2010-2013年湖南省手足口病病原学监测结果分析  

Etiology surveillance of Hand-Foot-Mouth Disease in Hunan Province,2010-2013

作　　者：张斯钰[1] 黄威[1] 罗垲炜[1] 张红[1] 高立冬[1] 陈雨[1] 邓志红[1] 周帅锋[1] 张帆[1] 胡世雄[1] 

机构地区：[1]湖南省疾病预防控制中心传染病预防控制科,湖南长沙410005

出　　处：《现代预防医学》2015年第9期1677-1679,1686,共4页Modern Preventive Medicine

基　　金：中华预防医学会公共卫生应用研究与疫苗可预防疾病科研项目(20101801;湖南省手足口病流行特征和重症病例危险因素研究);湖南省科学技术厅科技计划(2011FJ3137;湖南省手足口病可控危险因素及干预技术研究)

摘　　要：目的分析2010-2013年湖南省手足口病(HFMD)病原学监测结果,为HFMD防控提供科学依据。方法在湖南省所有县(市、区)连续收集手足口病病例的咽拭子、粪便等标本,应用RT-PCR技术检测肠道病毒71型(EV71)、柯萨奇病毒A组16型(Cox A16)、非EV71和Cox A16的其他肠道病毒(EV)。结果 2010-2013年共收集HFMD标本31 341份,检出阳性19 423份,阳性率为62.0%,EV71、Cox A16、其他EV和混合感染所占比例依次为40.7%、18.8%、39.4%和1.1%。湖南省HFMD病原谱的构成2010年和2012年以EV71为主(52.4%和55.9%),2011年EV71、Cox A16和其他EV所占比例相当,分别占34.3%、34.2%和31.4%,2013年以其他EV为主(67.3%)。多部位采样的阳性率最高(83.8%),单一部位采样的阳性率从大到小依次为粪便(78.3%)、疱疹液(70.8%)、肛拭子(67.6%)和(鼻)咽拭子(55.0%)。轻症、重症和死亡病例的标本阳性率依次为59.8%、73.4%和91.2%,其中EV71的构成比依次为34.8%、66.2%和89.1%。不同性别病例的病原谱构成差异无统计学意义。结论湖南省手足口病的主要病原体在2010-2013年间发生了改变,EV71是引起手足口病重症和死亡病例的主要毒株类型。为提高手足口病实验室诊断率,提倡对病例多部位联合采样。Objective To analyze the etiology surveillance results of Hand-Foot-Mouth Disease （HFMD） in Hunan between 2010 and 2013, and provide scientific evidences for the control and prevention of HFMD. Methods Throat-swabs and stool specimens were collected continuously from all over counties in Hunan. The nucleic acids of enterovirus 71 （EV71）, coxsackievirus A16 （Cox A16） and other enteroviruses （EVes） were detected by real-time RT-PCR. Results We collected 31341 specimens of HMFD between 2010 and 2013. 19423 specimens were detected with positive results, accounting for 62.0%. The proportions with positive results of EVT1, Cox A16, other EVes and mixed infection were 40.7%, 18.8%, 39.4% and 1.1%, respectively. HFMD pathogens spectrum of 2010 and 2012 in Hunan was mainly EV71, accounting for 52.4% and 55.9%, respectively. The proximate proportions of EV71, Cox A16 and other Eves in 2011 were 34.3%, 34.2% and 31.4%, respectively. In 2013, HFMD pathogens spectrum was mainly other Eves, accounting for 67.3%. Multi-location sampling had the highest positive rate of 83.8%, followed by single sampling from stool （78.3%）, idoxuridine （70.8%）, anal swab （67.6%） and nasopharyngeal swab （55.0%）. The positive rates of mild, severe and fatal cases were 59.8%, 73.4% and 91.2%, respectively, and the EV71 proportions of mild, severe and fatal cases were 34.8%, 66.2% and 89.1%, respectively. There was no significant difference between males and females about pathogens proportion. Conclusion The main pathogen of HFMD in Hunan Province had changed during 2010-2013 and EV71 was the main strain leading to severe cases and fatal cases. Multi-location sampling should be advocated to improve laboratory diagnostic rate of HFMD.

关 键 词：手足口病 逆转录-聚合酶链反应 肠道病毒71型 柯萨奇病毒A组16型 

分 类 号：R117[医药卫生—公共卫生与预防医学]