河北省2013-2017年其他肠道病毒手足口病重症和死亡病例流行病学和病原特征分析

Epidemiological and pathogenic characteristics of cases with severe and fatal hand,foot,and mouth disease caused by other enterovirus in Hebei province,2013-2017

目的掌握2013-2017年河北省其他肠道病毒感染所致手足口病重症和死亡病例的流行病学特征;分析柯萨奇病毒A组6型(CoxA6)的基因特征,进一步阐明其遗传进化特点及规律。方法利用描述性流行病学方法对2013-2017年河北省其他肠道病毒感染所致手足口病重症和死亡病例的三间分布特征进行分析。运用Mega 5.2软件对CoxA6的VP1区序列进行系统进化树分析。结果2013-2017年河北省累计报告其他肠道病毒手足口病重症和死亡病例86例(重症84例,死亡2例),占其他肠道病毒手足口病报告病例的1.12%(86/7698)。每年4月份发病人数逐渐上升,5-7月达到最高峰。人群分布上,1~岁年龄组儿童的5年累计占比65.12%(56/86)。男女性别比为1.39∶1(50/36)。职业分布上,散居儿童占总发病人数的93.02%(80/86)。标本经病毒分离获得阳性毒株39份,阳性分离率为45.35%(39/86)。亲缘进化树显示,CoxA6分离株与D3a和D3b这2种亚型代表株处于同一分支。结论2013-2017年河北省其他肠道病毒手足口病重症和死亡病例在发病时间上呈现季节性,与手足口病流行的整体趋势一致。CoxA6属于D3基因型,且未出现新的进化分支。

Objective To understand the epidemiological characteristics of cases with severe and fatal hand,foot,and mouth disease(HFMD)caused by other enterovirus in Hebei province,2013-2017.Genetic characteristics of the main pathogen cosackie virus A6(CoxA6)were also analyzed to further clarifying the characteristics and rules of genetic evolution on this virus.Methods Descriptive epidemiological methods were used to analyze the distribution of severe and fatal cases with HFMD caused by other enterovirus in Hebei,2013-2017.The VP1 sequences of CoxA6 were phylogenetically analyzed,using the Mega 5.2 software package.Results A total of 86 severe and fatal cases with HFMD caused by other enterovirus were reported,accounting for 1.12%,comparing to all the HFMD caused by other enterovirus.Cases began to rise in April,and peaked in May-July.65.12%of the cases occurred in children between 1 and 5 years old.The sex ratio between male and female was 1.39∶1.A total of 93.02%of the cases were children outside the child care settings.A total of 39 positive strains were identified,with positive isolation rate as 45.35%.Phylogenetic analysis on the VP1 sequences of CoxA6 strains in this study revealed that CoxA6 strains belonged to sub-genotypes D3a and D3b.Conclusions Severe and fatal HFMD cases that caused by other enterovirus in Hebei province was with seasonal feature,consistent with the overall trend of this disease,2013-2017.No new evolutionary branch appeared in the CoxA6 strain.