2017—2019年浙江省手足口病病原学特征分析

Pathogenic Characteristics of Hand,Foot and Mouth Disease in Zhejiang Province from 2017 to 2019

目的:分析2017—2019年浙江省手足口病的病原学特征,为制定手足口病防治措施提供依据。方法:从中国疾病预防控制中心传染病报告信息系统中获取2017—2019年浙江省手足口病监测数据和病原学数据,运用描述性流行病学方法分析浙江省手足口病的病原学特征。结果:2017—2019年浙江省报告手足口病实验室确诊病例分别为3 437例、4 329例和3 540例。病原学检测结果显示,EV-A71所占比例从2017年的22.6%持续下降到2019年的1.8%,CV-A16和CV-A6所占比例分别从2017年的17.1%和7.3%上升到2019年的40.6%和33.1%。CV-A16和CV-A6竞争成为肠道病毒生态中的优势血清型。与2008—2016年相比,浙江省手足口病EV-A71构成比和重症比例都呈下降趋势,但报告发病率并未呈现下降趋势。结论:EV-A71疫苗的主要作用在于预防重症手足口病,由于病原谱的变化,疫苗对降低手足口病发病率的作用并不显著,需要密切监测手足口病病原谱的变化和积极研发多价手足口病疫苗。

OBJECTIVE To analyze the pathogenic characteristics of hand,foot and mouth disease(HFMD) in Zhejiang Province from 2017 to 2019 and to provide a basis for the development of prevention and treatment measures for HFMD.METHODS The surveillance data and pathogenic data of HFMD in Zhejiang Province from 2017 to 2019 were obtained from the Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention,and the pathogenic characteristicsof HFMD in Zhejiang Province were analyzed with descriptive epidemiological methods.RESULTS From 2017 to 2019,3 437,4 329 and 3 540 laboratory-confirmed cases of HFMD were reported in Zhejiang Province,respectively.The pathogenic detection results found that the proportion of EV-A71 continued to decline from 22.6% in 2017 to 1.8% in 2019,and the proportions of coxsackievirus A16(CV-A16) and coxsackievirus A6(CV-A6) increased from 17.1% and 7.3% in 2017 to 40.6% and 33.1% in 2019,respectively.CV-A16 and CV-A6 competed to become the dominant serotypes in the enterovirus ecology.Compared with 2008 to 2016,the composition ratio of EV-A71 and the proportion of severe cases of HFMD in Zhejiang Province showed a decreasing trend,but not the reported incidence.CONCLUSION The main role of the EV-A71 vaccine was to prevent severe HFMD.The vaccine had no significant effect on reducing the incidence of HFMD,which was due to changes in the pathogen spectrum.It was necessary to closely monitor changes in the pathogen spectrum of HFMD and actively developed polyvalent HFMD vaccines.