湖南省2008—2017年手足口病病原学与流行特征分析

Epidemiology and etiology of hand, foot and mouth disease in Hunan province,2008-2017

目的分析湖南省2008—2017年手足口病的流行特征和病原谱的构成与变化,为完善手足口病防控策略和疫苗研发提供依据。方法采用描述性流行病学方法对手足口病监测资料和病原学检测结果进行分析。使用实时荧光定量PCR方法对手足口监测病例标本进行肠道病毒核酸检测与分型。用RD和Hep-2细胞对肠道病毒核酸检测阳性标本进行病毒分离,阳性分离毒株采用RT-PCR方法对VP1编码区扩增并进行核苷酸序列测定和分析。结果湖南省2008—2017年共报告手足口病例1255530例,其中重症病例10097例,死亡394人。年均发病率为190.38/10万。报告发病率呈上升趋势,重症数和死亡数呈下降趋势。发病曲线呈一大一小的双峰分布,发患者群以5岁以下儿童的散居儿童和幼托儿童为主。肠道病毒A组71型(enterovirus A71,EV-A71)、柯萨奇病毒A组16型(coxsackievirus A16,CV-A16)和非EV-A71、CV-A16的其他EV阳性标本分别占实验室诊断病例的33.29%,20.04%和46.67%。结论是湖南省手足口病流行有明显季节性和人群性。重症和死亡病例中EV-A71为优势病原体。不同年份有不同优势病原体引起手足口病流行,2008—2012年主要为EV-A71和CV-A16,2013年后,非EV-A71和非CV-A16的其他肠道病毒开始成为优势病原体。

Objective To understand the epidemiologic characteristics and pathogen spectrum of hand,foot and mouth disease (HFMD) in Hunan Province during 2008-2017 and provide the basis for the prevention and control strategy of hand,foot and mouth disease.Methods Collecting data from national disease reporting information system throughout 2008_2017,the descriptive epidemiological method were used to analyze the data of HFMD monitoring and the result of pathogenic agent detection.Results A total of 1,255,530 HFMD cases were reported throughout 2008-2017,including 10097 severe cases and 394 deaths.The average annual attack rate is 190.38/100,000.The peak incidence of HFMD occurred in summer and fall.The reported incidence is on the rise.The number of critically ill and the number of deaths is declining.Proportion of male cases was higher than that of females.The majority of the children were those under 5 years of age.Enterovirus (EV)-A71,coxsackievirus (CV)-A16 and other other EV positive cases accounted for 33.29%,20.04% and 46.67% of laboratory diagnosed cases.Conclusions The epidemic of hand,foot and mouth disease in Hunan has obvious seasonal and population characteristics.There are different dominant pathogens causing HFMD in different years.