2012-2016年扬州市手足口病流行病学和基因特征分析

Study on epidemiological and pathogenic characteristics of hand, foot, and mouth disease in Yangzhou city from 2012 to 2016

目的了解扬州市2012-2016年手足口病流行病学及病原学变化特点，为本地区防控手足口病提供科学依据。方法收集2012-2016年中国疾病监测信息系统报告的手足口病病例，对其流行特征进行分析；收集扬州市哨点医院手足口病病例样本，进行病毒核酸检测。结果扬州市2012-2016年共报告手足口病35720例，年均发病率为155．30／10万（35720／2300万），男女性别比为1．54：1，重症构成比为1．60％。（56／35720），死亡病例2例。病例以5岁以下儿童为主，占91．83％（32800／35720）。职业分布以散居儿童（60．18％，21498／35720）为主，其次为托幼儿童（35．93％，12834／35720）。全年均可发病，发病高峰主要集中在每年5至7月和10至12月；其中2012、2014和2016年发病率较高，2013和2015年发病率较低。2012-2016年病原学监测结果显示，普通病例柯萨奇病毒A16型（CoxA16）占33．28％（432／1298），肠道病毒71型（EV71）占28．58％（371／1298），其他肠道病毒占38．14％（495／1298）；重症病例主要以EV71（76．79％，43／56）为主，且重症病例EV71阳性率高于普通病例（1．05％，13／1242），差异有统计学意义（χ^2=66．62，P〈0．01）。结论扬州市手足口病的发生存在明显季节性及性别、年龄、职业、地区差异，且疫情呈现高发年与低发年交替的规律，病原主要为CoxA16、EV71，重症病例以EV71为主。应根据发病规律加强对手足口病流行病学和病原学监测，尤其是对EV71的监测，预防重症病例的出现。

Objective To explore the epidemiological and pathogenic characteristics of the hand, foot and mouth disease （HFMD） in Yangzhou city from 2012 to 2016, so as to provide evidences for prevention and control of the disease. Methods Information of the cases was collected by the Chinese national HFMD surveillance system from 2012 to 2016, and was analyzed by descriptive epidemiological methods. Meanwhile, samples of HFMD cases were collected for viral nucleic acid detection from Sentinel hospitals. Results 35 720 cases of HFMD were reported in Yangzhou from 2012 to 2016 and the average annual incidence was 155.30/100 000 （35 720/23 000 000）, the male-to-female ratio of ordinary cases was 1.54 ： 1 and the percentage of severe cases was 1.60%o （56/35 720）. There were 2 fatal cases. Children of 〈5 years old were the most susceptible to HFMD （91.83%, 32 800/35 720）. Most of the patients were the scatter children （60.18%, 21 498/35 720） and the children in kindergartens and nursery schools （35.93%, 12 834/35 720）. There were two peaks in May-July and October-December. The incidences were high in 2012, 2014 and 2016, and were low in 2013 and 2015. Coxsackievirus A16 （Cox A16） （33.28%, 432/1 298） and enterovirus 71 （EV71） （28.58%, 371/1 298） were the major pathogens for HFMD in Yangzhou from 2012 to 2016. EV71 accounted for most of the severe cases （76.79%, 43/56）. The positive rate of EV71 among severe cases （1.05%, 13/1 242） was significantly higher than that of ordinary cases （χ^2=66.62, P〈0.01）. Conclusions There were significant seasonal and gender, age, occupation and regional differences in the occurrence of HFMD in Yangzhou. The cases showed an alternating trend of high and low incidence peaks in different years. Meanwhile, Cox A16 and EV71 were the major pathogens for HFMD, and EV71 was more common among severe cases. Epidemiology and etiological surveillance of HFMD should be enhanced according to the rules above, especially for the monitoring of EV71.