2013-2014年浙江省奉化市手足口病患者及其密切接触者监测结果分析

Epidemiological characteristics of handfoot and mouth disease cases and close contacts in Fenghua,Zhejiang,2013-2014

目的了解浙江省奉化市手足口病患者及其密切接触者病原分布情况,分析2013-2014年手足口病疫情和病原学监测结果,为手足口病防控提供科学依据。方法每月采集手足口病患者5例及其15名密切接触者粪便标本检测肠道病毒,同时开展住院病例病原学监测,对2013-2014年病原学监测结果和手足口病疫情进行描述性流行病学分析。结果 2013-2014年奉化市手足口病发病率分别为225.99/10万和365.07/10万;街道发病率高于乡镇;发病率最高为1岁组。病例肠道病毒A组71型（EV71）、柯萨奇病毒A组16型（Cox A16）和其他肠道病毒阳性率分别为20.94%、20.42%和38.74%;2013年优势病毒为其他肠道病毒（占61.00%）,2014年为Cox A16和EV71;EV71发病年龄大于其他肠道病毒（Z=-3.70,P=0.00）;肠道病毒阳性病例和阴性病例的密切接触者阳性率分别为48.44%和18.75%,差异有统计学意义;不同病毒阳性病例的密切接触者其他肠道病毒阳性率在44.96%~48.15%之间,差异无统计学意义;病例与密切接触者肠道病毒以同型为主（Kappa值0.53）;1~8岁密切接触者阳性率42.08%,12~66岁密切接触者阳性率31.73%,差异无统计学意义。结论奉化市手足口病处于高流行态势,流动人口密集地区高发。多种病毒流行,优势病毒处于变化中,流行特征与病原体有关,病原监测有助于采取适当的防控措施,必要时应对其他肠道病毒开展进一步分型。密切接触者带病毒率高,应关注密切接触者管理。

Objective To understand the epidemiological and etiological characteristics of handfoot and mouthdisease（ HFMD）in Fenghua,Zhejiang province,from 2013 to 2014,and provide evidence for the prevention and control of HFMD. Methods During 2013 to 2014,the etiological detection of HFMD was carried out each month by using stool samples collected from 5HFMD cases and 15 close contacts. The hospitalized HFMD cases were also included in the etiological detection. Descriptive epidemiological analysis was conducted on the incidence and etiological data of HFMD. Results The average incidence of HFMD during this period was 225. 99 /100 000 and 365. 07 /100 000,respectively. The incidence was highest in age group 1 year（ 13 360. 92/100 000）. The incidencewas higher in the urban area than in rural area. The positive rate of Enterovirus A71（ EVA71）,Coxsackievirus A16（ Cox A16） and other enterovirus was 20. 94%,20. 42% and 38. 74%, respectively. Other enterovirus was predominant in 2013,while EV-A16 and EV-A71 were predominant in 2014. EV-A71 mainly affected older children compared with other enterovirus（ Z =- 3. 70,P = 0. 00）. The etiological positive rate of close contacts of enterovirus positive and negative HFMD were 48. 44% and 18. 75%,respectively,with significant difference. The positive rates of EV among close contacts of different etiological positive cases of HFMD were 44. 96%- 48. 15%,with no statistical significance.The results of etiological detection of HFMD were consistent with the results of the close contacts（ Kappa = 0. 53）. The positive rates of close contacts in age group 1- 8 years and 12- 66 years were 42. 08% and 31. 73%,respectively,with no significant difference. Conclusion The incidence of HFMD was high in Fenghua,Multi viruses spread and the predominant pathgen of HFMD was in change. The epidemiological characters of HFMD was affected by epidemiology of different EV. One of the control measures of HFMD is to strengthen the management of close contacts due to the high positive rate of EV in close contact.