2015年至2019年大理白族自治州手足口病的流行病学和病原学构成分析

Epidemiological characteristics and etiological study of hand-feet-mouth disease in Dali Bai Autonomous Prefecture from 2015 to 2019

目的分析大理白族自治州手足口病的流行病学和病原学构成,为制订手足口病的防控措施提供科学决策和依据。方法通过中国疾病预防控制信息系统收集2015年1月至2019年12月大理白族自治州手足口病病例的人口学资料,分析患者的发病率,流行病学特征,采用实时反转录聚合链反应检测手足口病患者粪便标本中的柯萨奇病毒A组16型、肠道病毒71型和其他肠道病毒核酸。统计学方法采用χ2检验。结果2015年至2019年,大理白族自治州共报告手足口病30730例,年均发病率为171.50/10万,2016年至2019年发病率呈上升趋势,其中重症病例24例(0.08%)。年均发病率居前3位者分别为永平县、宾川县和大理市。6月至7月为夏季发病高峰,共报告病例9168例(29.83%);9月至10月为秋季流行高峰,共报告病例5988例(19.49%),夏季高峰流行强度高于秋季高峰。30730例病例中,男17373例,女13357例,男性年均发病率为120.29/10万,高于女性的75.83/10万,差异有统计学意义(χ2=1637.467,P<0.01)。幼儿期(1~<3岁)的发病率最高,其次为学龄前期(3~<6岁),分别为4158.96/10万和1953.11/10万。从幼儿期开始,发病率随年龄的增长而降低;重症病例集中在幼儿期,共报告16例,占重症病例数的66.67%。人群分类以散居儿童为主,共报告20516例(66.76%)。1294例实验室确诊病例中,柯萨奇病毒A组16型感染者792例(61.21%),肠道病毒71型感染者为320例(24.73%),其他肠道病毒感染者182例(14.06%)。结论大理白族自治州手足口病发病具有明显的季节、年龄和人群特征,应加强部门合作、健康教育,严格落实各项防控措施,以降低发病率,并提高重症病例的早期识别救治能力。

Objective To investigate the epidemiological and etiological characteristics of hand-feet-mouth disease(HFMD)in Dali Bai Autonomous Prefecture and to provide scientific evidence for the prevention of HFMD.Methods The HFMD cases during January 2015 to December 2019 in Dali Bai Autonomous Prefecture were collected through the Chinese Information System for Disease Control and Prevention.The demographic data,incidence rate of HFMD and epidemiological characteristics were analysed.Coxsackie virus A16(CoxA16),enterovirus 71(EV71)and other enterovirus nucleic acid in stool samples of HFMD patients were detected by real-time reverse transcription polymerase chain reaction.Chi-square test was used as statistical method.Results From 2015 to 2019,30730 cases of HFMD were reported in Dali Bai Autonomous Prefecture.The annual incidence rate was 171.50/100000,and the incidence rate was on rise from 2016 to 2019.There were 24(0.08%)severe cases.Yongping County,Binchuan County and Dali City were with the top three average annual incidence rate.The peak incidence was from June to July in summer,9168 cases(29.83%)were reported.The peak incidence was from September to October in autumn,5988 cases(19.49%)were reported.The epidemic intensity in summer was higher than that in autumn.Among 30730 cases,there were 17373 males and 13357 females.The annual incidence rate of male patients was 120.29/100000,and that of female was 75.83/100000.The difference was statistically significant(χ2=1637.467,P<0.01).The highest incidence was in infancy(one to<three years old),followed by preschool stage(three to<six years old)and the incidence rate was 4158.96/100000 and 1953.11/100000,respectively.From infancy,the incidence decreased with age.Severe cases concentrated in infancy with a total of 16 cases,accounting for 66.67%of severe cases.The affected population was mainly scattered children,and a total of 20516 cases(66.76%)were reported.Among the 1294 laboratory confirmed cases,792(61.21%)were CoxA16 infected cases,320(24.73%)were EV71 infected cases,and 182(14.06%)were other enterovirus infected cases.Conclusions The incidence of HFMD in Dali Bai Autonomous Prefecture has obvious seasonal,age and population characteristics.It is necessary to strengthen the cooperation among departments,health education and strict implementation of prevention and control measures in order to reduce the incidence and improve the ability of early identification and treatment of severe cases.