CAJ | 학술논문

目的：探讨福建省＜4岁儿童手足口病再次罹患特征，为制定防控策略提供依据。方法运用队列研究方法以福建省手足口病监测资料中＜4岁患儿为研究对象，以首次罹患时的特征作为其再次罹患的影响因素，采用SAS 9.0软件的logistic逐步回归法筛选。结果共纳入研究对象82949例，其中多次罹患者2612例（3.15%）。在多次罹患者中，累计罹患2次者2510例，3次者98例，4次者3例，5次者1例。年龄＜2岁和2岁者首次罹患时，其再次罹患风险分别是年龄为3岁者的4.39（95%CI：3.80～5.07）倍和2.73（95%CI：2.35～3.18）倍；以居住地区＜6岁儿童手足口病患病率＜2%为对照，患病率＞4%、3%～4%和2%～3%的再次罹患风险分别为2.15（95%CI：1.88～2.45）倍、2.10（95%CI：1.85～2.38）倍和1.65（95%CI：1.44～1.89）倍；在妇幼保健机构就诊者再次罹患风险是在非妇幼保健机构就诊者的1.64（95%CI：1.51～1.78）倍；男性再次罹患风险是女性的1.34（95%CI：1.23～1.46）倍。引起再次罹患的主要病原是肠道病毒（EV）71型（33/60），并进展为重症病例（8/2612）；首次、再次罹患的致病病原有可能均为EV71型毒株（3/6）。结论是否重复罹患与其再次接触病原体的机会密切相关，对首次罹患的低龄幼儿应及时采取干预措施。
목적：탐토복건성＜4세인동수족구병재차리환특정，위제정방공책략제공의거。방법운용대렬연구방법이복건성수족구병감측자료중＜4세환인위연구대상，이수차리환시적특정작위기재차리환적영향인소，채용SAS 9.0연건적logistic축보회귀법사선。결과공납입연구대상82949례，기중다차리환자2612례（3.15%）。재다차리환자중，루계리환2차자2510례，3차자98례，4차자3례，5차자1례。년령＜2세화2세자수차리환시，기재차리환풍험분별시년령위3세자적4.39（95%CI：3.80～5.07）배화2.73（95%CI：2.35～3.18）배；이거주지구＜6세인동수족구병환병솔＜2%위대조，환병솔＞4%、3%～4%화2%～3%적재차리환풍험분별위2.15（95%CI：1.88～2.45）배、2.10（95%CI：1.85～2.38）배화1.65（95%CI：1.44～1.89）배；재부유보건궤구취진자재차리환풍험시재비부유보건궤구취진자적1.64（95%CI：1.51～1.78）배；남성재차리환풍험시녀성적1.34（95%CI：1.23～1.46）배。인기재차리환적주요병원시장도병독（EV）71형（33/60），병진전위중증병례（8/2612）；수차、재차리환적치병병원유가능균위EV71형독주（3/6）。결론시부중복리환여기재차접촉병원체적궤회밀절상관，대수차리환적저령유인응급시채취간예조시。
Objective To explore the recurrent epidemiological characteristics of hand,foot and mouth disease (HFMD) among children aged <4 years to provide evidence for HFMD prevention and control. Methods Principles on historical cohort study were followed when analyzing data related to HFMD surveillance in Fujian province. All the research objects were restricted to patients aged<4,with HFMD and who were permanent residents in Fujian province. Characteristics of the study objects were extracted as potential factors when the patients first showed symptoms of HFMD. These factors might cause the recurrence of HFMD and were filtered by the logistic stepwise regression with SAS 9.0. Results A total of 82 949 children were included. Among them,2 612 had repetitiously suffered from HFMD (occupied 3.15%),including 2 510 who had the histories of suffering twice,98 suffering three times,3 suffering four times,and 1 even suffering five times. Comparing with the objects who had the first onset at the age of 3,also with the risk increased to 4.39 (95%CI:3.80-5.07)times,when compared to those who had the first onset at the age below 2. Again, the risk among children whose first onset was at the age of 2 had increased to 2.73 (95%CI:2.35-3.18)times. According to the current residents areas,the morbidities of patients under 6 years old were below 2%when the symptoms first started,but the risk of the objects whose morbidities were higher than 4%,had increased 2.15(95%CI:1.88-2.45) times. Again,risk of the objects whose morbidities were between 3%and 4%had increased to 2.10(95%CI:1.85-2.38)times. Among those whose specific morbidities were between 2% and 3%,the risk had increased to 1.65(95%CI:1.44-1.89) times. Comparing with the objects who never visited any maternal/child care settings when started the first onset,the risk among the ones who had been to the maternal/child care settings, had increased to 1.64(95%CI:1.51-1.78)times. Boys had the risk 1.34(95%CI:1.23-1.46)times increase than girls. The preponderant pathogen causing HFMD recurrence was EV71 (33/60). Recurrence might cause more severe symptoms or signs (8/2 612). Pathogens causing the initial infection and recurrence might both belonged to the same-EV71(3/6). Conclusion Recurrence of the disease were closely related to the opportunities of contacting the pathogens. Interventions should be imposed on patients in time as soon as the disease initiated,especially at the younger age.