen, ZHOU Hao, ZHU Yue-feng, ZHANG Li-juan and ZHANG Wei

Keywords: hand, foot and mouth disease; diagnosis; epidemiology

Background Hand, foot and mouth disease (HFMD) is an emerging public health problem in China, not only threatening the health of children, but also causing tremendous loss and burden to both families and society. The aim of this study was to characterize the epidemiology and clinical features of HFMD, and to understand the key factors affecting HFMD in the Harbin region to provide scientific evidence for effective prevention and control strategies.

Methods Epidemiological and clinical information from 2379 randomly chosen cases of HFMD treated at the Harbin Center for Disease Control and Prevention from May 2008 to November 2011 were analyzed. All cases were separated into common and severe HFMD, with key factors for severe HFMD analyzed using multivariable Logistic regression.

Results Among the 2379 patients, 1798 were common cases and 581 severe cases, 14 of which resulted in death.

Most cases were in children younger than 5 years. Morbidity peaked in July and was higher in the surrounding country and cities than in Harbin proper. Medical expenses were significantly higher for severe than for common cases (P

<0.001). The primary clinical symptoms were fever and erythema; laboratory examination showed leucocytosis together

with pneumonia, carditis, and abnormal electrocardiogram and electroencephalogram in severe cases. Multivariable Logistic regression analysis showed that the key factors for severe HFMD were age, morbidity location, morbidity area, fever duration, mouth mucosal symptoms, and abnormal serum levels of neutrophils (NEUT), hemoglobin and glucose (P

<0.05).

Conclusions To improve prognosis, reduce medical expense and prevent the development of severe cases, we should improve the epidemiological detection of HFMD to treat patients quickly. We should also closely monitor children with the EV71 virus, who present with continuous fever as well as abnormal laboratory results, from areas highly susceptible to HFMD attacks.

Chin Med J 2012;125(7):1261-1265

and, foot and mouth disease (HFMD) is one of the

most common contagious diseases caused by an enterovirus, usually enterovirus 71 strain (EV71) or coxsackie virus A Group 16 strain (CA16).1The virus may reach the brainstem and spinal cord,2 causing severe complications in patients, usually infants. The clinical manifestation is mainly maculopapule and erythema on the hands, feet, mouth, and buttocks; severe cases may also present with cephalomeningitis, cephalitis, encephalomyelitis, pneumonedema, and dysaemia.3,4 Cases of HFMD have been reported in most countries and areas of the world. In China, the first confirmed case of HFMD was reported in 1981 in Shanghai.5Today, the disease is one of the most common contagious diseases in China, with a large morbidity area and increasing morbidity. According to national statistics, HFMD is ranked second in morbidity among all contagious diseases and is the sixth leading cause of death.6

Despite detailed investigations of the clinical symptoms and etiological diagnosis of HFMD, the epidemiology and clinical features of HFMD in Heilongjiang province are few, and very few reports of severe HFMD have described the key factors. In our study, we examined HFMD cases in Harbin from 2008 to 2011, and used retrospective analysis to determine the clinical features and epidemiology of HFMD. We also looked at the key factors associated with severe cases in this region, to develop effective prevention and control strategies.

METHODS

Patients

HFMD not only threatens the health of children, but also causes tremendous loss for both families and society. This disease has become a major public health problem for China and Asia at large. We analyzed a random sample of 2379 cases of HFMD who were admitted to the Harbin Center for Disease Control and Prevention from May 2008 to November 2011. Patients were assigned as having either common or severe HRMD, using the diagnostic code (DC) in the

H

DOI: 10.3760/cma.j.issn.0366-6999.2012.07.013

Department of Infectious Diseases, First Affiliated Clinical

Hospital of Harbin Medical University, Harbin, Heilongjiang

150086, China (Zhou H, Zhu YF, Zhang LJ and Zhang W)

Harbin Center for Disease Control and Prevention, Harbin,

Heilongjiang 150086, China (Guo SZ and Zhou H)

Correspondence to: ZHANG Wei, Department of Infectious

Diseases, First Affiliated Clinical Hospital of Harbin Medical

University, Harbin, Heilongjiang 150086, China (Fax:

86-451-53641561. Email: 1245537680@)