2019—2020年湖南省手足口病流行特征和病原学特征研究

Epidemic and etiological characteristics of hand-foot-mouth disease in Hunan Province, 2019-2020

目的分析2019—2020年湖南省手足口病的监测数据,掌握手足口病流行特征及病原变化情况,为手足口病防控策略的制定提供依据。方法对中国疾病预防控制信息系统中2019—2020年湖南省手足口病监测资料进行描述性流行病学分析,应用实时荧光聚合酶链式反应检测手足口病临床诊断病例标本中的肠道病毒71型(EV71)、柯萨奇病毒A组16型(CVA16)和其他肠道病毒。结果2019年湖南省共上报手足口病病例97110例,发病率为140.76/10万;2020年报告手足口病病例114400例,发病率为165.35/10万;2020年发病数较2019年上升15.1%,发病率较2019年上升14.9%;两年手足口病发病呈现单峰流行,2019年顶峰发生在6月,2020年则在10月达到顶峰;发病率较高的地区主要为湘中和湘西地区(如长沙市、湘西自治州与湘潭市);主要发病人群为5岁以下的散居儿童,男女比为1.27∶1;2019年湖南省共报告手足口病聚集性疫情168起,2020年共报告276起,2020年较2019年增加64.3%,两年合计报告444起,其中发生在幼托机构的有200起,占44.9%,发生在社区的有244起,占55.1%;两年共采集标本12398份,阳性标本7222份,总阳性率为58.2%;阳性样本中EV71型39份(0.5%)、CVA16型874份(12.1%)、其他肠道病毒型6306份(87.3%),在其他肠道病毒中,检测到CA6型159份(2.5%)、CA10型14份(0.2%)、CA4型10份(0.2%)和未分型6123份(97.1%),其他肠道病毒中未分型病毒成为湖南省2019—2020年的优势型别;不同年份(χ^(2)=486.38,P<0.001)、地区(χ^(2)=229.89,P<0.001)和年龄(χ^(2)=128.44,P<0.001)手足口病病原谱构成差异有统计学意义,2019年与2020年不同病例类型手足口病病原谱构成差异无统计学意义(χ^(2)=4.56,P>0.05;χ^(2)=2.36,P>0.05)。结论2019—2020年湖南省手足口病的流行具有明显季节性和区域性,5岁以下儿童是手足口病防控的重点人群,病原谱中其他肠道病毒构成比最高,需重点加强散居儿童的健康教育及病原学监测工作,及时掌握手足口病病原谱变化情况。

Objective To understand the epidemic features of hand-foot-mouth disease(HFMD)and virus changes of pathogens by analyzing the monitoring data of HFMD in Hunan Province from 2019 to 2020,and to provide a basis for formulating prevention and control strategies for HFMD.Methods Descriptive epidemiological analysis was conducted based on the HFMD surveillance data in Hunan Province in 2019-2020 collected from China Information System for Diseases Prevention and Control.Fluorescent quantitative RT-PCR was used to detect EV71,CVA16 and other enteroviruses in specimens of clinically-diagnosed HFMD cases.Results A total of 97,110 HFMD cases were reported in Hunan Province in 2019,with an incidence rate of 140.76/100,000.114,400 cases of HFMD were reported in 2020,with an incidence rate of 165.35/100,000.The number and the incidence rate of HFMD cases in 2020,as compared with those in 2019,increased by 15.1%and 14.9%,respectively.And the incidence of HFMD showed a unimodal prevalence,with the peak occurring in June in 2019 as well as in October in 2020.The high incidence was mainly in central and western Hunan(like Changsha City,Xiangxi Autonomous Prefecture and Xiangtan City).The main population of the disease was scattered children under 5 years old,and the ratio of male to female was 1.27:1.A total of 276 clusters of HFMD cases were reported in Hunan Province in 2020,which showed an increase of 64.3%compared with 168 cases in 2019.A total of 444 clusters of HFMD cases were reported during 2019-2020,of which 200(44.9%)cases occurred in child-care institutions,and 244(55.1%)cases in communities.A total of 12,398 HFMD specimens were collected,among which 7,222 were positive,with a total positive rate of 58.2%.The composition of pathogens in the positive samples was as follows:39 samples with EV71(0.5%),874 with CVA16(12.1%)and 6,306 with other enteroviruses(87.3%).Among the samples detected with other enteroviruses,there were 159(2.5%)samples tested positive for CA6,14(0.2%)for CA10,10(0.2%)for CA4,and 6,123(97.1%)for untyped enteroviruses,which became the dominant type in Hunan Province in 2019-2020.There were statistically significant differences in the composition of pathogens from HFMD in different years(χ^(2)=486.38,P<0.001),regions(χ^(2)=229.89,P<0.001)and ages(χ^(2)=128.44,P<0.001).But no statistically significant difference was found in the composition of pathogens among different type cases of HFMD between 2019 and 2020(χ^(2)=4.56,P>0.05;χ^(2)=2.36,P>0.05).Conclusion The prevalence of HFMD in Hunan Province in 2019-2020 showed obvious seasonal and regional characteristics.Children under 5 years old were the key population for HFMD prevention and control.Other enteroviruses became the dominant pathogen.It is crucial to strengthen health education and pathogen monitoring of scattered children,and take control of the changes of HFMD pathogen in time.