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Incidence trendency and epidemiological characteristics of scarlet fever in Guangdong Province,1950-2011

YANG Fen,ZHONG Hao-jie,HONG Teng,ZHANG Jin-qing,LIN Wen-qing.Guangdong Provincial Center for Disease Control and Prevention,Guangzhou 511430,China  
Objective To analyze the incidence trends and epidemic characteristics of scarlet fever in Guangdong Province during 1950-2011 and provide evidence for preventing and controlling scarlet fever.Methods Descriptive statistical analysis was performed on epidemiological data of scarlet fever during 1950-2011 obtained from Guangdong Diseases Reporting Information System.Results A total of 15 581 cases were reported to the Guangdong Notifiable Disease Database during 1950-2011 with the annual incidence ranging between 0 to 49.00/100 000.There are four epidemic stages: Distributed Period(1950-1973,the average annual incidence was 0.12/100 000),Outbreak Period(1974-1987,the average annual incidence was 15.16/100 000),Low-level Epidemic Period(1988-2003,the average annual incidence was 1.68/100 000) and Epidemic Rebound Period(2004-2011,the average annual incidence was 4.82/100 000).The incidence of scarlet fever in Guangdong appeared two seasonal peaks: the first peak(autumn peak) increased since September and reached the summit between November to January(the constituent ratio is 35.4%);the second peak(spring peak) is lower than the first peak which increased since March and reached the summit between April to June(the constituent ratio is 28.9%).The two peaks were almost in accordance with the school fall semester and spring semester,respectively.A total of 3 large outbreaks were reported in key areas of Guangdong.The first outbreak occurred in Shantou City in 1974 when 1 712 cases were reported(the incidence was 484.02/100 000) and children under 15 years of age accounted for 90.5% of all cases.Ten years later,the second outbreak occurred in the same city in 1984 when 360 cases were reported(the incidence was 80.62/100 000) and children under 15 years of age accounted for 91.4% of all cases.The third outbreak occurred in Zapo Town of Yangjiang County in 1987 when 690 cases were reported,children between 5 to 9 years old accounted for 14.6% of all cases.The incidence of scarlet fever in Guangdong rebounded in 2004-2011 and the top four cities for 2011 were Shenzhen(758 cases),Guangzhou(265 cases),Foshan(117 cases) and Dongguan(109 cases).The reported cases of these four cities in 2011 were higher than the average annual cases in 2004-2010 respectively and the biggest surge was in Shenzhen(increased by 422.7%).Compared with 2004-2010,the constituent ratio for preschoolers increased in 2011,but that for students declined(P0.01).Conclusion The fluctuation pattern of the epidemic for scarlet fever in Guangdong Province during 1950 to 2011 is that high incidence period alternated with low incidence one.Each period lasted about 15 to 20 years.The epidemic rebounded since 2004 and increased obviously especially in 2011 which showed that it would remain the epidemic period for the next several years in the province.Childcare facilities and schools should be the focus of prevention and control for scarlet fever in the future.
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