Hand, foot, and mouth disease in China, 2008-12: an epidemiological study.
Hand, foot, and mouth disease in China, 2008-12: an epidemiological study.
复制标题
DOI：
10.1016/s1473-3099(13)70342-6
复制
发表时间：
2014-04
影响因子：
56.3
通讯作者：
Yu, Hongjie
中科院分区：
文献类型：
--
作者：
Xing, Weijia;Liao, Qiaohong;Viboud, Cecile;Zhang, Jing;Sun, Junling;Wu, Joseph T.;Chang, Zhaorui;Liu, Fengfeng;Fang, Vicky J.;Zheng, Yingdong;Cowling, Benjamin J.;Varma, Jay K.;Farrar, Jeremy J.;Leung, Gabriel M.;Yu, Hongjie
手足口病是一种由肠道病毒引起的儿童常见疾病。它日益给整个东亚和东南亚带来巨大的疾病负担。为了更好地为疫苗和其他干预措施提供信息，我们在加强监测的基础上描述了中国手足口病的流行病学特征。我们从2008-2012年报告的手足口病病例中提取流行病学、临床和实验室数据，并汇编气候、地理和人口信息。所有分析均按年龄、疾病严重程度、实验室确认状态和肠道病毒亚型分层。监测登记处收集了7，200，092例可能的手足口病病例（年发病率为1.2/1，000），其中3.7%经实验室确诊，0.03%死亡。发病率和死亡率在12-23个月的儿童中最高（2012年：38.2例/1，000，1.5例/100，000）。从发病到确诊和死亡的中位时间分别为1.5天和3.5天。心肺或神经系统并发症的风险为1.1%，严重病例死亡风险为3.0%，其中>90%的死亡与肠道病毒71有关。手足口病在北方每年6月达到高峰，而中国南方在5月和9月/10月经历了半年一次的爆发。季节模式的地理差异与气候和人口因素的相关性较弱（方差分别解释了8-23%和3- 19%）。这是迄今为止最大规模的手足口病流行病学研究。未来的缓解政策应充分考虑到所确定的疾病负担的异质性。进一步的流行病学和血清学研究是必要的，以阐明当地手足口病的动态和免疫模式，并优化干预措施。中美新发和再发传染病合作项目、世界卫生组织、李嘉诚牛津全球健康计划和惠康基金会、哈佛传染病动态研究中心、香港特别行政区政府卫生及医学研究基金。
Hand–foot–and–mouth disease (HFMD) is a common childhood illness caused by enteroviruses. Increasingly it imposes a substantial disease burden throughout East and Southeast Asia. To better inform vaccine and other interventions, we characterized the epidemiology of HFMD in China based on enhanced surveillance. We extracted epidemiological, clinical and laboratory data from reported HFMD cases during 2008–2012 and compiled climatic, geographic and demographic information. All analyses were stratified by age, disease severity, laboratory confirmation status and enterovirus subtype. The surveillance registry captured 7,200,092 probable HFMD cases (annualized incidence, 1·2 per 1,000), of whom 3·7% were laboratory–confirmed and 0·03% died. Incidence and mortality were highest in children aged 12–23 months (in 2012: 38·2 cases per 1,000 and 1·5 death per 100,000). Median durations from onset to diagnosis and death were 1·5 days and 3·5 days respectively. The risk of cardiopulmonary or neurological complications was 1·1% and the severe-case fatality risk was 3·0%, with >90% of deaths associated with enterovirus 71. HFMD peaked annually in June in the North, whereas Southern China experienced semi-annual outbreaks in May and September/October. Geographic differences in seasonal patterns were weakly associated with climate and demographic factors (variance explained 8-23% and 3–19%, respectively). This is the largest population-based study to date of the epidemiology of HFMD. Future mitigation policies should take full account of the heterogeneities of disease burden identified. Additional epidemiologic and serologic studies are warranted to elucidate local HFMD dynamics and immunity patterns and optimize interventions. China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases; World Health Organization; The Li Ka Shing Oxford Global Health Programme and Wellcome Trust; Harvard Center for Communicable Disease Dynamics; Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region.