广州地区手足口病爆发流行的分子流行病学和气象学研究（英文）

Molecular epidemiology and meteorology of hand, foot and mouth disease in Guangzhou during a highly pandemic period

目的手足口病是2~5岁儿童常见的感染性疾病,近年来在亚太地区多次爆发流行,死亡率较高,本研究的目的是分析2008年广州地区爆发流行的手足口病的病毒分子流行病学及其与气象变量之间的关系。方法从互联网收集气象资料,收集466例疑似手足口病患儿的咽拭子标本,扩增人肠道病毒5′端非编码区,PCR产物测序并在Genbank中BLAST分析,分析肠道病毒基因型。结果成功从临床咽拭子标本中扩增了5′-NCR用于基因分型。从466例临床标本中扩增出165例阳性标本,获得12种肠道病毒类型：77例（46.67%）EV-71,37例（22.42%）CVA16,31例（18.79%）CV-A4,20例其它型别。EV-71和CV-A16是本次流行的主要病原。手足口病总发病率与CVA16和EV-71显著相关。手足口病发病率与疾病症状出现前7天的最高气温（P=0.00）、平均温度（P=0.001）和平均湿度（P=0.017）显著相关。结论 5＇-NCR测序是手足口病病原体基因分型和监测的敏感、简单、早期、快速的检测方法,EV-71和CV-A16是本次手足口病爆发的重要肠道病毒。气象变量包括最高温度、平均气温、相对湿度明显与手足口病发病率相关,在时间上滞后一周,这可作为手足口病暴发监测的潜在指标指导卫生决策。

Objective Hand, foot, and mouth disease（HFMD） is of serious concern in the Asia-Pacific region as a result of several major epidemics with high fatality rates in recent years..The relationship between viral molecular epidemiology and meteorology of pediatric HFMD that occurred in Guangzhou,.south China during a highly epidemic period in 2008 was analyzed. Methods Meteorological parameters were collected on internet..Enterovirus genotyping was carried out by amplifying the 5′ non-coding region of human enterovirus,.and the PCR products were sequenced and blasted in Genbank of NCBI. Results The 5′ non-coding region was successfully amplified from clinical throat swab samples for enterovirus genotyping. 466 cases were recruited and 12 types of enterovirus were successfully identified from165 positive clinical cases. There were 77（46.67%） cases of EV-71, 37（22.42%） cases of CV-A16, 31（18.79%）cases of CV-A4,.20 cases of other serotypes. HFMD total positive percentage was significantly related to CV-A16 and EV-71. The total HFMD incidence was obviously related to the maximum temperature（P =0.00）,.average temperature（P=0.001） and average humidity（P=0.017） 7 days prior to the outbreak. Conclusion The 5′ non-coding region PCRsequencing is a sensitive, simple, and early rapid method for HFMD pathogen genotyping and surveillance. EV-71 and CV-A16 were the primary enteroviruses responsible for this HFMD outbreak..Meteorological variables including high temperature,.average temperature and relative humidity one week before were significantly associated with HFMD incidence among children, which can be used as a potential indicator for HFMD outbreak surveillance.