摘要
目的对2009—2016年上海市手足口病(hand,foot and mouth disease,HFMD)哨点医院——复旦大学附属儿科医院及闵行区辖区社区卫生服务中心送检的手足口病病例标本进行实验室检测分析,探讨手足口病在本地区的病原学构成及流行病学特征,为手足口病的综合防治提供依据。方法收集2009—2016年复旦大学附属儿科医院及社区卫生服务中心送检的手足口病病例咽拭、粪便、肛拭标本,应用real-time RT-PCR技术检测肠道病毒通用型(Echo viruses,EV)、肠道病毒71型(EV71)、柯萨奇病毒A组16型(Coxsackie virus A16,CVA16)、柯萨奇病毒A组6型(CVA6)、柯萨奇病毒A组10型(CVA10),并分析病原体分布特征。结果共收集到手足口病病例3 744例,病原学检测发现3 176例肠道病毒检测阳性,阳性检出率高达84.83%。其中EV71和CVA16分别占64.45%和15.77%,其次是CVA6和其他肠道病毒,分别占9.23%和8.78%,CVA10检出率仅0.76%,主要病原体为EV71病毒。不同年份和不同季节的优势毒株呈现动态变化;2009年以EV71和CVA16共同流行为主;2010—2011年以EV71流行为主;2012年呈现EV71和CVA16共同流行趋势,以EV71为主;2013年以EV71和其他EV共同流行为主;2014年之后CVA6逐渐增多,至2015和2016年主要以CVA6流行为主;特别是2016年,CVA6所占比例范围高达40.55%。CVA10呈零星散发趋势,占比极低。病例人群男性高于女性(1.68∶1),主要发病年龄为5岁以下的婴幼儿,病例集中在1~3岁低幼年龄组,手足口病发病高峰主要集中在4~7月,其次是9~11月。结论手足口病主要发病季节呈现夏季和秋冬季的双峰流行模式;多发于5岁以下儿童;男性发病率高于女性;不同年份和不同季节的优势毒株呈现动态变化,其流行具有明显的年龄和季节性特征。
Objective To investigate the etiological agents of the outbreak of hand,foot and mouth disease（HFMD）in Minhang District of Shanghai from 2009 to 2016,and to provide evidence for the prevention and management policy of HFMD by collecting suspected HFMD samples for laboratory testing from HFMD sentinel hospitals,the Children＇s Hospitals of Fudan University and jurisdiction community health service centers. Methods Specimens including stools,throat swabs and anal swabs were collected from patients suspected of HFMD from surveillance hospitals,i.e.,Children＇s Hospital of Fudan University and jurisdiction community health service centers during 2009 and 2016.The specimens were detected by real-time RT-PCR with the five types of viruses including panenterovirus（EV）,enterovirus 71（EV71）,Coxsackie virus A16（CVA16）,Coxsackie virus A6（CVA6） and Coxsackie virus A10（CVA10）.The distribution characteristics of pathogens were analyzed. Results During 2009 and 2016 we collected 3 744 cases of HFMD,the positive detection rate of pan-enterovirus were 84.83%（3 176 cases）,including EV71（64.45%）and CVA16（15.77%）,then were CVA6（9.23%）and other EV（8.78%）,and CVA10 was only 0.76%.The major etiological agent was EV71.The advantage of different years and different season strain presented dynamic change,mainly EV71 and CVA16 co-popular in 2009,mainly EV71 epidemic from 2010 to 2011,EV71 and CVA16 were co-popular again in 2012,and the priority was EV71,then EV71 and other EV were co-popular in 2013.After 2014,CVA6 gradually increased,mainly CVA6 was popular 2015 and 2016,especially in 2016,the proportion of CVA6 ranged as high as 40.55%.CVA10 showed sporadic distribution trend in very low proportion.From the difference of age and gender in HFMD cases,the males were more than the females（1.68∶1）,and the incidence was the highest in children of 1-3 years old.The peak of incidence occured in April to July,then in September to November. Conclusions HFMD onset seasons mainly were summer and fall-and-winter in bimodal popular models.It happens in children under 5 years of age.The incidence was higher in male than in female.The advantage of different years and different season strains present dynamic change,and the prevalence has obvious age and season limit.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2017年第5期602-607,616,共7页
Fudan University Journal of Medical Sciences
基金
上海市第四轮公共卫生三年行动计划高端海外研修团队计划(GWTD2015S05)
上海市研究生教育创新计划~~
