北京市入托体检健康儿童肠道病毒71型和柯萨奇病毒A组16型感染状况及就诊行为调查

Infection status of enterovirus 71 and coxsackievirus A16 among children receiving health examination for child care setting entrance in Beijing and their related medical care seeking ;practice

目的：了解北京市入托儿童肠道病毒71型（EV71）和柯萨奇病毒A组16型（Cox A16）感染状况及其相关的就诊率，为估算手足口病疾病负担参考。方法2013年8月20－31日对北京市东城区、朝阳区和怀柔区进行入托体检的健康儿童开展血清学调查，采用ELISA方法检测血清中EV71和Cox A16的IgG和IgM抗体。结果共调查813名儿童，平均年龄为（3.5＆#177;1.0）岁。Cox A16 IgG阳性率为61.9%，IgM阳性率为4.4%；EV71 IgG阳性率为9.3%，IgM阳性率为1.1%；各种抗体阳性率在不同性别中的分布差异无统计学意义（P＞0.05），在不同年龄组中的分布差异有统计学意义（P＜0.05）。Cox A16抗体阳性者中7.8%有皮疹，EV71抗体阳性者中10.7%有皮疹。Cox A16或EV71抗体阳性者中，仅7.1%在父母陪伴下到医院就诊，而有皮疹的抗体阳性病例中，80.5%去医院就诊。结论北京市健康入托儿童中，既往感染Cox A16的比例较大，EV71抗体阳性率明显低于Cox A16，提示托幼儿童对EV71普遍易感，应是手足口病防控重点人群。

Objective To understand the infection status of enterovirus 71（EV71） and coxsackievirus A16（Cox A16） among children receiving health examination for child care setting entrance in Beijing and their related medical care seeking practice and provide evidence for the estimation of disease burden caused by hand foot and mouth disease（HFMD）. Methods Serological survey was conducted in the local children receiving health examination for child care setting entrance. Enzyme-linked immunosorbent assay （ELISA） was conducted to detect anti-EV71 and anti-Cox A16 IgG and IgM. Results A total of 813 children were surveyed（mean age：3.5＆#177;1.0 year old）. The seropositive rate was 61.9%and 4.4%for anti-Cox A16 IgG and IgM. The seropositive rate was 9.3% and 1.1% for anti-EV71 IgG and IgM. No significant difference was observed in sex specific seropositive rate （P〉0.05）. However,significant differences were found in seropositive rate among different age groups（P〈0.05）. Among the children who were anti-Cox A16 positive, 7.8%had ever had rashes on their hands and feet,mouth or buttocks（HFMD-like rashes）. Among the children who were anti-EV71 positive,10.7%had ever had HFMD-like rashes. For the children who were anti-Cox A16 or anti-EV71 positive,only 7.1% were brought to see doctors by their parents. However,among the seropositive children with rashes,80.5% were brought to see doctors. Conclusion In the healthy children at the age to go to child care setting in Beijing,most had ever infected with Cox A16. The anti-EV71 positive rate was much lower than the anti-Cox A16 positive rate. It was necessary to strengthen the prevention and control of EV71 infection in child cares settings.