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目的探讨无锡市托幼机构手足口病(HFMD)聚集性疫情发生的危险因素,为制定托幼机构HFMD防控措施提供科学依据。方法在无锡市469所幼儿园中选择2012—2014年连续发生聚集疫情或暴发疫情(3年内发生频次≥3次)的31所幼儿园作为研究组,按照街道、幼儿园性质、1∶2频数匹配原则,选择同时期同一街道未发生聚集疫情的68家托幼机构作为对照组。采用条件logistic回归分析探讨其危险因素。结果研究组和对照组托幼机构的机构性质、生源、校医基本情况及幼师基本情况差异均无统计学意义(均P>0.05)。多因素分析表明,1~10人使用1个水龙头(OR=0.150,95%CI=0.028~0.789)、缺勤追踪到位(OR=0.071,95%CI=0.011~0.470)及正确处理出现HFMD患儿的教室和午休室(OR=0.029,95%CI=0.001~0.638)是托幼机构HFMD聚集疫情发生的保护因素;和学生数≤349人相比,学生数350~499人(OR=9.622,95%CI=1.374~67.365)和学生数≥500人(OR=19.288,95%CI=2.787~133.477)是托幼机构HFMD流行的危险因素。结论建议托幼机构应根据园内面积控制招收规模,增加人均水龙头设备,做到缺勤追踪到位,正确处理出现HFMD疫情的教室和午休室,以降低托幼机构发生HFMD聚集疫情的风险。
Objective To explore the risk factors of HFMD epidemic in Wuxi kindergarten institutions and to provide a scientific basis for the establishment of HFMD prevention and control measures. Methods A total of 31 nurseries were selected from 469 kindergartens in Wuxi City for consecutive epidemics or outbreaks in 2012-2014 (frequency ≥ 3 times within three years) as research groups. According to the principles of street, kindergarten, 1: 2 frequency matching, Sixty-eight nurseries in the same street were selected as the control group. Logistic regression analysis was used to explore the risk factors. Results There were no significant differences in the nature of institutions, students, school physicians and the basic situation of kindergarten teachers in both study group and control group (all P> 0.05). Multivariate analysis showed that 1 to 10 people used one faucet (OR = 0.150,95% CI = 0.028-0.789), absent place tracking (OR = 0.071, 95% CI = 0.011-0.470) and correct treatment of children with HFMD (OR = 0.029, 95% CI = 0.001-0.638) were the protective factors for HFMD outbreak in kindergartens and nurseries. Compared with 349 students, the number of students was 350-499 (OR = 9.622, 95% CI = 1.374 ~ 67.365) and the number of students ≥500 (OR = 19.288,95% CI = 2.787-133.477) were the risk factors for HFMD prevalence in nurseries. Conclusion It is suggested that nurseries and kindergartens should control the enrollment scale according to the area of the park and increase the per capita faucet equipment so that absences can be traced in place and the classrooms and lunch break rooms with HFMD epidemic can be correctly handled to reduce the risk of HFMD epidemic.