2016年杭州手足口病的流行病学研究

Analysis on the epidemiology of hand, foot and mouth disease in Hangzhou in 2016

目的了解2016年杭州手足口病(hand,foot and mouth disease,HFMD)的流行特征,为HFMD防控提供参考。方法回顾总结2016年杭州市儿童医院门诊和住院HFMD病例临床资料,同时调查患儿家庭环境和卫生因素以及密切接触的家庭成员隐性感染情况。结果2016年杭州市儿童医院门诊报告HFMD临床诊断病例14600例,住院病例1492例,病例集中于5~7月份。1492例HFMD住院病例中,肠道病毒(enterovirus,EV)阳性1374例,占92.1%,EV阳性例数中266例(19.36%)为肠道病毒A组71型(enterovirus A group 71 type,EV-A71),151例(10.99%)为柯萨奇病毒A组16型(coxsackievirus A group 16 type,CV-A16),957例(69.65%)为非EV-A71和CV-A16。调查与75名EV-A71阳性患儿有密切接触的家庭成员共108名,其中31份粪便标本EV-A71核酸阳性,占28.7%(31/108)。150例EV阳性的HFMD患儿中生后非母乳喂养54例,占36%(54/150);居住在农村及城乡结合部的有83例,占55.3%(83/150);卫生条件差的有87例,占58%(87/150);家庭中成员数量3人以上的有112例,占74.7%(112/150);主要照顾者文化程度为高中及以下的有90例,占60%(90/150);有幼托儿童家庭中该幼托儿童近期患病的有36例,占64.3%(36/56),未接受HFMD健康教育115例,占76.7%(115/150)。结论2016年杭州市儿童HFMD感染以非EV-A71和CV-A16的其他型EV为优势血清型,家庭因素与HFMD发病和传播可能具有一定相关性。

Objective To investigate the epidemiological characteristics of hand,foot and mouth disease(HFMD)in Hangzhou in 2016,so as to provide evidence for prevention and control of HFMD.Methods The clinical data of HFMD diagnosed in outpatient and inpatient department of Hangzhou Children′s Hospital were retrospectively analyzed.At the same time,we investigated their family health and environment,and whether there was any silent infection among family members who were closely contacted with HFMD cases.Results There were 14600 cases of HFMD diagnosed,including 1492 hospitalized patients in 2016.The peak of cases occurred from May to July.Of the 1492 hospitalized cases of HFMD 1374 were positive for enterovirus,accounting for 92.1%.Of all positive specimens,266 cases were positive for EV-A71,accounting for 19.36%,151 cases were positive for coxsackievirus A16(CV-A16),accounting for 10.99%,and 957 cases were positive for other enterovirus,accounting for 69.65%.A total of 108 family members who had close contact with 75 EV-A71 positive children were investigated.Among them,31 fecal specimens were positive for EV-A71 nucleic acid,accounting for 28.7%(31/108).There were 54 cases of children without breastfeeding,accounting for 36%(54/150),83 children living in rural and suburban areas,accounting for 55.3%(83/150),87 children with poor health conditions,accounting for 58%(87/150),112 families had 3 or more family menbers,accounting for 74.7%(112/150),90 main family caregivers were educated at high school or below,accounting for 60%(90/150),36 families have kindergarten children in family members and he/she was ill at that time,accounting for 64.3%(36/56),115 families had no accepted knowledge of HFMD,accounting for 76.7%(115/150).Conclusions The etiology of HFMD in Hangzhou in 2016 is mainly other enterovirus,and family factors may have certain correlation in the pathogenesis and transmission of HFMD.