烟台市2010-2015年手足口病核酸检测及病原学分析

Enterovirus DNA test and etiological analysis of patients with hand-foot-mouth disease in Yantai City, Shandong Province,China during 2010 ~ 2015

目的对烟台市2010~2015年手足口病(hand-foot-mouth disease,HFMD)病例进行核酸检测及病原学分析。方法在2010~2015年烟台各县市区临床诊断的HFMD病例(包括门诊轻症病例和住院重症病例)中,每月采集5例首次就诊的普通病例及所有重症和死亡病例的咽拭子标本,RT-PCR法进行肠道病毒(enterovirus,EV)核酸检测。结果 2010~2015年烟台市HFMD病例年均报告发病率68.68/10万,重症病例占0.36%,男女性别比例为1.81∶1,发病以低于5岁幼儿为主,占91.22%,每年5~8月为发病高峰。病原谱构成差异有统计学意义(P<0.01),其中EV71型769例,占30.95%,柯萨奇病毒A16型(coxsackievirus A16,Cox A16)814例,占32.76%,其他EV型902例,占36.30%。HFMD病原体以EV71和Cox A16交替为主,其中重症患者的主要致病原为EV71(52.54%)。结论烟台市2010~2015年EV71、Cox A16和其他EV交替为HFMD病例的主要病原体,HFMD的发病存在明显季节、性别、年龄差异,重症病例的主要致病原为EV71,应加强对该型别的监测,防控工作重点为托幼机构及小学低年级儿童。

Objective To perform enterovirus（EV） DNA test and etiological analysis on the patients with hand-footmouth disease（HFMD） in Yantai City, Shandong Province, China during 2010 - 2015. Methods Throat swabs were collected from five common patients with HFMD who visited the medical institutions for the first time in each month, from all the patients with severe HFMD and from the patients who died from the disease in Yantai City during 2010 - 2015,and tested for EV DNA by RT-PCR. Results The annual average incidence rate of HFMD in Yantai City during 2010 -2015 was 68. 68 / 100 000, of which the severe cases accounted for 0. 36%. The ratio of male to female patients was1. 81 ∶ 1. A portion of 91. 22% of the cases appeared in the children at ages of less than 5 years. The peak incidence of the disease appeared from May to August every year. There were significant differences in the composition of pathogen spectrum（P〈0. 01）. Of the cases, 769（30. 95%）were caused by EV71, while 814（32. 76%）by coxsa-ckievirus A16（Cox A16）, and 902（36. 30%）by other EV types. The main pathogens of HFMD in Yantai were EV71 and Cox A16.However, 52. 54% of severe cases were caused by EV71. Conclusion EV71, Cox A16 and EV of other types were the dominant pathogens of HFMD in Yantai during 2010 - 2015. The incidences of HFMD were significantly different in various seasons and in the population of both genders and at various ages. However, the main pathogen of severe cases was EV71 on which the monitoring should be strengthened. HFMD prevention and control work should focus on the children in kindergarten and lower grade pupils.