济南地区2009—2013年手足口病分子流行病学特征

Molecular epidemiologic characteristics of hand,foot,and mouth disease in Ji'nan city,2009-2013

目的对2009—2013年山东省济南地区手足口病(HFMD)的病原及流行特征进行分析,了解HFMD的发病特点及流行趋势,为HFMD防控提供科学依据。方法选取济南地区2009—2013年临床诊断为HFMD的病例为对象,收集各县(市、区)疾病预防控制中心对辖区内发生的HFMD病例的流行病学调查资料,采集患者发病1周内的粪便、咽拭子等标本共计3 792例,采用肠道病毒通用(PE)、肠道病毒71型(EV71)和柯萨奇病毒A组16型(Cox A16)特异性引物通过逆转录聚合酶链式反应(RT-PCR)进行病原学分析;采用SPSS 11.0统计软件对流行病学资料进行统计分析。结果 2009—2013年济南地区3 792例HFMD患者(包括138例重症)标本中,2 843例检测到肠道病毒,阳性率为74.97%;其中1 143例为EV71阳性(40.20%),955例为Cox A16阳性(33.59%),其他肠道病毒(EV)阳性737例(25.92%),EV71和Cox A16混合感染阳性8例(0.28%);138例重症患者的感染病原主要为EV71(86.36%);HFMD患者主要集中于<4岁儿童(82.15%),发病高峰集中于4—5月份(31.70%),肠道病毒阳性检出率与性别无关;5年间呈现出EV71和Cox A16交替流行的态势,病原构成比之间差异有统计学意义(χ2=116.38,P<0.05)。结论山东省济南地区2009—2013年HFM D病原以EV71和Cox A16为主,并交替流行;EV71是引起HFMD重症及死亡病例的主要毒株类型。

Objective To analyze pathogenic characteristics of hand, foot and mouth disease（HFMD） in Ji＇nan city of Shandong province from 2009 through 2013 and to provide evidences for prevention and control of the disease. Meth- otis Specimens including stool and pharynx swabs were collected from 3 792 clinically-diagnosed cases of HFMD （ in- cluding 138 severe cases）in Ji＇ nan city from 2009 through 2013 and epidemiological data on the cases were collected. Reverse transcription PCR（RT-PCR） analysis was used with universal primers within 5＇untranslated region of enterovirus and VP1 region of coxsackievirus A16（CoxA16） and enterovirus 71 （EVT1）to assay the enterovirnses isolated from the HFMD cases. Statistical analysis of epidemiological data was conducted with SPSS 11.0. Results Among the 3 792 specimens from the HFMD cases, the positive rate of enterovirus RNA was 74. 97% （2 843/3 792） ;of the 2 843 entero- virus RNA positive cases,1 143（40. 20% ） were positive for EV71,955（33. 59% ） positive for CoxA16,737（25.92% ） positive for other enteroviruses, and 8 （0. 28% ） positive for both EVT1 and CoxA16. The major pathogen of 138 severe HFMD cases was EV71（86. 36% ）. The majority of HFMD cases were less than 4 years old（82. 15% ） and the high- occurrence season of HFMD was from April to May of a year（ 31.70% ）. The positive rate of enteroviruses was not relat- ed with gender. The dominant prevalence of EV71 and CoxA16 alternated and the constituent ratio of the pathogens was significantly different between the years （χ2 = 116. 38, P 〈 0. 05 ）in Ji＇nan city during the 5-year period. Conclusion The major pathogens of HFMD epidemics were EV71 and CoxA16 and EV71 was a common pathogen of severe HFMD cases in Ji＇nan city from 2009 through 2013.