一起疱疹性咽峡炎混合手足口病疫情持续传播调查分析

Investigation and analysis of persistent transmission of herpangina mixed with hand,foot and mouth disease

目的明确深圳市罗湖区某幼儿园一起疱疹性咽峡炎(herpangina,HA)混合手足口病(hand,foot and mouth disease,HFMD)聚集性疫情的流行病学特征,分析疫情持续传播的因素,为制定有效的防控措施提供科学依据。方法应用现场流行病学方法整理分析疫情相关资料,在疫情接报和持续传播阶段分别采集病例咽拭子、肛拭子以及环境样本检测肠道病毒核酸及基因分型。结果本起疫情共持续42d,报告115例病例,无重症、住院及死亡病例。其中HA 86例,HFMD 11例,其他18例。幼儿园整体罹患率为20.7%(115/555),其中教学楼二楼儿童罹患率为27.5%(57/207),与一楼相比差异具有统计学意义(RR=1.824,95%CI:1.187~2.804)。实验室检测发现前后两次采样的病原体型别不同。疫情持续传播可能与社区密切接触、首诊误诊、晨检不规范、游园活动等因素有关。结论这是一起由多个传播源头引起的HA混合HFMD聚集性疫情。既有社区到幼儿园的传播,也存在幼儿园跨班级间传播。建议校园传染病防控增加居家隔离观察期,以防疫情持续传播。

Objective To understand the epidemiological characteristics of an outbreak of herpangina(HA)combined hand,foot and mouth disease(HFMD)in a kindergarten in Luohu District,Shenzhen,and analyze the factors of sustained transmission and provide scientific basis for formulating effective prevention and control measures.Method Field epidemiological methods were used to collate and analyze the relevant data of the epidemic.Throat swabs,anal swabs and environmental samples were collected to detect the nucleic acid and genotype of enterovirus in the stages of reporting and continuous transmission of the epidemic.Result The epidemic lasted for 42 days,115 cases were reported,no severe cases,no hospitalization cases,no death cases.There were 86 cases of HA,11 cases of HFMD and 18 others.The overall incidence was 20.7%(115/555),and the incidence of children on the second floor of the teaching building was 27.5%(57/207),the difference was statistically significant(RR=1.824,95%CI:1.187-2.804).The pathogens in the two samples were different,and the sustained spread of the epidemic may be related to factors such as close community contact,misdiagnosis of the first diagnosis,irregular morning examination,and park activities.Conclusion This is an outbreak of HA mixed HFMD caused by multiple transmission sources.There is not only communication from community to kindergarten,but also communication between kindergarten classes.It is recommended to add the observation period of home isolation for the prevention and control of campus infectious diseases to prevent the continued spread of the epidemic.