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Title: [Epidemiological characteristics and Spatial-temporal clustering of hand, foot and mouth disease in Shanxi province, 2009-2020].
Author: Ren H, Liu Y, Wang XC, Li MC, Quan DC, Rao HX, Luo TE, Zhao JF, Li GH, Qiu L.
Journal: Zhonghua Liu Xing Bing Xue Za Zhi; 2022 Nov 10; 43(11):1753-1760. PubMed ID: 36444458.
Abstract:
Objective: To analyze the epidemiology and spatial-temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Shanxi province. Methods: The data of HFMD in Shanxi province from 2009 to 2020 were collected from notifiable disease management information system of Chinese information system for disease control and prevention and analyzed by descriptive epidemiology, Joinpoint regression, spatial autocorrelation analysis and spatio- temporal scanning analysis. Results: A total of 293 477 HFMD cases were reported in Shanxi province from 2009 to 2020, with an average annual incidence of 67.64/100 000 (293 477/433 867 454), severe disease rate of 5.36/100 000 (2 326/433 867 454), severe disease ratio of 0.79%(2 326/293 477), mortality of 0.015/100 000 (66/433 867 454), and fatality rate of 22.49/100 000 (66/293 477). The reported incidence rate, severe disease rate, mortality rate and fatality rate of HFMD showed decreasing trends. The main high-risk groups were scattered children and kindergarten children aged 0-5. The incidence of HFMD had obvious seasonal variation, with two peaks every year: the main peak was during June-July, the secondary peak was during September-October and the peak period is from April to November. A total of 13 942 laboratory cases were confirmed, with a diagnosis rate of 4.75% (13 942/293 477), including 4 438 (35.11%, 4 438/293 477) Enterovirus A71 (EV-A71) positive cases, 4 609 (33.06%, 4 609/293 477) Coxsackievirus A16 (CV-A16) positive cases, and 4 895 (31.83%, 4 895/293 477) other enterovirus positive cases. There was a spatial positive correlation (Moran's I ranged from 0.12 to 0.58, all P<0.05) and the spatial clustering was obvious. High-risk regions were mainly distributed in Taiyuan in central Shanxi province, Linfen and Yuncheng in southern Shanxi province, and Changzhi in southeastern Shanxi province. Spatial-temporal scanning analysis revealed 1 the most likely cluster and 8 secondary likely clusters, of which the most likely cluster (RR=2.65, LLR=22 387.42, P<0.001) located in Taiyuan and Jinzhong city, Shanxi province, including 12 counties (districts), and accumulated from April 1, 2009 to November 30, 2018. Conclusions: There was obvious spatial-temporal clustering of HFMD in Shanxi province, and the epidemic situation was in decline. The key areas were the districts in urban areas and the counties adjacent to it. Meanwhile, the monitoring and classification of other enterovirus types of HFMD should be strengthened. 目的： 分析山西省手足口病流行特征及时空聚集性特征。 方法： 资料来源于中国疾病预防控制信息系统传染病报告信息管理系统2009-2020年山西省手足口病数据，运用描述流行病学方法、Joinpoint 回归、空间自相关分析和时空扫描对山西省手足口病进行分析。 结果： 山西省2009-2020年共报告手足口病病例293 477例，年均报告发病率为67.64/10万（293 477/433 867 454），重症率为5.36/10万（2 326/433 867 454），重症比例为0.79%（2 326/293 477），死亡率为0.015/10万（66/433 867 454），病死率为22.49/10万（66/293 477）。手足口病报告发病率、重症率、死亡率和病死率均呈下降趋势。主要的高发人群为0~5岁散居儿童和托幼儿童。手足口病发病存在明显的季节性变化，每年有两个发病高峰，主高峰为6-7月，次高峰为9-11月，高发期为4-11月。实验室共确诊病例13 942例，确诊率为4.75%（13 942/293 477），其中肠道病毒A71型（EV-A71）阳性4 438例（35.11%，4 438/293 477），柯萨奇病毒A16型（CV-A16）阳性4 609例（33.06%，4 609/293 477），其他肠道病毒阳性4 895例（31.83%，4 895/293 477）。山西省手足口病存在空间正自相关（Moran's I值介于0.12~0.58，均P<0.05）即存在空间聚集性，高值聚集区主要分布在山西省中部太原市、南部临汾市、运城市和晋东南地区长治市。时空扫描探测到1个一类聚集区和8个二类聚集区，其中一类聚集区（RR=2.65，LLR=22 387.42，P<0.001）位于山西省太原市和晋中市，包括12个县（区），聚集时间为2009年4月1日至2018年11月30日。 结论： 山西省2009-2020年手足口病存在明显的时空聚集性，疫情总体呈下降趋势，重点区域为地级市的市中心所在区及与其相邻县（区），应加强对手足口病其他肠道病毒监测及型别区分。.

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