某高中一起柯萨奇病毒A组6型手足口病暴发疫情的流行病学调查

Epidemiological investigation of one hand-foot-mouth disease outbreak caused by Coxsackie virus A6 in a senior high school

目的了解某高中一起手足口病暴发疫情的流行病学特征，寻找导致该暴发发生的危险因素，同时了解柯萨奇病毒A组6型（CVA6）手足口病的临床表现。方法按照病例定义开展病例搜索。采用统一设计的调查表调查患者一般情况和临床表现，采用病例对照研究分析暴发危险因素。结果该学校从8月17日-9月10Et出现28名病例（24例学生，4例家长），其中23例临床诊断病例，5例实验室确诊病例（检出病原体CVA6）。患者中82．1％（23／28）的病例出现发热症状，64．3％（18／28）的病例体温≥38．5℃；21，4％（6／28）的病例出现皮疹部位疼痛症状；46．4％（13／28）的病例恢复期出现脱皮症状；17．9％（5／28）的病例出现脱甲症状。发病前1周与手足口病患者接触、饭前不洗手是手足口病发病的危险因素。结论患者未及时隔离、与患者密切接触和饭前不洗手是造成疾病蔓延的主要原因。CVA6导致的手足口病患者常出现高热、脱甲、脱皮等非典型手足口病临床症状。

Objective To investigate the epidemiological characteristics and the risk factors of the hand-toot-mouth disease （HFMD） outbreak, and to analyze the clinical manifestations of HFMD caused by Coxsackievirus A6 （CVA6）. Methods The eases were searched according to the case definition for HFMD. The generic information and clinical data of cases were collected through face to face questionnaire survey, and the risk factors of outbreak were analyzed by case-control study. Results Twenty-tree clinically diagnosed cases of HFMD and 5 laboratory-confirmed cases of CVA6 were found from 17th August to 10th September, including 24 students and 4 parents. Of these 28 cases, 23 cases （82. 1%） suffered fever, and 18 cases （64. 3%） had increased body temperature （ ≥38.5℃）. Six cases （21.4%） complained of pain at rash sites. Thirteen cases （46.4%） experienced desquamation at palms and soles during convalescent phases, and 5 cases （ 17.9% ） developed onychomadesis. Contacting with patients one week before onset and not washing hands before meals were the risk factors. Conclusions Delayed quarantine, close contacting with patients and poor hygiene behaviors were the main causes of this outbreak. HFMD patients with CVA6 infection oflen experienced some atypical symptoms, including high fever, desquamation and onyehomadesis.