2021年承德市疱疹性咽峡炎和手足口病的病原学及临床特征研究

Etiology and Clinical Characteristics of Herpangina and Hand,Foot,and Mouth Disease in Chengde,China in 2021

疱疹性咽峡炎(Herpangina, HA)和手足口病(Hand, foot, and mouth disease, HFMD)是婴幼儿最常见的由肠道病毒(Enteroviruses, EVs)感染引起的病毒性传染病,同时HA和HFMD的病原体谱也因地区和年份不同而异。为了确定引起2021年承德市HA和HFMD的病原体组成及其临床特征,本研究收集2021年6月-12月在承德医学院第二临床学院儿科就诊的HA和HFMD患者咽拭子标本69份,通过逆转录-聚合酶链式反应扩增EV的5’UTR区和5’UTR-VP4-VP2区进行EV的鉴定、型别分析及临床特征分析。结果显示,共有30例HA和HFMD患者呈现EV阳性;共计25份EV阳性标本获得655bp的EV 5’UTR-VP4-VP2区扩增产物和序列测序完成,EV型别分析为48.0%(12/25)患者为柯萨奇病毒A4(Coxsackievirus-A4, CV-A4)感染、52.0%(13/25)患者为CV-A6感染,其中CV-A4感染引起的HA和HFMD各为11例和1例、CV-A6感染引起的HA和HFMD各为5例和8例。CV-A4主要集中在7-9月且以5岁以下儿童为主要感染对象,其中7月份最多(7例);CV-A6则在6-11月均有分布且各年龄段儿童均可感染。与CV-A4感染者相比,CV-A6感染者的C-反应蛋白(C-reactive protein, CRP)显著升高(P <0.05)。CV-A4和CV-A6引起承德市2021年HA和HFMD的暴发,应该加强HA和HFMD患者非肠道病毒A71型(Enterovirus-A71, EV-A71)和CV-A16病原体的监测,以便于HA和HFMD的防控。

Herpangina(HA)and hand,foot,and mouth disease(HFMD)are two of the most common viral infectious diseases in children.They are caused by enteroviruses(EVs),and the pathogen spectrum varies among different regions and years.We wished to determine the pathogen composition and clinical characteristics of HA and HFMD in Chengde,China,in 2021.Sixty-nine throat swabs were collected at the Department of Pediatrics at Number 2 Clinical Teaching Hospital of Chengde Medical University between June and December 2021.Gene segments of EV 5'UTR and 5'UTR-VP4-VP2 regions were amplified using reverse transcription-polymerase chain reaction(RT-PCR).PCR products were sequenced to determine EV genotypes.The clinical characteristics of EV-positive cases were analyzed.Thirty HA and HFMD cases were positive for EVs.Twenty-five EV-positive throat swabs with amplified EV 5'UTR-VP4-VP2 regions of length of 655 bp were sequenced.We found that 48.0%(12/25)of cases were infected with coxsackievirus-A4(CV-A4)and 52.0%(13/25)cases were infected with CV-A6.Eleven cases of HA and eight cases of HFMD were caused by CV-A4 or CV-A6,respectively.CV-A4 was distributed mainly from July to September(especially in July:seven cases),and children under 5 years of age were susceptible to CV-A4.CV-A6 was distributed between June and November and all age groups were susceptible to CV-A6.Compared with cases infected with CV-A4,the level of C-reactive protein in patients infected with CV-A6 was increased significantly(P<0.05).In conclusion,CV-A4 and CV-A6 were the pathogens of the outbreak of HA and HFMD in Chengde in 2021.Surveillance of HA and HFMD should concentrate on non-EV-A71 and non-CV-A16 pathogens(e.g.,CV-A4,CV-A6,CV-A2)to facilitate the prevention and control of HA and HFMD.