2009-2018年湖南省手足口病病原学特征分析  

Pathogenic characteristics of hand-foot-mouth disease in Hunan Province,2009-2018

作　　者：陈长[1] 赵善露 黄威[1] 罗垲炜[1] 陈雨[1] 湛志飞[1] 高立冬[1] 邓志红[1] 李世康[1] 戴志辉 张帆[1] 周帅锋[1] 胡世雄[1] CHEN Zhang;ZHAO Shan-lu;HUANG Wei;LUO Kai-wei;CHEN Yu;ZHAN Zhi-fei;GAO Li-dong;DENG Zhi-hong;LI Shi-kang;DAI Zhi-hui;ZHANG Fan;ZHOU Shuai-feng;HU Shi-xiong(Hunan Provincial Center for Disease Control and Prevention,Changsha,Hunan 410005,China)

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》2020年第9期1537-1540,1546,共5页Modern Preventive Medicine

基　　金：湖南省自然科学基金科卫联合项目(2019JJ80115,湖南省手足口病动力学模型的建立及应用研究);湖南省卫生计生委科研课题(B2019038,湖南省不同病原手足口病重症病例的临床特征及其危险因素研究);湖南省卫生计生委科研课题(B20190039,湖南省手足口病预测预警模型研究).

摘　　要：目的分析2009-2018年湖南省手足口病(HFMD)病原学变化趋势,为制定HFMD防控策略提供依据。方法收集湖南省各级CDC病原学监测结果,使用实时荧光定量PCR方法对手足口监测病例标本进行肠道病毒核酸检测,采用描述性流行病学方法进行分析。结果 2009-2018年共采集HFMD标本78 856份,总体阳性率为70.0%。EV-A71、CV-A16和其他肠道病毒所占比例分别是29.3%、21.3%和49.4%。湖南省病原谱的构成:2009年优势病原为其他肠道病毒,2010和2012年优势病原为EV-A71(54.1%和56.8%),2011年EV-A71、CV-A16和其他肠道病毒比例相当(分别占34.4%、34.3%、31.3%),2013-2018年均以其他肠道病毒为主(分别为67.3%、41.4%、70.7%、42.5%、71.2%和65.2%)。轻症病例中,2009-2012年优势病原依次为其他肠道病毒、EV-A71、CV-A16、EV-A71,2013-2018年均以其他肠道病毒为主。重症病例中,除了2013、2015、2017和2018年优势病原为其他肠道病毒外,其他年份均以EV-A71为主。EV-A71是死亡病例的优势病原。各年龄组(χ^2=1190.6,P<0.001)、不同性别(χ^2=7.6,P<0.023)病原谱差异有统计学意义。粪便阳性率最高(77.3%),其次为多部位采样(75.8%)、疱疹液(71.2%)、肛拭子(64.8%)、(鼻)咽拭子(55.8%)、其他标本(31.1%)。结论手足口病由肠道病毒多种血清型共同循环引起,2009-2018年湖南省手足口病的优势病原不断变化,2013年以后其他肠道病毒成为优势病原体,EV-A71仍是重症和死亡病例的主要优势病原。建议优先采集粪便标本。Objective To analyze the variation of pathogens of hand-foot-mouth disease(HFMD) in Hunan from 2009 to 2018 for providing appropriate intervention measures for HFMD. Methods Data of etiology surveillance was collected from centers for disease control and prevention at all levels in Hunan Province, the specimens of HFMD cases were detected enterovirus nucleic acid by Real-time RT-PCR, and the descriptive epidemiological method was used to analyze. Results A total of 78856 HFMD specimens were collected from 2009 to 2018. The overall positive rate was 70.0%. The proportions of EV-A71, CV-A16 and other enteroviruses were 29.3%, 21.3% and 49.4%, respectively. The composition of pathogenic spectrum in Hunan Province-The dominant pathogen was other enteroviruses in 2009. In 2010 and 2012, the dominant pathogen was EV-A71(54.1% and 56.8%). In 2011, the proportions of EV-A71, CV-A16 and other enteroviruses were similar(34.4%, 34.3%, 31.3%). The dominant pathogens were other enteroviruses(67.3%, 41.4%, 70.7%, 42.5%, 71.2% and 65.2%, respectively) from 2013 to 2018. In mild cases, the predominant pathogens, in order from 2009 to 2012 were other enteroviruses, EV-A71, CV-A16, EV-A71 and in 2013-2018 other enteroviruses were predominant. In severe cases, EV-A71 was the predominant pathogen except in 2013, 2015, 2017 and 2018, which were the other enteroviruses. EV-A71 was the predominant pathogen of death. There were significant differences in pathogen spectrum between different age groups(χ^2=1190.6, P<0.001) and gender groups(χ^2=7.6, P<0.023). The fecal positive rate was the highest(77.3%), followed by multi-site sampling(75.8%), herpes fluid(71.2%), anal swab(64.8%), pharyngeal swab(55.8%) and other specimens(31.1%). Conclusion HFMD is caused by multiple serotypes of enterovirus circulating together. The dominant pathogens of HFMD in Hunan Province have been changing from 2009 to 2018. After 2013, other enteroviruses have become dominant pathogens. EV-A71 is still the dominant pathogen among severe and death cases. It i

关 键 词：手足口病 肠道病毒 病原学 

分 类 号：R725.1[医药卫生—儿科] R181.3[医药卫生—临床医学]