我国手足口病病原学研究和关键防控技术的建立及推广应用  

Etiological research,development and application of key techniques for the prevention and control of hand,foot and mouth disease in China

作　　者：张勇[1] 杨帆[2] 胡永峰[2] 张燕[1] 檀晓娟[1] 冀天骄 祝双利[1] 杜江[2] 崔爱利[1] 吴志强[2] 张静[3] 薛颖[2] 王显军[4] 邵育晓 张誌 刘中华 许文波[1] ZHANG Yong YANG Fan HU Yong-feng ZHANG Yan TAN Xiao-juan JI Tian-jiao ZHU Shuang-li DU Jiang CUI Ai-li WU Zhi-qiang ZHANG Jing XUE Ying WANG Xian-jun SHAO Yu-xiao ZHANG Zhi LIU Zhong-hua XU Wen-bo(National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China)

机构地区：[1]中国疾病预防控制中心病毒病预防控制所卫生部医学病毒学和病毒病重点实验室,北京102206 [2]中国医学科学院病原生物学研究所,北京100730 [3]中国疾病预防控制中心,北京102206 [4]山东省疾病预防控制中心,山东济南250014 [5]北京贝尔生物工程有限公司,北京102612 [6]北京金豪制药股份有限公司,北京100176 [7]江苏硕世生物科技有限公司,江苏泰州225300

出　　处：《中国病毒病杂志》2017年第2期87-95,共9页Chinese Journal of Viral Diseases

摘　　要：目的开展手足口病(hand,foot and mouth disease,HFMD)病原学和流行病学系统研究,以满足我国对HFMD防控的迫切需求。方法建立并完善覆盖全国范围的HFMD三级实验室监测网络体系,将研制的针对我国HFMD防控所急需的系列组合检测和监测技术推广应用到各省、市级实验室,开展全国范围内的HFMD病原学检测和流行病学监测工作。结果通过连续多年、系统的HFMD病原学和流行病学研究,结果显示,肠道病毒71型(EV-A71)在HFMD病原的构成比例与当地出现重症和死亡病例的多少呈高度正相关;证实C4基因亚型是我国EV-A71引起的HFMD流行的绝对优势本土基因亚型,同时依据C4基因亚型的变异变迁规律,将其进一步划分为C4a和C4b两个进化分支,EV-A71C4a和C4b的更替与2008年之后我国HFMD重症和死亡病例增多密切相关;在此基础上,完成了EV-A71灭活疫苗种子毒株的筛选;同时,阐明了我国HFMD流行特征及规律,揭示了健康人群中EV-A71和CV-A16抗体水平及变化趋势;解析了我国HFMD病原谱构成,发现多种肠道病毒可引起HFMD疫情暴发,且不同年代和地区HFMD病原谱构成存在动态变化。结论本研究是国内外唯一连续多年针对HFMD开展系统病原学监测和研究的项目。对我国HFMD防控,保护我国儿童生命健康有非常重要的科学意义。Objective To systemically study the etiology and epidemiology of hand, foot and mouth disease （HFMD） in China and provide efficient measures for its prevention and control. Methods Based on the es- tablished three-level etiology surveillance laboratory network of HFMD in mainland of China, a series of key techniques for the detection and surveillance of HFMD in the Labnet and the etiological detection and epidemio- logical surveillance were carried out. Results The proportion of EV-AT1 detection in HFMD showed high positive correlation with the number of local severe and fatal HFMD cases. EV-AT1 subtype C4 was the pre- dominant virus that caused the severe and fatal cases of HFMD across the country; subtype C4 can be further divided into C4a and C4b evolutionary branches based on the genetic variation and evolution of EV-A71, and replacement from C4b to C4a was closely related to the increasing number of the severe and fatal cases of HFMD. At the same time, screening of inactive vaccine seed of EV-A71 was also done and the epidemiologie characteristics of HFMD in mainland of China was clarified, and the changing trend of the antibody levels for EV-A71 and CV-A16 among different age groups of healthy population was revealed. In addition, the patho- genic spectrum of HFMD and the corresponding dynamic changes, geographical variances were clarified and many kinds of enteroviruses were found to be associated with HFMD. Conclusions Systemic and dynamic data for HFMD etiology and epidemiology were obtained to guide the prevention and control of this disease in China.

关 键 词：手足口病 肠道病毒A组71型 病原学研究 手足口病病原谱 关键防控技术 

分 类 号：R183[医药卫生—流行病学] R373.2[医药卫生—公共卫生与预防医学]