2018-2022年开封市儿童手足口病流行病学特征及病原学分析

Epidemiological characteristics and etiological analysis of hand-foot-and-mouth disease in children in Kaifeng city from 2018 to 2022

目的 研究2018-2022年开封市儿童手足口病(HFMD)流行病学特征及病原学检测结果,为制定和调整预防策略提供参考信息。方法 从“中国疾病预防控制信息系统”导出2018-2022年开封市HFMD患儿资料,从性别、年龄和发病时间等维度分析流行病学特征,同时记录病原学检测结果和疫苗接种情况,采用描述性流行病学方法进行分析和总结。结果 2018-2022年开封市儿童HFMD发病率(341.74/10万、178.30/10万、164.09/10万、93.14/10万、54.14/10万)逐年降低,差异有统计学意义(χ^(2)=5 334.949,P<0.001);5年间累积报告病例14 385例,其中2018、2019年重症病例数分别为9、5例,2020-2022年未发现重症病例。发病高峰时间2018、2019年为4-7月,2020年为8-10月,2021、2022年为6-8月。1~<2岁发病率最高为1 068.45/10万,随着年龄增长发病率明显降低,差异有统计学意义(χ^(2)=40 102.739,P<0.001);5年间0~<4岁患儿累积报告例数为11 978例,占83.27%;0~<6岁患儿累积报告例数为13 823例,占96.09%。男性发病率高于女性,各年比较差异均有统计学意义(χ^(2)=255.601、110.045、47.887、49.199、25.565,P均<0.001);5年间累积报告病例中男8 499例(59.08%),女5 886例(40.92%),性别比为1.44∶1。病原学抽检结果显示,2019年肠道病毒71型(EV-71)阳性率较2018年显著升高,差异有统计学意义(χ^(2)=63.154,P<0.001);2020、2021年均以其他肠道病毒感染为主,未发现EV-71阳性病例;2020年柯萨奇病毒A组16型(CV-A16)阳性率较2018、2019和2021年均显著降低,差异有统计学意义(χ^(2)=47.224,P<0.001)。适龄儿童EV-71疫苗估算接种率2018-2020年分别为10.86%、11.46%和15.74%,2021年下降至11.61%,2022年上升至15.27%,接种率整体呈上升趋势。结论 2018-2022年开封市儿童HFMD发病率呈逐年降低趋势,流行病学特征具有明显季节、性别和年龄差异,积极开展病原学检测和疫苗接种工作对HFMD预防具有积极作用。

Objective To study the epidemiological characteristics and etiological detection results of hand-foot-and-mouth disease(HFMD) in children in Kaifeng city from 2018 to 2022, and provide reference information for formulating and adjusting the prevention strategies. Methods The data of children with HFMD in Kaifeng city from 2018 to 2022 were exported from the “China Information System for Disease Control and Prevention”, and the epidemiological characteristics were analyzed from the dimensions of gender, age and onset time. The etiological detection results and vaccination were recorded, and the descriptive epidemiological methods were used for analysis and summary. Results The incidence rate of HFMD in children in Kaifeng city showed a significantly decreasing trend from 2018 to 2022(341.74/100 000, 178.30/100 000, 164.09/100 000, 93.14/100 000, 54.14/100 000), with a statistical difference (χ^(2)=5 334.949,P<0.001). A total of 14 385cases were reported in the past 5 years, including 9 severe cases in 2018 and 5 severe cases in 2019, and no severe cases were found in 2020-2022. The peak time of the disease was from April to July in 2018 and 2019, from August to October in 2020 and from June to August in 2021 and 2022. The highest incidence rate was 1-<2 years old(1 068.45/100 000), and the incidence rate was decreased significantly with the increase of age,the difference was statistically significant(χ^(2)=40102.739, P<0.001). The cumulative number of reported cases in 0-<4 years old was 11 978, accounting for 83.27%, and the cumulative number of reported cases in 0-<6 years old was 13 823, accounting for 96.09%. The incidence rate in male patients was higher than that in female patients, and the difference in each year was statistically significant (χ^(2)=255.601, 110.045, 47.887, 49.199, 25.565;all P<0.001). The cumulative reported cases in the past 5 years were 8 499 males(59.08%) and 5 886 females(40.92%), with the gender ratio of 1.44∶1. Etiological sampling showed that the positive rate of enterovirus type 7(EV-71) in 2019 was significantly higher than that in 2018, the difference was statistically significant (χ^(2)=63.154, P<0.001). In 2020 and 2021, other enterovirus infections were dominant, and no EV-71 positive cases were found. The positive rate of coxsakievirus A16(CV-A16) in 2020 was significantly lower than that in 2018, 2019 and 2021,the difference was statistically significant(χ^(2)=47.224, P<0.001). The estimated vaccination rates of EV-71 vaccine among school-age children from 2018 to 2020 were 10.86%, 11.46% and 15.74%, respectively, which decreased to 11.61% in 2021 and increased to 15.27% in 2022, indicating an overall upward trend in vaccination rate. Conclusions The incidence rate of HFMD in children in Kaifeng city showed a significantly decreasing trend from 2018 to 2022, and the epidemiological characteristics show obvious season, gender and age differences. Active etiological detection and vaccination had a positive effect on the prevention of HFMD.