2009-2016年三峡水库库区与非库区手足口病流行病学和病原学特征分析

Epidemiological and etiological characteristics of hand foot and mouth disease in reservoir and non-reservoir areas of three gorges area in China, 2009–2016

目的了解三峡地区库区、非库区手足口病流行特征及其影响因素,识别重点防控问题,为制定手足口病防控策略提供依据。方法利用《传染病报告信息管理系统》中报告的2009-2016年三峡地区手足口病监测数据,对库区、非库区监测数据进行描述性分析并进行比较。结果 2009-2016年三峡地区库区年均发病率为145.66/10万,报告重症比例为0.19%,报告病死率为0.045%;非库区年均发病率为78.42/10万,重症比例为0.28%,报告病死率为0.05%。库区发病率显著高于非库区,库区重症比例显著低于非库区(χ^2=28.732,P<0.01)。库区与非库区报告病死率差异无统计学意义(χ^2=0.876,P=0.349)。库区重症病例以肠道病毒71型(EV71)(79.17%)占绝对优势,非库区重症由EV71(47.37%)和其他肠道病毒(35.34%)共同主导;库区轻症病例以其他肠道病毒构成(37.83%)最高,非库区轻症病例也以EV71构成(41.19%)最高。结论 2009-2016年三峡库区手足口病报告发病率高于非库区,但库区重症比例低于非库区,库区与非库区重点发病人群均为3岁及以下儿童,库区和非库区手足口病病原构成存在差异。提示三峡地区手足口病防控应重点关注病原变化,采取EV71疫苗接种及综合性措施保护重点人群,降低总体发病率。

Objective To understand the epidemiological and pathogenic characteristics of hand foot and mouth disease(HFMD) and influence factors in the reservoir area and non-reservoir area in three gorges area, and provide evidence for the development of prevention and control strategies of HFMD. Methods The HFMD surveillance data in these areas from 2009 to 2016 were collected from National Notifiable Infectious Disease Reporting Information System for a descriptive epidemiologic analysis, the results in reservoir area and non-reservoir area were compared. Results From 2009 to 2016, the average annual morbidity rate of HFMD was 145.66/100 000, the proportion of severe cases was 0.19%, and the reported case fatality rate was 0.045% in reservoir area. The average annual morbidity rate of HFMD was 78.42/100 000, the proportion of severe cases was 0.28%, and the reported fatality rate was 0.05% in non-reservoir area. The reported morbidity rate of HFMD in reservoir area was higher than that in non-reservoir area. The proportion of severe cases in reservoir area was lower than that in non-reservoir area(χ^2=28.732, P<0.01). There was no significant difference in reported case fatality rate between reservoir area and non-reservoir area(χ^2=0.876, P=0.349). The pathogen causing severe cases was mainly EV71(79.17%) in reservoir area, while the pathogen causing severe cases were mainly EV71(47.37%) and other enterovirus(35.34%) in non-reservoir area. Other enteroviruses(37.83%) were more common in mild cases in reservoir area, while EV71(41.19%) was more common in mild cases in non-reservoir area too. Conclusion From 2009 to 2016, the reported morbidity rate of HFMD in reservoir area was higher than that in non-reservoir area in three gorges area, but the severe case rate in the reservoir area was lower than that in the non-reservoir area. The cases were mainly children aged ≤3 years in both reservoir and non-reservoir areas. There was difference in pathogen condtituent of HFMD between reservoir area and non-reservoir area. It is suggested that the prevention and control of HFMD should be focused on the pathogen changes, and EV71 vaccination and comprehensive measures should be taken to protect the population at high risk to reduce the overall incidence of HFMD in three gorges area.