一起托幼机构手足口病暴发的病原学诊断及其传播途径分析  

Analysis of etiological diagnosis and transmission on hand-foot-mouth disease outbreak in nurseries

作　　者：陈宏标 杨伟康 王金明 

机构地区：[1]深圳市龙华新区疾病预防控制中心,广东深圳518109 [2]深圳市龙华新区妇幼保健中心,广东深圳518109

出　　处：《现代预防医学》2015年第13期2323-2325,2346,共4页Modern Preventive Medicine

摘　　要：目的 了解该托幼机构手足口病暴发的流行特征,明确致病病原体及追溯可能的传播途径,分析防控措施效果,为今后更好的防治和处理手足口病疫情提供科学依据。方法 采用描述性流行病学调查方法对该园手足口病暴发的流行病学特征进行分析,采集患儿所在班级的环境样本（玩具、门把手、毛巾、口杯、水龙头及老师手表面）以及患儿和部分密切接触者咽拭子及粪便标本进行进行COXA16及EV71的RT-PCR检测。结果 该起暴发疫情历时11 d,发病人数共计11人（其中一名为重症手足口病患者）,涉及3个班,罹患率为12.22%,全部患者年龄均在3~4岁之间,男性7例,女性4例;共采集样本66份,其中患儿咽拭子COXA16、EV71阳性率均为36.36%,COXA16＋EV71均阳性的样本有18.18%,粪便标本中检出COXA16阳性率为75.00%,EV71阳性率为25.00%,COXA16＋EV71均阳性的样本有25.00%,密切接触者中咽拭子COXA16阳性率为16.67%,EV71阳性标本未检出,粪便标本COXA16阳性率为75.00%,EV71阳性率为16.67%,环境样本中毛巾及水龙头COXA16的检出率分别为18.18%和33.33%,未检出EV71阳性标本,玩具、门把手、口杯及老师手表面均未检出阳性标本。结论 这是一起以COXA16及EV71为主要病原体引起的手足口病暴发事件,传播媒介可能是毛巾及水龙头。Objective To understand the epidemiological characteristics of hand-foot-mouth disease（HFMD） outbreak in nurseries.To find out the causative pathogens and the possible transmission. To analyze the effect of prevention and control measures. To provide a scientific basis on how to get better prevention and treatment on HFMD. Methods The descriptive epidemiological investigation was carried out to analyze the epidemiological characteristics on the hand-foot-mouth disease outbreak department.We collected the environmental samples, including toys, doorknobs, towels, cups, taps and the teacher surface of hands from classrooms where sick students came, as well as the samples from patients and part of the close contacts, and then used the RT-PCR to detect COXA16 and EV71 by throat swab culture and stool specimens. Results The outbreak lasted for 11 d, with the overall incidence of 11 people（including one with severe infection）, which involved three classes. The attack rate was 12.22%, and all patients were at the age of 3-4, with 7 males and 4 females. 66 samples were collected, in which throat swab culture samples the COXA16 and EV71 positive rates are 36.36%, and the COXA16＋EV71 positive rate is 18.18%. While in stool specimens, the positive rates are 75.00%, 25.00% and 25.00%, respectively. In close contacts, the COXA16 positive rate in throat swab culture is 16.67%.However, the EV71 positive samples are not detected. Meanwhile, COXA16 positive rate in stool specimens is 75.00% and the EV71 positive rate is 16.67%. Among the environmental samples, the COXA16 positive rates of towels and taps are 18.18% and 33.33%,while no EV71 positive samples were detected, and no positive samples found in toys, doorknobs, cups and the teacher surface of hands. Conclusion The main pathogens causing this outbreak of HFMD are COXA16 and EV71, and the possible transmission may be the contaminated towels and taps.

关 键 词：手足口病 暴发 流行病学调查 COXA16 EV71 

分 类 号：R17[医药卫生—妇幼卫生保健]