2013-2017年无锡市手足口病流行病和病原学特征分析
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摘要
目的了解无锡市2013-2017年手足口病(HFMD)流行病学及病原学变化特征,为本地区HFMD防控提供科学依据。方法利用2013-2017年疾病监测信息系统报告的HFMD病例进行描述性流行病学分析。同时收集无锡市哨点医院HFMD病例的粪便样本,采用肠道病毒通用(EV)、肠道病毒71型(EV71)和柯萨基病毒A组16型(CA16)荧光定量检测试剂盒进行核酸检测和测序分析。结果无锡市2013-2017年共报告HFMD 82 132例,年均发病率249.32/10万。病例报告以1～3岁发病率最高,且以散童(53.72%)为主。全年有5-7月和11-12月2个发病高峰,重症发生集中在7-8月。2013-2017年病原学监测结果显示,普通病例以EV71(46.08%)和CA16(35.78%)为主,重症病例以EV71(86.45%)为主(P<0.001)。2012-2016年其他肠道病毒以CB5为主,占72.50%;2017年其它肠道病毒以CA6为主,占90.00%。结论无锡市HFMD的发生存在周期性和季节性,呈现每隔1～2年出现1次流行高峰的特点;居住在城乡结合部地区的1～3岁儿童是HFMD的重点防控人群;2017年其他肠道病毒优势株由CB5转为CA6,CA6可能成为继CA16、EV71的另一个其他肠道病毒优势株。
Objective The aim of this study was to explore the epidemiological and pathogenic characteristics of the handfoot-and-mouth disease(HFMD) in Wuxi city, and to provide evidence for prevention and control of the disease. Methods Information of the cases was collected through the Chinese national HFMD surveillance system from 2013 to 2017, and analyzed by descriptive epidemiological methods. Meanwhile, stool samples of HFMD cases were collected from sentinel hospitals for viral nucleic acid detection. Those strains of non-Enterovirus 71 and non-CA16 were sequenced and analyzed by VP1, and then the type of strains was identified by BLAST program. Results 82132 cases of HFMD were reported in Wuxi from 2013 to 2017 and the average annual incidence was 249.32/100000. The incidence rate was the highest in the age group of 1-3 years old and 53.72% of the patients were children at home. There were two seasonal peaks in May-July(spring and summer peak) and November-December(winter peak). The incidence of severe HFMD was highest in July and August. The EV71(46.08%) and CA16(35.78%) were major pathogens for HFMD in Wuxi from 2013 to 2017. EV71(86.45%)accounted for most of the severe cases. CB5 was the main strain of other enteroviruses from 2012 to 2016, accounting for 72.5%,while CA6 in 2017, accounted for 90.0%. Conclusion The incidence of HFMD in Wuxi was periodic with seasonal distribution. It presented the characteristics of one peak every 1 to 2 years. Children aged 1-3 living in urban and rural areas were the key population for HFMD prevention and control. In 2017, the other enterovirus dominant strains changed from CB5 to CA6, and CA6 may become another predominant enterovirus strain following CA16 and EV71.
Objective The aim of this study was to explore the epidemiological and pathogenic characteristics of the handfoot-and-mouth disease(HFMD) in Wuxi city, and to provide evidence for prevention and control of the disease. Methods Information of the cases was collected through the Chinese national HFMD surveillance system from 2013 to 2017, and analyzed by descriptive epidemiological methods. Meanwhile, stool samples of HFMD cases were collected from sentinel hospitals for viral nucleic acid detection. Those strains of non-Enterovirus 71 and non-CA16 were sequenced and analyzed by VP1, and then the type of strains was identified by BLAST program. Results 82132 cases of HFMD were reported in Wuxi from 2013 to 2017 and the average annual incidence was 249.32/100000. The incidence rate was the highest in the age group of 1-3 years old and 53.72% of the patients were children at home. There were two seasonal peaks in May-July(spring and summer peak) and November-December(winter peak). The incidence of severe HFMD was highest in July and August. The EV71(46.08%) and CA16(35.78%) were major pathogens for HFMD in Wuxi from 2013 to 2017. EV71(86.45%)accounted for most of the severe cases. CB5 was the main strain of other enteroviruses from 2012 to 2016, accounting for 72.5%,while CA6 in 2017, accounted for 90.0%. Conclusion The incidence of HFMD in Wuxi was periodic with seasonal distribution. It presented the characteristics of one peak every 1 to 2 years. Children aged 1-3 living in urban and rural areas were the key population for HFMD prevention and control. In 2017, the other enterovirus dominant strains changed from CB5 to CA6, and CA6 may become another predominant enterovirus strain following CA16 and EV71.
引文
[1]李建明,刘映霞,林益敏,等.258例手足口病中枢神经系统并发症的临床特征及预后分析[J].中华实验和临床病毒学杂志,2014,28(4):241-244.
[2]孙军玲,张静.手足口病流行病学研究进展[J].中华流行病学杂志,2009,30(9):973-976.
[3]Zhang Y,Zhu Z,Yang W,et al.An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of hand foot and mouth disease in Fuyang city of China[J].Virology Journal,2010,7:94.
[4]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):34-38,41.
[5]杭惠,夏瑜,陈立凌.2011-2015年苏州市手足口病流行病学特征分析[J].现代预防医学,2016,43(21):3850-3854.
[6]许长沙,朱伟光,郑卫民,等.2008-2014宿迁市年手足口病流行病学及病原学特征分析[J].现代预防医学,2016,43(2):362-365.
[7]张钟,嵇红,洪镭,等.2011-2015年南京市手足口病流行特征及病原学监测分析[J].现代预防医学,2017,44(7):1153-1156,1170.
[8]Liu W,Ji H,Shan J,et al.Spatiotemporal dynamics of hand-footmouth disease and its relationship with meteorological factors in Jiangsu province,China[J].PLOS One,2015,10(6):e0131311.
[9]孙大鹏,王显军,方立群,等.2009年临沂市手足口病流行特征及重症病例危险因素分析[J].中国病原生物学杂志,2011,6(2):108-110.
[10]靳飞虎,徐玉萍,郑亮,等.包头地区儿童手足口病发病率以及患者人群中年龄与病毒分型相关性分析[J].中国保健营养,2017,27(31):238-239.
[11]Ruan F,Yang T,Ma H,et al.Risk factors for hand,foot,and mouth disease and herpangina and the preventive effect of hand-washing[J].Pediatrics,2011,127(4):e898-e904.
[12]张进,史永林,吴家兵,等.安徽省2008-2012年HFMD流行病学及病原学特征分析[J].中华疾病控制杂志,2014,18(6):497-500.
[13]石平,陈婉君,嵇红,等.无锡市手足口病时空聚集性分析及气象因素研究[J].现代预防医学,2016,43(23):4388-4393.
[14]Li YP,Dang SS,Deng HL,et al.Breastfeeding,previous EpsteinBarr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].European Journal of Pediatrics,2013,172(5):661-666.
[15]何春荣,吴水新,何云,等.2011-2013年龙岩市手足口病流行病学及病原学特征分析[J].现代预防医学,2015,42(17):3079-3081,3123.
[16]李洋,张相萍,翟明强,等.2011-2015年安阳地区手足口病相关人肠道病毒B种病原组成及柯萨奇病毒B2、B5 VP1基因特征分析[J].中华微生物学和免疫学杂志,2016,36(6):435-441.
[17]肖红,管大伟,曾汉日,等.2008-2009年广东手足口病非CA16非EV71肠道病毒株的鉴定及其VP1基因分型研究[J].中华微生物学和免疫学杂志,2011,31(9):808-812.
[2]孙军玲,张静.手足口病流行病学研究进展[J].中华流行病学杂志,2009,30(9):973-976.
[3]Zhang Y,Zhu Z,Yang W,et al.An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of hand foot and mouth disease in Fuyang city of China[J].Virology Journal,2010,7:94.
[4]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):34-38,41.
[5]杭惠,夏瑜,陈立凌.2011-2015年苏州市手足口病流行病学特征分析[J].现代预防医学,2016,43(21):3850-3854.
[6]许长沙,朱伟光,郑卫民,等.2008-2014宿迁市年手足口病流行病学及病原学特征分析[J].现代预防医学,2016,43(2):362-365.
[7]张钟,嵇红,洪镭,等.2011-2015年南京市手足口病流行特征及病原学监测分析[J].现代预防医学,2017,44(7):1153-1156,1170.
[8]Liu W,Ji H,Shan J,et al.Spatiotemporal dynamics of hand-footmouth disease and its relationship with meteorological factors in Jiangsu province,China[J].PLOS One,2015,10(6):e0131311.
[9]孙大鹏,王显军,方立群,等.2009年临沂市手足口病流行特征及重症病例危险因素分析[J].中国病原生物学杂志,2011,6(2):108-110.
[10]靳飞虎,徐玉萍,郑亮,等.包头地区儿童手足口病发病率以及患者人群中年龄与病毒分型相关性分析[J].中国保健营养,2017,27(31):238-239.
[11]Ruan F,Yang T,Ma H,et al.Risk factors for hand,foot,and mouth disease and herpangina and the preventive effect of hand-washing[J].Pediatrics,2011,127(4):e898-e904.
[12]张进,史永林,吴家兵,等.安徽省2008-2012年HFMD流行病学及病原学特征分析[J].中华疾病控制杂志,2014,18(6):497-500.
[13]石平,陈婉君,嵇红,等.无锡市手足口病时空聚集性分析及气象因素研究[J].现代预防医学,2016,43(23):4388-4393.
[14]Li YP,Dang SS,Deng HL,et al.Breastfeeding,previous EpsteinBarr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].European Journal of Pediatrics,2013,172(5):661-666.
[15]何春荣,吴水新,何云,等.2011-2013年龙岩市手足口病流行病学及病原学特征分析[J].现代预防医学,2015,42(17):3079-3081,3123.
[16]李洋,张相萍,翟明强,等.2011-2015年安阳地区手足口病相关人肠道病毒B种病原组成及柯萨奇病毒B2、B5 VP1基因特征分析[J].中华微生物学和免疫学杂志,2016,36(6):435-441.
[17]肖红,管大伟,曾汉日,等.2008-2009年广东手足口病非CA16非EV71肠道病毒株的鉴定及其VP1基因分型研究[J].中华微生物学和免疫学杂志,2011,31(9):808-812.
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