手足口病患儿和健康儿童家庭成员肠道病毒感染情况及影响因素

Risk of enterovirus between hand foot and mouth disease among family members of infected and healthy children in Baoshan District of Shanghai

目的了解手足口病患者家庭密切接触者和健康儿童家庭成员肠道病毒隐性感染状况及危险因素,为手足口病的科学防治提供参考。方法选取2016—2017年上海市宝山区手足口病实验室确诊病例76例,按照1∶1的比例选取健康儿童,入户调查病例家庭密切接触者及健康儿童家庭成员人口学信息、居住环境、卫生习惯等,采集粪便(或肛拭子)标本,采用荧光定量PCR检测病原体,比较两者肠道病毒感染情况并分析影响因素。结果 76例病例的179名家庭密切接触者检出肠道病毒阳性45名,检出率为25.14%;76名健康儿童共168名家庭成员检出肠道病毒阳性9名,检出率为5.36%,差异有统计学意义(χ~2=25.81,P<0.01)。病例家庭密切接触者中,病例的兄弟姐妹阳性率较高(55.56%),父母次之(25.78%),外/祖父母最低(16.67%),差异有统计学意义(χ~2=6.05,P<0.05);与手足口病患儿接触时间≥6 h/d的阳性率(34.44%)高于接触时间<6 h/d(15.73%),差异有统计学意义(χ~2=8.33,P<0.01)。人均居住面积≤15m^2(OR=2.727,95%CI=1.329~5.593)、近1周内去过人群密集场所(OR=6.055,95%CI=2.432~15.074)为肠道病毒隐性感染的危险因素,经常晾晒床上用品(OR=0.015,95%CI=0.003~0.080)为感染保护因素。结论手足口病密切接触者带病毒率高,需加强手足口病密切接触者的管理和宣传教育。

Objective To understand of risk of hand,foot and mouth disease（ HFMD） among family close contacts of infected and healthy children and to provide the basis for HFMD prevention and control.Methods Confirmed cases of HFMD from Baoshan district,onset in Jan 2016 to Dec 2017,were matched with 1 ∶ 1 healthy children from the same area.Family members of the HFMD cases and healthy children were investigated with information on demographic information,living environment and health related behaviors.The stool or anal swabs of all members were detected by real-time RT-PCR.The enterovirus infection rates were compared.Results Among the 76 cases,45 of 179（ 25.14%） family close contacts were enterovirus positive,compared with 9 of168（ 5.36%） family members of healthy children.The positive rate was highest among brothers and sisters of infected children（ 55.56%）,followed by parents（ 25.78%） and grandparents（ 16.67%）（ χ^2= 6.05,P = 0.048）.The positive rates among family members close contact with cases for more than 6 h per day was highest（ 34.44%） than those spent 6 h per day（ χ^2= 8.33,P =0.004）.Enterovirus infection risk among family members closely contact with HFMD cases correlated with living area less than 15 m^2（ OR = 2.727,95%CI： 1.329-5.593）,been to crowded places within a week（ OR = 6.055,95%CI： 2.432-15.074）,while frequent sun drying mattress（ OR = 0.015,95% CI： 0.003-0.080） showed protective effect.Conclusion The enterovirus infection risk among family members closely contact with HFMD infected children can＇t be ignored.Management and health education should be strengthened among family close contacts with HFMD cases.