Analysis of clinical characteristics of 49 763 children with hand, foot and mouth disease

doi:10.3877/cma.j.issn.1673-5250.2017.05.008

Objective

To study the clinical characteristics of children with hand, foot and mouth disease (HFMD) in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

Methods

A total of 45 793 children with HFMD in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 1, 2013 to December 31, 2016, were selected as research subjects. After obtaining informed consents of all cases, throat swabs or (and) herpes fluid samples were collected from 363 mild type of HFMD cases, and throat swabs samples from 732 severe type of HFMD cases to detect enterovirus (EV) including EV71, coxsackievirus (Cox)A16 and other types of EV. Clinical data of all children with HFMD were analyzed retrospectively, and the characteristics of HFMD cases in our hospital from 2013 to 2016 were analyzed statistically including: ①rates of severe type and fatality rates of HFMD in each year; ②distribution characteristics of HFMD including months, ages, gender, crowd and region, and rates of severe type of HFMD of these factors; ③etiologic characteristics of HFMD cases. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

Results

①Among 45 793 HFMD children, 98.40% (45 061/45 793) of them were with mild type of HFMD, and 1.60%(732/45 793) were with severe type of HFMD. Fatality rate of children with severe type of HFMD was 1.64%(12/732). In 2013, rate of severe type of HFMD (1.13%) was the lowest compared to that of 2014 (1.85%), 2015 (1.69%) and 2016 (1.65%), respectively, and all the differences were statistically significant (P<0.05). Fatality rate of children with HFMD in 2014 (0.06%) was higher than that of 2013 (0.01%) and 2015 (0), respectively, and all the differences were statistically significant (P<0.05). ②Constituent ratio of HFMD monthly incidence: the most cases occurred in September in 2013 and 2015 with proportion of 30.90% and 26.43%, respectively, while the most cases occurred in May in 2014 and 2016 with proportion of 28.59% and 31.47%, respectively. The highest rate of severe type of HFMD every month in each year were 2.15% in April 2013, 5.34% in February 2014, 6.48% in March 2015 and 5.50% in October 2016, respectively. ③For age distribution characteristics: the largest proportion was 57.47% in age of children >1-3 years old. 94.96% of HFMD cases were age of children ≤5 years old.Rates of severe type of HFMD in children ≤1 year old or >1-3 years old were higher than those of children >3-5 years old and >5 years old, respectively, and all the differences were statistically significant (P<0.05). ④The proportion of male children with HFMD was 61.47% (28 149/45 793). Rate of male with severe type of HFMD (1.80%, 508/28 149) was higher than that of female (1.27%, 224/17 644), and the difference was statistically significant (χ²=19.745, P<0.001). HFMD proportion of scattered children, children in kindergarten and students were 73.11%, 25.56% and 1.33%, respectively, and rates of severe type of HFMD were 1.92%, 0.67% and 1.97%, respectively. HFMD constituent ratio of living in Nanning city, other counties in Nanning and other districts outside Nanning were 91.48%, 8.31% and 0.21%, respectively, and rates of severe type of HFMD children were 1.09%, 7.25% and 1.03%, respectively. ⑤EV positive rate of mild type of HFMD cases (87.05%, 316/363) was higher than that of severe type of HFMD cases (78.28%, 573/732), and the difference was statistically significant (χ²=12.272, P<0.001). The preponderant EV from mild type of HFMD cases were CoxA16 in 2013, EV71 in 2017, other types of EV in 2015 and CoxA16 in 2016, and the preponderant EV from severe type of HFMD cases were other types of EV in 2013, EV71 in 2014, other types of EV in 2015 and other types of EV in 2016. There were 12 death cases, and 83.34% (10/12) of them were tested positive of EV71.

Conclusions

From 2013 to 2016 in our hospital, the most HFMD cases occurred annually from April to June, or from August to October, boys were more affected of HFMD than that of girls, and high risk populations were in scattered children≤ 5 years old in Nanning city. The mild type of HFMD cases were mainly caused by Cox A16, and the severe type of HFMD cases were mainly caused by other types of EV.

Key words: Hand, foot and mouth disease, Coxsackievirus infections, Enterovirus A, human, Child

表1 本院2013－2016年手足口病重症率及病死率比较[例数(%)]

年份(年)	例数	HFMD重症率	HFMD病死率
2013	10 038	113(1.13)	1(0.01)
2014	12 666	234(1.85)	8(0.06)
2015	10 721	181(1.69)	0(0)
2016	12 368	204(1.65)	3(0.02)
χ²值	?	20.009	10.442
P值	?	<0.001	0.015

表1 本院2013－2016年手足口病重症率及病死率比较[例数(%)]

年份(年)	例数	HFMD重症率	HFMD病死率
2013	10 038	113(1.13)	1(0.01)
2014	12 666	234(1.85)	8(0.06)
2015	10 721	181(1.69)	0(0)
2016	12 368	204(1.65)	3(0.02)
χ²值	?	20.009	10.442
P值	?	<0.001	0.015

表2 本院2013－2016年手足口病月份分布构成比及每月手足口病重症率[例数(%)]

年份(年)	例数	1月		2月		3月		4月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	69(0.69)	0(0)	46(0.46)	0(0)	129(1.28)	1(0.78)	652(6.49)	14(2.15)
2014	12 666	303(2.39)	5(1.65)	131(1.03)	7(5.34)	510(4.03)	12(2.35)	2 352(18.57)	10(0.43)
2015	10 721	97(0.91)	1(1.03)	58(0.54)	1(1.72)	216(2.02)	14(6.48)	473(4.41)	12(2.54)
2016	12 368	324(2.62)	2(0.62)	143(1.15)	2(1.40)	529(4.28)	10(1.89)	2 865(23.16)	40(1.40)
年份(年)	例数	5月		6月		7月		8月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	900(8.97)	13(1.44)	872(8.69)	13(1.49)	893(8.90)	11(1.23)	1 351(13.46)	20(1.48)
2014	12 666	3 621(28.59)	25(0.69)	2 177(17.19)	71(3.26)	827(6.53)	24(2.90)	353(2.79)	13(3.68)
2015	10 721	1 001(9.34)	27(2.70)	856(7.98)	30(3.50)	760(7.09)	16(2.11)	1 440(13.43)	17(1.18)
2016	12 368	3 892(31.47)	54(1.39)	1 866(15.09)	39(2.09)	929(7.51)	11(1.18)	273(2.21)	4(1.47)
年份(年)	例数	9月		10月		11月		12月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	3 102(30.90)	14(0.45)	1 206(12.01)	13(1.08)	445(4.43)	6(1.35)	373(3.72)	8(2.14)
2014	12 666	824(2.06)	17(2.06)	798(2.63)	21(2.63)	480(3.79)	16(3.33)	290(2.29)	13(4.48)
2015	10 721	2 834(26.43)	31(1.09)	1 747(16.30)	16(0.92)	797(7.43)	8(1.00)	442(4.12)	8(1.81)
2016	12 368	320(2.59)	9(2.81)	309(2.50)	17(5.50)	507(4.10)	6(1.18)	411(3.32)	10(2.43)

表2 本院2013－2016年手足口病月份分布构成比及每月手足口病重症率[例数(%)]

年份(年)	例数	1月		2月		3月		4月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	69(0.69)	0(0)	46(0.46)	0(0)	129(1.28)	1(0.78)	652(6.49)	14(2.15)
2014	12 666	303(2.39)	5(1.65)	131(1.03)	7(5.34)	510(4.03)	12(2.35)	2 352(18.57)	10(0.43)
2015	10 721	97(0.91)	1(1.03)	58(0.54)	1(1.72)	216(2.02)	14(6.48)	473(4.41)	12(2.54)
2016	12 368	324(2.62)	2(0.62)	143(1.15)	2(1.40)	529(4.28)	10(1.89)	2 865(23.16)	40(1.40)
年份(年)	例数	5月		6月		7月		8月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	900(8.97)	13(1.44)	872(8.69)	13(1.49)	893(8.90)	11(1.23)	1 351(13.46)	20(1.48)
2014	12 666	3 621(28.59)	25(0.69)	2 177(17.19)	71(3.26)	827(6.53)	24(2.90)	353(2.79)	13(3.68)
2015	10 721	1 001(9.34)	27(2.70)	856(7.98)	30(3.50)	760(7.09)	16(2.11)	1 440(13.43)	17(1.18)
2016	12 368	3 892(31.47)	54(1.39)	1 866(15.09)	39(2.09)	929(7.51)	11(1.18)	273(2.21)	4(1.47)
年份(年)	例数	9月		10月		11月		12月
年份(年)	例数	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率	HFMD构成比	HFMD重症率
2013	10 038	3 102(30.90)	14(0.45)	1 206(12.01)	13(1.08)	445(4.43)	6(1.35)	373(3.72)	8(2.14)
2014	12 666	824(2.06)	17(2.06)	798(2.63)	21(2.63)	480(3.79)	16(3.33)	290(2.29)	13(4.48)
2015	10 721	2 834(26.43)	31(1.09)	1 747(16.30)	16(0.92)	797(7.43)	8(1.00)	442(4.12)	8(1.81)
2016	12 368	320(2.59)	9(2.81)	309(2.50)	17(5.50)	507(4.10)	6(1.18)	411(3.32)	10(2.43)

表3 本院2013－2016年手足口病患儿各年龄段手足口病重症率[例数(%)]

年龄(岁)	例数	HFMD重症率
≤1	6 331	114(1.80)
>1～3	26 319	493(1.87)
>3～5	10 835	105(0.97)
>5	2 308	20(0.87)
χ²值	?	49.419
P值	?	<0.001

表3 本院2013－2016年手足口病患儿各年龄段手足口病重症率[例数(%)]

年龄(岁)	例数	HFMD重症率
≤1	6 331	114(1.80)
>1～3	26 319	493(1.87)
>3～5	10 835	105(0.97)
>5	2 308	20(0.87)
χ²值	?	49.419
P值	?	<0.001

表4 本院2013－2016年手足口病病原学检查结果[例数(%)]

年份(年)	普通型HFMD
年份(年)	例数	EV71	CoxA16	其他EV	阴性
2013	76	1(1.32)	39(51.31)	27(35.53)	9(11.84)
2014	99	37(37.38)	20(20.20)	28(28.28)	14(14.14)
2015	85	10(11.77)	14(16.47)	50(58.82)	11(12.94)
2016	103	35(33.98)	39(37.87)	16(15.53)	13(12.62)
合计	363	83(22.87)	112(30.85)	121(33.33)	47(12.95)
年份(年)	重症HFMD
年份(年)	例数	EV71	CoxA16	其他EV	阴性
2013	113	10(8.85)	8(7.08)	67(59.29)	28(24.78)
2014	234	98(41.88)	6(2.56)	76(32.48)	54(23.08)
2015	181	17(9.39)	7(3.87)	123(67.96)	34(18.78)
2016	204	61(29.90)	22(10.78)	78(38.24)	43(21.08)
合计	732	186(25.41)	43(5.87)	344(47.00)	159(21.72)

表4 本院2013－2016年手足口病病原学检查结果[例数(%)]

年份(年)	普通型HFMD
年份(年)	例数	EV71	CoxA16	其他EV	阴性
2013	76	1(1.32)	39(51.31)	27(35.53)	9(11.84)
2014	99	37(37.38)	20(20.20)	28(28.28)	14(14.14)
2015	85	10(11.77)	14(16.47)	50(58.82)	11(12.94)
2016	103	35(33.98)	39(37.87)	16(15.53)	13(12.62)
合计	363	83(22.87)	112(30.85)	121(33.33)	47(12.95)
年份(年)	重症HFMD
年份(年)	例数	EV71	CoxA16	其他EV	阴性
2013	113	10(8.85)	8(7.08)	67(59.29)	28(24.78)
2014	234	98(41.88)	6(2.56)	76(32.48)	54(23.08)
2015	181	17(9.39)	7(3.87)	123(67.96)	34(18.78)
2016	204	61(29.90)	22(10.78)	78(38.24)	43(21.08)
合计	732	186(25.41)	43(5.87)	344(47.00)	159(21.72)

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