2008-2018年中国手足口病重症病例流行病学特征分析

Epidemiological characteristics of severe cases of hand, foot, and mouth disease in China, 2008-2018

目的了解我国2008-2018年手足口病重症病例的流行病学特征,为重症手足口病的防控提供依据。方法从中国疾病预防控制中心传染病报告信息管理系统中获取2008-2018年所有手足口病重症病例个案资料,采用描述性流行病学方法分析手足口病重症病例的三间分布、病原构成及变化,采用Joinpoint回归模型分析重症率、重症比例和重症病死率的变化趋势。结果2008-2018年全国手足口病重症病例157065例,年均重症率为1.05/10万,重症比例为0.76%,重症病死率为2.34%,重症率和重症比例2010年后出现下降趋势,重症病死率2014年后显著下降。重症病例男性高于女性(1.78∶1),以≤3岁婴幼儿为主(91.47%),EV-A71引起的重症手足口病中位年龄最高(1.99岁)且逐年升高,其他肠道病毒感染在≤1岁婴儿中构成较高(66.56%)。4-7月为主要的发病高峰,2018年其他肠道病毒代替EV-A71成为优势血清型(61.97%)。西南部、中部及东部地区部分省份为手足口病重症病例高发省份。结论我国大陆地区手足口病重症率、重症比例及重症病死率整体呈下降趋势,部分省份优势病原由EV-A71转为其他肠道病毒,应加强重点人群、高发季节、区域防控工作,开展多种手足口病病原监测。

Objective To characterize the epidemiology of severe hand,foot and mouth disease(HFMD)in China from 2008 to 2018 and provide evidence for the prevention and control of severe HFMD.Methods The incidence data of severe HFMD cases from 2008 to 2018 were collected from the National Notifiable Infectious Diseases Reporting System of Chinese Center for Disease Control and Prevention.Descriptive epidemiological methods were used to analyze distributions,pathogen constituent and change of severe HFMD.Joinpoint regression model was used to analyze the trends of severity rate,proportion of severe cases and severe fatality rate.Results From 2008 to 2018,a total of 157065 cases of severe HFMD were reported in China,with an average annual case-severity rate of 1.05/100000,a severe case proportion of 0.76%and a severity-fatality rate of 2.34%.The severity rate and the proportion of severe cases showed a downward trend after 2010,and severe fatality rate decreased significantly after 2014.The severe cases mainly occurred in infants aged≤3 years(91.47%),more boys were affected than girls(1.78∶1).The median age of severe HFMD cases caused by EV-A71 was highest(1.99 years)and increased year by year,other enterovirus infection cases accounted for a higher proportion in infants aged≤1 year(66.56%).The incidence peak occurred during April-July,other enteroviruses replaced EV-A71 as the predominant serotype in 2018(61.97%).The incidence of severe HFMD were high in some provinces in southwestern,central and eastern China.Conclusion The overall severity rate,proportion of severe cases and severe fatality rate of HFMD in the mainland of China have shown a downward trend.The predominant pathogen in some provinces has changed from EV-A71 to other enteroviruses.It is necessary to strengthen the prevention and control of HFMD in key population,high incidence seasons and areas and carry out the surveillance of various pathogens of HFMD.