2013年至2018年大理白族自治州手足口病病原学时空相关性分析

Spatiotemporal correlation analysis of the etiology of hand, foot, and mouth disease in Dali Bai Autonomous Prefecture from 2013 to 2018

目的:通过分析大理白族自治州手足口病患儿柯萨奇病毒A16型(coxsackievirus A16,CoxA16)和肠道病毒71型(enterovirus 71,EV71)的时空分布特征,为手足口病防控提供科学依据。方法:运用实时荧光聚合酶链反应检测2013年1月1日至2018年12月31日大理白族自治州辖区内手足口病患儿的3527份咽拭子或粪便标本,检测病原体为CoxA16和EV71。采用ArcGIS 10和SaTScanv 9.6软件对CoxA16和EV71进行时空相关性分析。结果:3527份病原学标本中,2013年[12.0%(91/758)]、2014年[40.4%(180/446)]、2017年[26.7%(155/581)]均以EV71为优势病原体,2015年[29.9%(162/541)]、2016年[40.0%(219/547)]、2018年[13.8%(90/654)],均以CoxA16为优势病原体;综合2013年至2018年病原体检测数据,CoxA16病原体检出率略高于EV71(χ^2=1128.72,P<0.05)。CoxA16和EV71聚集主要在夏季至秋季。CoxA16呈聚集分布[莫兰指数=0.344,P<0.05],其热点区为祥云县(Z=2.72,P<0.01)和弥渡县(Z=1.68,P<0.1),以祥云县(对数似然比=40.178,P<0.05)为中心,辐射半径为39.00 km;EV71呈离散分布(莫兰指数=-0.194,P>0.05),其热点区在鹤庆县(Z=2.14,P<0.05)、剑川县(Z=1.76,P<0.1)和大理市(Z=1.71,P<0.1),主要聚集区为以洱源县(对数似然比=39.376,P<0.05)为中心,辐射半径为64.21 km。结论:大理白族自治州手足口病病原体CoxA16和EV71存在时空聚集,应加强监测,科学防控疾病。

Objective To analyze the etiological spatialtemporal distribution characteristics of coxsackievirus A16(CoxA16)and enterovirus 71(EV71)in children with hand,foot,and mouth disease(HFMD)in Dali Bai Autonomous Prefecture,and to provide references for its prevention and control.Methods Real-time polymerase chain reaction(PCR)was used to detect the etiology of children with HFMD in Dali Bai Autonomous Prefecture from January 1,2013 to December 31,2018,including CoxA16 and EV71.Spatialtemporal correlation analysis of CoxA16 and EV71 were performed by ArcGIS 10 and SaTScanv 9.6 softwares.Results Among 3527 pathogen samples,EV71 was dominant with 12.0%(91/758)in 2013,40.4%(180/446)in 2014,and 26.7%(155/581)in 2017.CoxA16 was the dominant pathogen with 29.9%(162/541)in 2015,40.0%(219/547)in 2016,and 13.8%(90/654)in 2018.According to the pathogen detection data from 2013 to 2018,the detection rate of CoxA16 pathogen was higher than that of EV71(χ^2=1128.72,P<0.05).CoxA16 and EV71 were aggregated from summer to autumn.CoxA16 was presented with clustered distribution(Moran′s index=0.344,P<0.05),and the hot spots of CoxA16 were Xiangyun County(Z=2.72,P<0.01)and Midu County(Z=1.68,P<0.1).The radius radiates was 39.00 km from the center of Xiangyun County(log likelihood ratio(LLR)=40.178,P<0.05).EV71 was presented with discretely distribution(Moran′s index=-0.194,P>0.05),and the hot spots of EV71 were Heqing County(Z=2.14,P<0.05),Jianchuan County(Z=1.76,P<0.1)and Dali City(Z=1.71,P<0.1).The main gathering area was the radiation radius of 64.21 km centered of Eryuan County(LLR=39.376,P<0.05).Conclusions There are spatiotemporal aggregations of CoxA16 and EV71 in childhood cases with HFMD.The monitoring should be strengthened,and the disease should be scientifically prevented and controlled.