东莞市一起CoxA_(16)病毒引起的幼儿园手足口病爆发疫情调查

Investigation of An Outbreak of Hand,Foot and Mouth Disease Caused by CoxA_(16) Virus in A Kindergarten in Dongguan City

目的分析一起由CoxA16病毒引起的幼儿园手足口病爆发疫情的流行病学调查与处理结果,为有效预防控制幼儿园手足口病提供科学依据。方法对幼儿园发病儿童进行流行病学和临床特征的调查;并采集住院病例咽拭子、粪便标本,进行肠道病毒核酸RT-PCR检测。结果本次疫情发病8例,涉及3个班,罹患率为1.49%。所有患儿均小于5岁。与首发病例同楼层班级和其它楼层班级之间学童罹患率的差别有统计学意义(P<0.05)。患儿主要的临床症状是口腔、手、足部的疱疹,其中2名患儿有发热。检测了3例住院患儿的粪便、咽拭子标本,COXA16核酸均为阳性,EV71核酸均为阴性。通过采取隔离传染源、切断传播途径和保护易感人群的控制措施21 d后,确认疫情终止。结论CoxA16肠道病毒是导致本次幼儿园手足口病爆发的病原。年龄小于5岁、在同教室内与患儿密切接触可能是本次手足口病发病的危险因素。提高对手足口病的认识,严格执行晨午检筛查制度、消毒隔离制度及疫情报告制度可有效预防幼儿园手足口病。

Objective To investigate the epidemiological characteristics of an outbreak of the hand, foot and mouth disease （HFMD） in a kindergarten, and to provide scientific evidence for the effective prevention and control of HFMD. Method The patients＇ epidemiological and clinical characteristics were investigated. Stool and throat swabs were collected to identify the pathogen by RT-PCR. Result Eight children from 3 different classrooms were found infected with the attack rate of 1.49%. All patients were less than 5 years old. The attack rate of children from the first floor was higher than the other floors （P〈0.05）. Major clinical symptoms were observed in mouth, foot and hands, and two children had a fever. Stool and throat swabs of three hospitalized patients were tested, in which the CoxA16 nucleic acid was detected. EV71 nucleic acid was not found. 21 days after the implementation of the disease prevention measures （e.g. controlling the source of infection, cutting off the route of transmission and protecting susceptive population）, the outbreak was end. Conclusion The causative agent causing HFMD was identified as CoxA16. Age （〈5） and close contact with patients were the risk factors for this incidence of outbreak. The key points of controlling of HFMD are disease monitoring of the children in the morning, isolation of the infected patients, strengthening the disinfection program of public facilities in the kindergarten and early disease notification to the health authority.