昆明市妇幼保健院2014~2018年门急诊手足口病的病原构成变化

Changes in Pathogen Composition of Hand-Foot-and-Mouth Disease in Outpatient and Emergency Departments in Kunming Maternal and Child Health Hospital during 2014-2018

目的通过对昆明市妇幼保健院手足口病病原构成观察,了解肠道病毒EV71疫苗接种后免疫保护情况;为肠道病毒EV71疫苗接种推广提供临床客观依据。方法采集2014年1月至2018年12月间到昆明市妇幼保健院门急诊就诊临床确诊手足口病患儿的粪便标本,进行肠道病毒EV71,柯萨奇病毒A组16型,肠道病毒通用型PCR检测。按照是否接种肠道病毒EV71型灭活疫苗分为观察组和对照组。比较2组EV71及非EV71型病原构成比;同时把是否EV71感染作为因变量,是否接种疫苗,性别和年龄作为自变量进行多因素分析。结果观察组和对照组感染肠道病毒EV71构成比分别为0.6%、15%,2组之间存在差异(χ^(2)=27.088,P<0.05)。多因素分析结果显示只有是否接种疫苗为影响因素,接种疫苗为保护因素,接种疫苗者对EV71保护率达96.8%。结论昆明市妇幼保健院门急诊手足口病患儿中接种肠道病毒EV71灭活疫苗者感染肠道病毒EV71的构成比低于未接种者,推广疫苗接种对人群预防EV71感染引起的手足口病有很好的效果。

Objective To explore the pathogenic composition of hand-foot-and-mouth disease(HFMD)in outpatient of The Maternal and Child Health Hospital of Kunming from 2014 to 2018,so as to understand the immune protection status of enterovirus 71(EV71)vaccine,and to provide clinical basis for EV71 vaccination promotion of enterovirus.Methods Fecal samples of children diagnosed with hand-foot-and-mouth disease in outpatient and emergency department of The Maternal and Child Health Hospital of Kunming from 2014 to 2018 were collected for detection of EV71,coxsackievirus A 16 and enterovirus universal by PCR.We divided these HFMD children into observation group and control group,according to vaccination of EV71,and analysed EV71 and non-EV71 pathogens ratio of two groups.Multivariate analysis was performed with EV71 infection status,vaccination,gender and age as independent variables.Results The constituent ratio of EV71 in the observation group and the control group were 0.6%and 15%,respectively,and there were statistically significant difference(χ^(2)=27.088,P<0.05).Multi-factor analysis showed that vaccination status was influencing factor;vaccination was protective factor with protection rate of 96.8%.Conclusion Among the children with HFMD in the outpatient and emergency department of Kunming Maternal and Child Health Hospital,the infection rate of EV71 was lower in those who had been vaccinated with EV71 inactivated vaccine than those who had not.Therefore,the promotion of vaccine vaccination also had a good effect on preventing hand-foot-mouth disease caused by EV71 infection in the population.