2007-2010年上海市静安区儿童手足口发病情况分析和病原学研究

Etiological study of hand,foot and mouth disease among children in Jing'an District in Shanghai,2007-2010

目的分析上海市静安区2007-2009年手足口病发病情况,并分析2009-2010年静安区监测点儿童手足口病病原型别及肠道病毒71型(enterovirus 71,EV71)VP1区基因特征。方法分析上海市静安区2007-2009年手足口病流行概况;收集2009年4月～2010年12月辖区内儿童医院、幼托机构手足口病患儿咽拭标本,并进行实时荧光RT-PCR检测,确定手足口病病原型别。选择2010年不同月份共19份(含1份重症病例)EV71 PCR阳性标本,接种Vero细胞进行病毒分离培养,并设计特异引物对EV71 VP1全序列进行核苷酸序列测定、比对,构建系统发生树。结果 2008年静安区手足口病发病率明显增高,2009年发病数稳中略降,病例以发生在幼托机构为主。2009年病例咽拭标本实时荧光RT-PCR检测结果显示,柯萨奇病毒A组16型(coxsackievirus A16,CoxA16)阳性率为51.0%(52/102),EV71阳性率为15.7%(16/102),其他肠道病毒属阳性率2.9%(3/102);2010年CoxA16和EV71阳性率均为31.3%(36/115),其他肠道病毒属阳性率10.4%(12/115)。19株EV71分离株与2008年安徽阜阳EV71分离株同属C基因型中的C4a亚型,核苷酸同源性达95.0%～97.1%,氨基酸同源性为95.1%～98.3%。结论静安区手足口病发病率2008年明显增高,2009年发病数稳中略降。2009-2010年静安区手足口病主要病原体为EV71和CoxA16,其他肠道病毒属引起的手足口病有所增加,需加强对其他肠道病毒属的鉴定。

Objective To investigate the epidemiological characteristics of hand-foot-mouth disease （HFMD） in Jing＇ an District, 2007-2009, find out the pathogenic spectrum of children＇ s HFMD and genetic characteristic of human enterovirus 71 （ EVT1 ） VP1, 2009-2010. Methods An epidemiological survey was done to the HFMD eases, in Jing＇an District, 2007-2009. Real-time RT-PCR was used to detect human enterovirus, EV71 and Coxsackievirus A16 （CoxA16） in throat swabs from HFMD eaeses in children＇s hospital and several kindergartens in Jing＇ an District. EVT1 was isolated in Vero cell line from some positive swabs of 2010, then complete VP1 of EV71 isolates were amplified and sequenced by specific primers. The VPI sequences of isolates were compared with sequences of reference EV71 strains from GeneBank by homogeneity and phylogenetic tree analyses. Results The HFMD morbidity in Jing＇ an District was higher in 2008 than 2007, and was relatively stable with a slightly decrease in 2009. Most cases occurred in the kindergarten. 102 throat swabs were collected in 2009, including 51.0% （52/102） of CoxA16, 15.7% （16/102） of EV71, and 2.9% （3/102） of other enterovirus. 115 throat swabs were collected in 2010, including 31.3% of CoxA16 and the same rate of EVT1, and 10.4% of other enteroviruses. 19 isolates of EVT1 （ including 1 from severe cases） were similar with the isolates from Fuyang, Anhui Province in 2008, which were belonged to the genotype CAa. The nucleotide homogeneity was up to 95.0%- 97.1% , and the amino acid homogeneity was up to 95.1% -98.3%. Conclusions The HFMD morbidity in Jing＇ an District was higher in 2008 than 2007, and was relatively stable with a slightly decrease in 2009. The main pathogens of HFMD in Jing＇ an District were EVT1 and CoxA16, 2009-2010, but the HFMD caused by other enterovirus was increasing in 2010. More attention should be paid to identify the other enteroviruses.