肠道病毒A组71型疫苗接种对广州市肠道病毒A组71型手足口病发病影响分析  

Effectiveness of enterovirus A71 vaccination on the incidence of enterovirus A71 associated hand,foot and mouth disease in Guangzhou

作　　者：陈纯[1] 李意兰[1] 蔡文锋[1] CHEN Chun;LI Yilan;CAI Wenfeng(Guangzhou Municipal Center for Disease Control and Prevention,Guangzhou,Guangdong 510440,China)

机构地区：[1]广州市疾病预防控制中心,广东广州510440

出　　处：《中国病毒病杂志》2024年第2期130-134,共5页Chinese Journal of Viral Diseases

基　　金：广东省医学科学技术研究基金项目(B2020005);广州市科技计划项目(2023A03J0938)。

摘　　要：目的了解肠道病毒A组71型(enterovirus A71,EV-A71)疫苗推广使用后广州地区EV-A71手足口病发病情况变化,为手足口病防控提供参考依据。方法应用“中国疾病预防控制信息系统”2010—2021年广州市各年度报告的EV-A71型手足口病发病、重症和死亡数据,以2016年EV-A71疫苗接种推广使用作为干预分界线,应用中断时间序列方法(interrupt time series,ITS)及卡方检验综合分析EV-A71疫苗推广使用前后EV-A71型手足口病发病率、重症发病率和病死率变化。结果EV-A71疫苗接种措施实施前后累计EV-A71型手足口病发病率(38.661/10万vs 13.382/10万,χ^(2)=1772.28,P<0.01)、重症发病率(1.616%vs 0.197%,校正χ^(2)=23.958,P<0.01)、病死率(0.307%vs 0.049%,Fisher χ^(2)=4.116,P<0.05),差异均有统计学意义;通过ITS比较实施前后的发病率、重症发病率和病死率,结果显示,实施前后3个指标均呈现下降趋势,但除EV-A71型手足口病重症发病率斜率改变量(β_(1)=-0.666,P<0.01;β_(3)=0.585,P<0.05)差异有统计学意义外,其余指标改变量比较差异均无统计学意义。结论鉴于广州市EV-A71疫苗推广接种以来,EV-A71型手足口病发病率以及重症和死亡发生率都出现下降趋势,所以尽管存在手足口病每年病原体变化以及新型冠状病毒感染疫情等因素的影响,EV-A71疫苗的推广接种在预防手足口病特别是预防重症和死亡方面可能仍然起到了一定效果。Objective To analyze the effectiveness in enterovirus A71(EV-A71)vaccination on the incidence of EV-A71 associated hand,foot and mouth disease(HFMD)in Guangzhou city and to provide the evidence for the prevention and control of HFMD.Methods The annual incidence,severity and death data of EV-A71 associated HFMD reported by the China Disease Prevention and Control Information System in Guangzhou from 2010 to 2021 were applied.The year of 2016 was chosen as the intervention boundary during which the expanding of EV-A71 vaccination was executed.Interrupted time series(ITS)and Chi-square test were used to analyze the morbidity,severe morbidity and mortality of EV-A71 associated HFMD before and after EV-A71 vaccination promotion.Results Chi-square test was used to compare and analyze the cumulative incidence(38.661/100000 vs 13.382/100000,χ^(2)=1772.28,P<0.01),severe morbidity(1.616%vs 0.197%,adjusted χ^(2)=23.958,P<0.01)and mortality(0.307%vs 0.049%,Fisher χ^(2)=4.116,P<0.05)of EV-A71 associated HFMD before and after EV-A71 vaccination,and the differences were statistically significant.ITS analysis of morbidity,severe morbidity and mortality before and after implementation showed that the three indexes had a downward trend,except for the statistically significant change in the slope of severe morbidity of EV-A71 associated HFMD(β_(1)=−0.666,P<0.01;β_(3)=0.585,P<0.05),other changes were not statistically significant.Conclusion Although there are influencing factors such as the changing of HFMD pathogens and the COVID-19 epidemic,the EV-A71 vaccination may play a specific role in preventing HFMD,especially for preventing severe cases and death cases,considering the downward trend of incidence rate,severe and death cases of EV-A71 associated HFMD after the promotion of the EV-A71 vaccination.

关 键 词：手足口病 EV-A71疫苗 发病率 重症 死亡 中断时间序列 广州市 

分 类 号：R186[医药卫生—流行病学]