青岛市健康幼儿及监护人手足口病隐性感染及相关因素分析

信雪苓; 张洪梅; 纪乾鹏; 贾静; 王春辉

doi:10.16835/j.cnki.1000-9817.2024140

青岛市健康幼儿及监护人手足口病隐性感染及相关因素分析

doi: 10.16835/j.cnki.1000-9817.2024140

信雪苓¹,
张洪梅²,
纪乾鹏³,
贾静^1, ,,
王春辉^4, ,

1.
山东省青岛市疾病预防控制中心/青岛市预防医学研究院传染病防制所，266033
2.
青岛市崂山区疾病预防控制中心应急管理和传防科
3.
平度市疾病预防控制中心传染病防制科
4.
青岛市市北区疾病预防控制中心

基金项目:

山东省医药卫生科技发展计划项目 202112070250

详细信息

作者简介:
信雪苓(1990-)，女，山东济宁人，硕士，主管医师，主要从事传染病预防与控制方面工作

通讯作者:
贾静，E-mail：sdjiajing_1986@163.com

王春辉，E-mail：wch011321@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R181.3⁺2 R193
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出版历程
- 收稿日期: 2024-02-27
- 修回日期: 2024-03-21
- 网络出版日期: 2024-05-30
- 刊出日期: 2024-05-25

Analysis of recessive infection of hand, foot and mouth disease and associated risk factors among healthy children and guardians in Qingdao

1.
Department of Infectious Disease Prevention and Control, Qingdao Centre for Disease Control and Prevention/Qingdao Institute of Prevention Medicine, Qingdao (266033), Shandong Province, China

摘要

摘要: 目的了解青岛市不同流行期健康幼儿及监护人的手足口病隐性感染率及相关因素，为手足口病预防控制提供依据。方法采用整群随机抽样的方法，在2022年非流行期选择青岛市崂山区和平度市城镇和农村托幼机构各1所共4所托幼机构健康幼儿及监护人546份肛拭子样本作为研究对象，2023年流行期抽取市北区、崂山区和平度区城镇和农村托幼机构共6所，采集健康幼儿及监护人肛拭子样本690份，并开展问卷调查，采用Logistic回归分析手足口病隐性感染的相关因素，采用优势分析方法探讨相关因素对隐性感染影响的相对重要性。结果健康幼儿和监护人隐性感染率流行期分别为18.84%和13.62%，非流行期分别为9.09%和4.44%。多因素Logistic回归分析结果表明，居住于农村地区(OR=4.71，95%CI=2.57~8.61)和监护人隐性感染(OR=18.62，95%CI=7.45~46.56)的健康幼儿手足口病隐性感染风险较高，饭前/便后洗手(OR=0.09，95%CI=0.04~0.20)、独用毛巾(OR=0.17，95%CI=0.07~0.40)、接种EV71疫苗(OR=0.42，95%CI=0.20~0.87)的健康幼儿手足口病隐性感染风险较低(P值均<0.05)；使用公用厕所(OR=3.02，95%CI=1.50~6.09)和每季度1次晾晒被褥(OR=3.89，95%CI=1.75~8.68)的监护人手足口病隐性感染风险较高，良好的住房采光(OR=0.31，95%CI=0.12~0.79)和餐具消毒(OR=0.31，95%CI=0.15~0.65)的监护人手足口病隐性感染风险较低(P值均<0.05)。优势分析结果显示，监护人隐性感染对健康幼儿手足口病隐性感染影响相对最重要(41.51%)，餐具消毒对监护人隐性感染(28.87%)影响相对最重要。结论青岛市健康人群中手足口病隐性感染情况较为普遍，幼儿流行期隐性感染率较高，监护人在幼儿隐性感染中起重要作用。应针对重点人群加强健康教育，尤其是提高家长的防控意识，减少幼儿及监护人手足口病隐性感染的发生。
- 手足口病 /
- 感染 /
- 回归分析 /
- 法定监护人 /
- 儿童，学龄前
Abstract: Objective To investigate the recessive infection rate of healthy children and guardians in different epidemic periods of hand, foot and mouth disease (HFMD) in Qingdao, analyze the risk factors affecting recessive infection, so as to provide the basis for HFMD prevention and control. Methods In the non-epidemic period of 2022, the random cluster sampling method was used to selected 546 children and guardians from 4 childcare institutions in Laoshan District and Pingdu City. In the epidemic period of 2023, 690 children and guardians were selected from 6 childcare institutions in Shibei District, Laoshan District and Pingdu District. A questionnair survey was conducted in the epidemic period. Logistic regression analysis was used to analyze the factors affecting the recessive infection. Dominance analysis was used to explore the relative importance of the risk factors affecting recessive infection. Results The results showed that the recessive infection rates of healthy children and guardians in the epidemic period were 18.84% and 13.62%, respectively; the recessive infection rates were 9.09% and 4.44% in the non-epidemic period, respectively. The results of multivariate Logistic analysis showed that rural areas (OR=4.71, 95%CI=2.57-8.61) and recessive infection of guardians (OR=18.62, 95%CI=7.45-46.56) were positively correlated with recessive infection of HFMD in healthy children (P<0.05). Washing hands (OR=0.09, 95%CI=0.04-0.20), using towels alone (OR=0.17, 95%CI=0.07-0.40), and EV71 vaccination (OR=0.42, 95%CI=0.20-0.87) were negatively correlated with recessive infection of HFMD in healthy children (P<0.05). Public toilets (OR=3.02, 95%CI=1.50-6.09) and drying bedding once per quarter (OR=3.89, 95%CI=1.75-8.68) were positively correlated with recessive infection of HFMD in healthy guardians. Housing with good lighting (OR=0.31, 95%CI=0.12-0.79), and tableware disinfection (OR=0.31, 95%CI=0.15-0.65) were negatively correlated with recessive infection of HFMD in healthy guardians (P<0.05). The results showed that recessive infection of guardians was relatively the most important for healthy children (41.51%), and tableware disinfection was relatively the most important for recessive infection of guardians (28.87%). Conclusions The recessive infections of HFMD are common among healthy populations in Qingdao, and the recessive infection rate among children during the epidemic period is relatively higher. Guardians play an important role in the recessive infection of healthy children. Therefore, healthy education should be strengthened for key populations, especially to enhance parents' awareness of prevention and control to reduce the occurrence of recessive infections of hand, foot and mouth disease in children and guardians.
- Hand, foot and mouth disease /
- Infection /
- Regression analysis /
- Legal guardians /
- Child, preschool
注释:

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表 1 青岛市健康人群手足口病隐性感染率流行期和非流行期比较

Table 1. Comparison of results of hand, foot and mouth disease recessive infection among healthy people in Qingdao City

人群	城乡	流行期		非流行期		χ²值	P值
人群	城乡	样本量	阳性数	样本量	阳性数	χ²值	P值
健康幼儿	农村	153	48(31.37)	116	18(15.52)	8.98	< 0.01
	城镇	192	17(8.85)	115	3(2.61)	4.61	< 0.01
	小计	345	65(18.84)	231	21(9.09)	10.36	< 0.01
监护人	农村	153	41(26.80)	165	11(6.67)	23.52	< 0.01
	城镇	192	6(3.13)	150	3(2.00)	0.09	0.76
	小计	345	47(13.62)	315	14(4.44)	16.54	< 0.01
合计		690	112(16.23)	546	35(6.41)	28.06	< 0.01
注：()内数字为阳性率/%。

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表 2 青岛市健康幼儿手足口病隐性感染的单因素分析

Table 2. Univariable regression analysis of hand, foot and mouth disease recessive infection in healthy children

变量	选项	人数	感染人数	χ²值
性别	男	172	37(21.51)	1.60
	女	173	28(16.18)
年龄/岁	≤3	87	29(33.33)	15.98^**
	>3	258	36(13.95)
居住地区	农村	153	48(31.37)	28.24^**
	城镇	192	17(8.85)
饭前/便后洗手^a	经常	280	34(12.14)	43.60^**
	一般	65	31(47.69)
吸吮手或玩具	是	69	23(33.33)	11.85^**
	否	276	42(15.22)
饮用生水	是	18	11(61.11)	22.19^**
	否	327	54(16.51)
独用毛巾	是	299	43(14.38)	29.16^**
	否	46	22(47.83)
接种EV71疫苗	是	224	33(14.73)	7.05^**
	否	121	32(26.45)
班级内近2周出现手足口病聚集疫情史	是	58	19(32.76)	8.83^**
	否	287	46(16.03)
监护人隐性感染	是	47	32(68.09)	86.30^**
	否	298	33(11.07)
注：()内数字为感染率/%；**P<0.01。a经常为5次能洗4次以上，一般为5次洗3次或更少。

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表 3 青岛市健康幼儿手足口病隐性感染的多因素Logistic回归分析(n=345)

Table 3. Multivariate Logistic regression analysis of hand, foot and mouth disease recessive infection in healthy children in Qingdao City(n=345)

自变量	分组	β值	标准误	Wald χ²值	OR值(95%CI)	P值
居住地区	农村	1.55	0.31	25.28	4.71(2.57~8.61)	< 0.01
	城镇				1.00
饭前/便后洗手^a	经常	-2.41	0.41	33.89	0.09(0.04~0.20)	< 0.01
	一般				1.00
独用毛巾	是	-1.78	0.44	16.22	0.17(0.07~0.40)	< 0.01
	否				1.00
接种EV71疫苗	是	-0.88	0.38	5.42	0.42(0.20~0.87)	0.02
	否				1.00
监护人隐性感染	是	2.92	0.47	39.14	18.62(7.45~46.56)	< 0.01
	否				1.00
注：a经常为5次能洗4次以上，一般为5次洗3次或更少。

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表 4 监护人手足口病隐性感染的单因素分析

Table 4. Univariable regression analysis of hand, foot and mouth disease recessive infection in guardians

变量	分组	人数	感染人数	χ²值
性别	男	88	8(9.09)	2.06
	女	257	39(15.18)
文化程度	大学及以上	106	5(4.72)	12.95^**
	高中/中专	138	20(14.49)
	初中及以下	101	22(21.78)
人均居住面积/m²	< 15	38	9(23.68)	3.75
	15~<30	171	22(12.87)
	≥30	136	16(11.76)
厕所	公用	76	23(30.26)	22.94^**
	独用	269	24(8.92)
家庭卫生	好	284	28(9.86)	19.34^**
	一般	61	19(31.15)
住房采光	好	315	35(11.11)	19.43^**
	一般	30	12(40.00)
餐具消毒	是	245	20(8.16)	21.41^**
	否	100	27(27.00)
晾晒被褥	每季度1次	83	21(25.30)	12.67^**
	每月1次	98	10(10.20)
	每月3次	164	16(9.76)
近1周曾去人群密集场所	是	94	18(19.15)	3.35
	否	241	29(12.03)
注：()内数字为感染率/%；**P<0.01，住房采光好的标准为居住于平房或楼房楼层为中楼层以上。

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表 5 监护人手足口病隐性感染的多因素Logistic回归分析(n=345)

Table 5. Multivariate Logistic regression analysis of hand, foot and mouth disease recessive infection in guardians(n=345)

自变量	分组	β值	标准误	Wald χ²值	OR值(95%CI)	P值
厕所	公用	1.11	0.36	9.52	3.02(1.50~6.09)	< 0.01
	独用				1.00
住房采光	好	-1.17	0.48	5.98	0.31(0.12~0.79)	0.01
	一般				1.00
餐具消毒	是	-1.17	0.37	9.80	0.31(0.15~0.65)	< 0.01
	否				1.00
晾晒被褥	每季度1次	1.36	0.41	11.08	3.89(1.75~8.68)	< 0.01
	每月1次	0.32	0.46	0.48	1.38(0.56~3.41)	0.49
	每周3次				1.00

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参考文献(19)

[1]	TSENG F C, HUANG H C, CHI C Y, et al. Epidemiological survey of enterovirus infections occurring in Taiwan between 2000 and 2005: analysis of sentinel physician surveillance data[J]. J Med Virol, 2007, 79(12): 1850-1860. doi: 10.1002/jmv.21006
[2]	HUANG C C, LIU C C, CHANG Y C, et al. Neurologic complications in children with enterovirus 71 infection[J]. N Engl J Med, 1999, 341(13): 936-942. doi: 10.1056/NEJM199909233411302
[3]	中国疾病预防控制中心病毒病预防控制所. 手足口病预防控制指南(2009版)[EB/OL]. (2012-03-20)[2024-02-25]. https://ivdc.chinacdc.cn/jbkz/jsfa/201203/t20120320_58800.htm. National Institute for Viral Disease Control and Prevention, China CDC. Guidelines for the prevention and control of hand-foot-and-mouth disease (2009 edition)[EB/OL]. (2012-03-20)[2024-02-25]. https://ivdc.chinacdc.cn/jbkz/jsfa/201203/t20120320_58800.htm.
[4]	张元元, 王建醒, 袁璐, 等. 山东省2017-2021年手足口病流行病学特征及病原学监测分析[J]. 病毒学报, 2023, 39(2): 453-459. https://www.cnki.com.cn/Article/CJFDTOTAL-BDXB202302017.htm ZHANG Y Y, WANG J X, YUAN L, et al. Epidemiological characteristics and etiology of HFMD cases in Shandong Province, China, from 2017 to 2021[J]. Chin J Virol, 2023, 39(2): 453-459. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BDXB202302017.htm
[5]	贾静, 孙大鹏, 王显军, 等. 2014年山东省青岛市201例手足口病重症病例经济负担调查[J]. 疾病监测, 2016, 31(8): 703-706. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201608023.htm JIA J, SUN D P, WANG X J, et al. Investigation on economic burden caused by severe hand-foot-mouth disease in Qingdao City of Shandong Province, 2014[J]. Dis Surveill, 2016, 31(8): 703-706. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201608023.htm
[6]	LIU W, WU S, XIONG Y, et al. Co-circulation and genomic recombination of coxsackievirus A16 and enterovirus 71 during a large outbreak of hand, foot, and mouth disease in Central China[J]. PLoS One, 2014, 9(4): e96051. doi: 10.1371/journal.pone.0096051
[7]	JIA J, KONG F, XIN X, et al. Epidemiological characteristics of hand, foot and mouth disease outbreaks in Qingdao, 2009-2018[J]. Iran J Public Health, 2021, 50(5): 999-1008.
[8]	占华剑, 柯昌文. 全球手足口病流行现状及分子流行病学研究进展[J]. 华南预防医学, 2011, 37(5): 34-38. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201105008.htm ZHAN H J, KE C W. Global epidemic status and molecular epidemiological research progress of hand, foot and mouth disease[J]. South Chin J Prev Med, 2011, 37(5): 34-38. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201105008.htm
[9]	向伦辉, 袁国平, 杨兴堂, 等. 手足口病患儿和健康儿童家庭成员肠道病毒感染情况及影响因素[J]. 中国学校卫生, 2018, 39(7): 1063-1065. doi: 10.16835/j.cnki.1000-9817.2018.07.030 XIANG L H, YUAN G P, YANG X T, et al. Risk of enterovirus between hand, foot and mouth disease among family members of infected and healthy children in Baoshan District of Shanghai[J]. Chin J Sch Health, 2018, 39(7): 1063-1065. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.07.030
[10]	李亮, 许可, 祁贤, 等. 儿童手足口病影响因素病例对照研究[J]. 中国公共卫生, 2011, 27(1): 16-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201101007.htm LI L, XU K, QI X, et al. Risk factors of hand-foot-and-mouth disease among children: a case-control study[J]. Chin J Public Health, 2011, 27(1): 16-18. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201101007.htm
[11]	侯万里, 赵志广, 符霞, 等. 深圳市幼儿园儿童手足口病发病影响因素分析[J]. 中国公共卫生, 2017, 33(11): 1615-1619. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201711019.htm HOU W L, ZHAO Z G, FU X, et al. Influence factors of hand, foot and mouth disease incidents among kindergarten children in Shenzhen[J]. Chin J Public Health, 2017, 33(11): 1615-1619. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201711019.htm
[12]	XIN X, HU X, ZHAI L, et al. The effect of ambient temperature on hand, foot and mouth disease in Qingdao, China, 2014-2018[J]. Int J Environ Health Res, 2023, 33(11): 1081-1090. doi: 10.1080/09603123.2022.2072818
[13]	CHENG Q, BAI L, ZHANG Y, et al. Ambient temperature, humidity and hand, foot and mouth disease: a systematic review and Meta-analysis[J]. Sci Total Environ, 2018, 625: 828-836. doi: 10.1016/j.scitotenv.2018.01.006
[14]	陈霞, 姜文国, 颜丙新, 等. 泗水县手足口病不同流行期健康人群肠道病毒带毒状况调查[J]. 华南预防医学, 2013, 39(3): 36-37. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201303009.htm CHEN X, JIANG W G, YAN B X, et al. Investigation of enterovirus carrying status in healthy population of hand, foot and mouth disease during different epidemic periods in Sishui County[J]. South Chin J Prev Med, 2013, 39(3): 36-37. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201303009.htm
[15]	莫礼峰, 王兰, 任燕, 等. 深圳市春秋两季健康人群手足口病病原隐性感染调查[J]. 现代医药卫生, 2012, 28(12): 1916-1917. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201212102.htm MO L F, WANG L, REN Y, et al. Investigation on recessive infection of hand, foot and mouth disease pathogens among healthy population during spring and autumn in Shenzhen City[J]. J Mod Med Health, 2012, 28(12): 1916-1917. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201212102.htm
[16]	姜文国, 丁淑军, 高中静, 等. 手足口病流行期健康儿童及其监护人肠道病毒带毒状况调查[J]. 中国病原生物学杂志, 2011, 6(11): 857-860. https://www.cnki.com.cn/Article/CJFDTOTAL-ZISC201111020.htm JIANG W G, DING S J, GAO Z J, et al. Investigation of the prevalence of enterovirus carriers among healthy children and their guardians during HFMD outbreaks[J]. J Pathog Biol, 2011, 6(11): 857-860. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZISC201111020.htm
[17]	康宁, 谭毅, 闭福银, 等. 广西壮族自治区南宁市50例非手足口病幼儿肠道病毒感染状况分析[J]. 疾病监测, 2010, 25(9): 682-683, 690. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201009005.htm KANG N, TAN Y, BI F Y, et al. Inapparent infection of enteroviruses in 50 children in Nanning[J]. Dis Surveill, 2010, 25(9): 682-683, 690. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201009005.htm
[18]	ZHANG D, LI Z, ZHANG W, et al. Hand-washing: the main strategy for avoiding hand, foot and mouth disease[J]. Int J Environ Res Public Health, 2016, 13(6): 610. doi: 10.3390/ijerph13060610
[19]	TENG S, WEI Y, ZHAO S Y, et al. Intestinal detoxification time of hand-foot-and-mouth disease in children with EV71 infection and the related factors[J]. World J Pediatr, 2015, 11(4): 380-385. doi: 10.1007/s12519-015-0045-z