2010至2013年黄石市手足口病的流行特征及病原学分析

Epidemic features and etiology of hand, foot and mouth disease in Huangshi from 2010 to 2013

目的分析黄石市2010至2013年手足口病的流行病学和病原学特征,为手足口病的防控提供依据。方法利用国家疾病预防控制信息系统,采用描述流行病学方法对黄石市2010至2013年收治的18 011例手足口病监测资料和病原学监测结果进行统计分析,采用实时荧光定量聚合酶链反应方法对3 089例手足口病病例进行肠道病毒核酸检测。结果研究期间黄石市手足口病发病年龄主要集中在0~5岁,占95.40%以上,绝大多数为散居儿童;0~5岁手足口病发病儿童中,男女比例为2.03︰1（12 061/5 950）,男孩显著高于女孩（χ~2=10.91,P〈0.01）。从各城区（县市）发病率曲线图看,城区高于农村县市;每年手足口病流行起于3月份开始,4、5、6月份急剧上升至高峰,随后逐月下降。2012年11~12月份、2013年11~12月份又出现一个轻微的抬升,呈现第二个高峰。实验室诊断病例病原学分析结果显示,2010年手足口病流行以EV71为主,占44.52%;2011年则以Cox A16为主,占76.24%;2012年、2013年再度以EV71为主导,分别占98.99%和91.49%。结论气温和适宜的湿度是手足口病发生与传播的主要原因,流行时间特征与当地气温和湿度密切相关,存在2年为一个流行周期的可能。EV71和Cox A16为黄石市手足口病流行的两种主要病原体,每年引起流行的病原体呈现交替主导的特征。

Objective To analyze the epidemic features and etiology of hand, foot and mouth disease（HFMD） in Huangshi from 2010 to 2013, and to provide scientific basis for making preventive and control measures of HFMD. Methods Total of 18 011 cases collected from the National Disease Surveillance Information Management Program of HFMD were analyzed by descriptive epidemiological method. Nucleic acid of enterovirus genome of 3 089 HFMD cases were detected by real-time RT-PCR. Results Among the reported cases, above 95.40% were children less than 5 years old and the majority（72.09%） of cases occurred in scattered children. There were significantly more cases of HFMD in boys compared with girls（χ~2 = 10.91, P 0.01） in the 0-5 years aged group, and the male-to-female sex ratio was 2.03/1（12 061/5 950）. The incidence rate of HFMD in urban area was higher than that in rural area. HFMD occurred at the begining of March each year. The number of cases increased significantly, with the highest peak in April to June, and then declined each month. There was a slight rise, presenting another peak in November through December in 2012 and 2013. The majority of the pathogen was Coxsackievirus（Cox A16） in 2011 and Enterovirus 71（EV71） was predominant in 2012 and 2013. Conclusions The warmer climate and favorable humidity may be main causes of HFMD spread and transmission, that HFMD epidemics may be colsely related to local temperature and humidity, and may have been shown to occur in 2-year cycles. The major pathogens causing HFMD were EV 71 and Cox A16, presenting an alternating dominant characteristics of the major pathogens.