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<strong><span style="FONT-SIZE: 12pt; COLOR: blue; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">一、疾病概述 </span><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-comfficeffice" /><o:p></o:p></span></strong><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">手足口病(<span lang=EN-US>Hand, foot and mouth disease, HFMD</span>)是由肠道病毒引起的传染病,多发生于婴幼儿,可引起手、足、口腔等部位的疱疹,个别患者可引起心肌炎、肺水肿、无菌性脑膜脑炎等并发症。引发手足口病的肠道病毒有<span lang=EN-US>20</span>多种<span lang=EN-US>(</span>型<span lang=EN-US>)</span>,柯萨奇病毒<span lang=EN-US>A</span>组的<span lang=EN-US>16</span>、<span lang=EN-US>4</span>、<span lang=EN-US>5</span>、<span lang=EN-US>9</span>、<span lang=EN-US>10</span>型,<span lang=EN-US>B</span>组的<span lang=EN-US>2</span>、<span lang=EN-US>5</span>型,以及肠道病毒<span lang=EN-US>71</span>型均为手足口病较常见的病原体,其中以柯萨奇病毒<span lang=EN-US>A16</span>型(<span lang=EN-US>Cox A16</span>)和肠道病毒<span lang=EN-US>71</span>型(<span lang=EN-US>EV 71</span>)最为常见。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">该病的潜伏期为<span lang=EN-US>2</span>~<span lang=EN-US>7</span>天,传染源包括患者和隐性感染者。流行期间,患者为主要传染源。患者在发病急性期可自咽部排出病毒;疱疹液中含大量病毒,破溃时病毒溢出;病后数周,患者仍可自从粪便中排出病毒。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">该病传播方式多样,以通过人群密切接触传播为主。病毒可通过唾液、疱疹液、粪便等污染的手、毛巾、手绢、牙杯、玩具、食具、奶具以及床上用品、内衣等引起间接接触传播;患者咽喉分泌物及唾液中的病毒可通过飞沫传播;如接触被病毒污染的水源,亦可经水感染;门诊交叉感染和口腔器械消毒不合格亦是造成传播的原因之一。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">人群对引起手足口病的肠道病毒普遍易感,感染后可获得免疫力。由于不同病原型别感染后抗体缺乏交叉保护力,因此,人群可反复感染发病。成人大多已通过隐性感染获得相应抗体,因此,手足口病的患者主要为学龄前儿童,尤以≤<span lang=EN-US>3</span>岁年龄组发病率最高。据国外文献报道,每隔<span lang=EN-US>2</span>~<span lang=EN-US>3</span>年在人群中可流行一次。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 24pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">手足口病分布广泛,无明显的地区性;四季均可发病,以夏秋季高发。本病常呈暴发流行后散在发生;流行期间,幼儿园和托儿所易发生集体感染,家庭也亦可发生聚集发病现象。该病传染性强,传播途径复杂,在短时间内可造成较大规模流行。<span lang=EN-US><o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><b><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: blue; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span></b><b><span style="FONT-SIZE: 12pt; COLOR: blue; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">二、防控措施 </span></b><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">(一)加强医疗机构感染性疾病科工作,做好传染病预检分诊和诊治。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 1</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.根据病例临床特征,结合流行病学史,对手足口病病例进行临床诊断。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">临床特征:急性起病,发热;口腔粘膜出现散在疱疹,米粒大小,疼痛明显;手掌或脚掌部出现米粒大小疱疹,臀部或膝盖偶可受累。疱疹周围有炎性红晕,疱内液体较少。部分患儿可伴有咳嗽、流涕、食欲不振、恶心、呕吐、头疼等症状。该病为自限性疾病,多数预后良好,不留后遗症。极少数患儿可引起脑膜炎、脑炎、心肌炎、弛缓性麻痹、肺水肿等严重并发症。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">了解流行病学接触史有助于病例诊断,包括:当地幼托机构或学校有类似疫情,或病例与类似患者有接触史等。发病对象以学龄前儿童为主。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 2. </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">轻症病例以门诊对症治疗为主。对重症病例(出现神经症状或心血管症状等)应收住院,重点救治。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 3. </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">强化医院感染控制工作,避免院内交叉感染。医院要落实预诊制度,设立发热与疱疹病例专门诊室;重点加强医院产房、儿科病房的消毒,防止新生儿、婴幼儿院内感染而导致严重后果。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">(二)开展疫情监测与流行病学调查,掌握流行动态。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 1</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.加强对托幼机构、学校等重点地区和人群的疫情监测和管理;深入医疗机构及时了解疫情,并鼓励医疗机构主动报告疫情。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 2</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.注意区别手足口病与病毒性脑炎,开展病毒性脑炎等相关疾病的监测与调查,确保流行病学调查的准确性。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 24pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">3</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.手足口病流行地区要在托幼机构及小学加强晨检工作,及时发现病例。发现患有疱疹的患儿,应立即动员家长对其进行家庭隔离治疗,直至病愈方可返校。 <span lang=EN-US><o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 24pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">4</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.托幼机构应每日对玩具、用具等进行清洗消毒,减少间接接触传播。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 5</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.加强食品与环境卫生监督工作,减少手足口病经食品及公共场所传播。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 6</span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">.对新发病人应及时采集标本,进行病原学诊断。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">(三)开展宣传教育与健康促进工作。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">在托幼机构、中小学、医院等场所,开展饭前便后洗手、促进房间通风等相关内容的健康教育;印刷相关宣传品,对群众进行健康知识普及,倡导建立良好的个人卫生习惯;建议家长尽量少让孩子到拥挤公共场所,减少被感染机会。出现发热、出疹等症状及时就诊,及时隔离。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-ALIGN: left; mso-pagination: widow-orphan; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" align=left><span lang=EN-US style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </span><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">(四)做好专业人员培训和考核工作。<span lang=EN-US> <o:p></o:p></span></span></p><p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 24pt; LINE-HEIGHT: 150%"><span style="FONT-SIZE: 12pt; COLOR: black; LINE-HEIGHT: 150%; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">各地应对医疗机构及疾病预防控制机构专业人员进行手足口病防治技术培训。疾病预防控制机构要依法开展对辖区内医疗机构手足口病防治工作的指导和考核。<span lang=EN-US><o:p></o:p></span></span></p> |
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