Molecular Epidemiological Analysis of Echovirus 19 Isolated From an Outbreak Associated With Hand, Foot, and Mouth Disease (HFMD) in Shandong Province of China

To elucidate the genetic characterization and molecular epidemiological features of Echovirus 19 （El9） isolates collected from an outbreak associated with hand, foot and mouth disease （HFMD） in Tai＇an city of Shandong Province of China from July to September, 2003. Methods Thirty seven Echovirus 19 isolates were isolated from stool specimens and throat swabs collected during the outbreak, then major capsid （VP1） genomic sequence was determined, and phylogenetic tree was done based on the VP1 sequences among these 37 and other El9 viruses deposited in the Genbank. Also a representative strain named CHN-SD03-TN12 was selected for sequencing of 5′-untranslated regions （5′-UTR）. Results The identity rate was about 98.9%-100% among all these 37 El9 viruses. The genetic relationships between these 37 El9 isolates and other strains reported were also depicted. The identity rate was about 78.4%-78.9% compared with El9 reference strain Burke. The substitutions in the sequence of 5′-UTR resulted in changes in the conjectural properties of 5′-UTR of El9 viruses. Condusion The genetic features of El9 viruses isolated during the outbreak in Shandong Province in 2003 may be associated with a genetic and antigenic drift that changes the virulence of the Shandong isolates, but the molecular changes in Shandong El9 viruses contributing to their phenotype remain to be further illuminated. However, the sequences described in this paper substantiate the changes taken place in capsid VPI and 5′UTR regions. These substitutions may contribute to their tropism and virulence, and play a significant role in pathogenesis and clinical manifestations of the disease.

Molecular Epidemiology of Enteroviruses Associated with Hand, Foot, and Mouth Disease in the Mainland of China

Hand, foot, and mouth disease （HFMD） is a common contagious illness which occurs worldwide both sporadically and in epidemics. The disease mainly affects, children and the typical symptoms, which may resolve spontaneously, include mucocutaneous papulovesicular lesions on the hands, feet, mouth, and buttocks. In rare cases, however, the patients may also develop neurological complications such as neurogenic pulmonary edema,

The Comparative Study on Two Models of Syndrome Differentiation of the Hand, Foot and Mouth Disease: An Investigation Analysis of the Signs and Symptoms on 2325 Cases

Objective To realize the characteristics of "zheng" differentiation-treatment for hand, foot and mouth disease(HFMD), a new methodology of syndrome differentiation for different stages of HFMD has been explored. Methods Total of 2 325 cases with HFMD were recorded by distributing them into exterior syndrome stage, interior syndrome stage, severe syndrome stage and recovered syndrome stage, respectively, and the main symptoms and subsidiary symptoms of different stages of HFMD have been observed. The major and minor pathogenesis of HFMD in different stages were obtained, and compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD". Results It was found that the major pathogenesis of exterior stage was defined as "the invation of the wenevil to the defender of the body with the collaterals got involved ", and the minor as "qi deficiency"; in interior stage, "the fury of Gan-Yang" was the main pathogenesis, and "qi in chaos and qi deficiency" was the minor; in severe syndrome stage, "the damage of heart, liver and lung" was the main pathogenesis, and "qi in chaos" was the minor; and the pathogenesis of recovered stage was "qi-yin deficiency". Compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD", it showed that "the obstruction of the fei-pi qi by the mixture of shi-re evil" and "the mixture of shi-re" in vivo was quite difficult to be explained in completely different context in the general situation; in the severe stage, the TCM clinical characteristics of syndrome differentiation might lose; in the early acute severe cases, the phenomenon that xin-yang and fei-qi almost ran out was difficult to be observed, then, the line between the severe and the acute severe became vague.Conclusions The theory of syndrome differentiation by stages of HFMD was reasonable in the actual situation of clinical description on HFMD which was expected to be further tested and widely applied in the "zheng" differentiation-treatment of HFMD in the future.

Regional characteristics and spatiotemporal differentiation of the prevalence of hand, foot, and mouth disease in Xinjiang, China

In recent years,the number of hand,foot,and mouth disease(HFMD)cases in China has continued to grow,and the disease has become a serious public health issue.Xinjiang Uygur Autonomous Region is located in the arid areas of Northwest China,where the epidemiological trend of HFMD is gradually increasing and characterized by geographical heterogeneity.In this study,based on the HFMD case data in all counties and cities in Xinjiang,we employed statistical and GIS spatial analyses,and geographic probe models to characterize the spatiotemporal differentiation of HFMD epidemics in Xinjiang during the period of 2009–2018,and quantitatively analyzed the factors influencing the spatial differentiation of HFMD epidemics.The results showed that HFMD incidence rate in Xinjiang had non-stationary temporal characteristics on the interannual and monthly scales,and the monthly variation characteristics of HFMD epidemic were quite different in southern and northern Xinjiang.The spatial distribution characteristics of HFMD epidemics showed a north–south spatial differentiation pattern with the Tianshan Mountains as the boundary;cold spot and hot spot of HFMD epidemics in Xinjiang have shifted from scattered to concentrated,and the spatial differentiation pattern had gradually stabilized.Moreover,the dominant factors influencing the spatial differentiation of HFMD epidemics in Xinjiang were socioeconomic factors,such as per capita GDP and urbanization rate,while the basic factors affecting its spatial differentiation were natural environmental factors.The spatial differentiation and evolution patterns of HFMD epidemics differed between northern and southern Xinjiang.Specifically,the leading role of socioeconomic factors is more obvious in southern Xinjiang than in northern Xinjiang,while natural environmental factors(e.g.,dryness and relative humidity)contribute to the prevalence of HFMD epidemics in northern Xinjiang,and the perturbing effect of these factors was more prominent than other factors.The results of this study can provide a scientific basis for the prevention of HFMD epidemics and early warning of HFMD epidemics in Xinjiang.

The non-stationary and spatially varying associations between hand,foot and mouth disease and multiple environmental factors:A Bayesian spatiotemporal mapping model study

The transmission and prevalence of Hand,Foot and Mouth Disease(HFMD)are affected by a variety of natural and socio-economic environmental factors.This study aims to quantitatively investigate the non-stationary and spatially varying associations between various environmental factors and HFMD risk.We collected HFMD surveillance cases and a series of relevant environmental data from 2013 to 2021 in Xi'an,Northwest China.By controlling the spatial and temporal mixture effects of HFMD,we constructed a Bayesian spatiotemporal mapping model and characterized the impacts of different driving factors into global linear,non-stationary and spatially varying effects.The results showed that the impact of meteorological conditions on HFMD risk varies in both type and magnitude above certain thresholds(temperature:30°C,precipitation:70 mm,solar radiation:13000 kJ/m^(2),pressure:945 hPa,humidity:69%).Air pollutants(PM_(2.5),PM_(10),NO_(2))showed an inverted U-shaped relationship with the risk of HFMD,while other air pollutants(O_(3),SO_(2))showed nonlinear fluctuations.Moreover,the driving effect of increasing temperature on HFMD was significant in the 3-year period,while the inhibitory effect of increasing precipitation appeared evident in the 5-year period.In addition,the proportion of urban/suburban/rural area had a strong influence on HFMD,indicating that the incidence of HFMD firstly increased and then decreased during the rapid urbanization process.The influence of population density on HFMD was not only limited by spatial location,but also varied between high and low intervals.Higher road density inhibited the risk of HFMD,but higher night light index promoted the occurrence of HFMD.Our findings further demonstrated that both ecological and socioeconomic environmental factors can pose multiple driving effects on increasing the spatiotemporal risk of HFMD,which is of great significance for effectively responding to the changes in HFMD epidemic outbreaks.

National Epidemiology and Evolutionary History of Four Hand, Foot and Mouth Disease-Related Enteroviruses in China from 2008 to 2016

Hand, foot and mouth disease(HFMD) is a major public health concern in China. The most predominant enteroviruses that cause HFMD have traditionally been attributed to enterovirus A71(EVA71) and coxsackievirus A16(CVA16). Since its first large outbreak in 2008, the dominant HFMD pathogens are constantly changing. In 2013 and 2015, CVA6 exceeded both EVA71 and CVA16 to become the leading cause of HFMD in some provinces. However, there still lacks a comprehensive overview on the molecular epidemiology and evolution of HFMD-related enteroviruses at the national level. In this study, we performed systematic epidemiological analyses of HFMD-related enteroviruses using the data of 64 published papers that met the inclusion criteria, and conducted phylogenetic analyses based on 12,080 partial VP1 sequences identified in China before 31 st June 2018. We found that EVA71 prevalence has decreased sharply but other enteroviruses have increased rapidly from 2008 to 2016 and that one subtype of each enterovirus is represented during the epidemic. In addition, four genotypes EVA71_C4, CVA16_B1, CVA6_D and CVA10_C are the most predominant enterovirus strains and collectively they cause over 90% of all HFMD cases in China according to the phylogenetic trees using representative partial VP1 sequences. These four major enterovirus genotypes have different geographical distributions, and they may cocirculate with other genotypes and serotypes. These results suggest that more molecular epidemiological studies should be performed on several enteroviruses simultaneously, and such information should have implications for virological surveillance, disease management, vaccine development and policy-making on the prevention and control of HFMD.

EV-A71感染手足口病患儿发生重症的相关因素及预防措施

目的探究肠道病毒A71型(EV-A71)病原菌感染手足口病患儿发生重症的相关因素及预防措施。方法选取郑州人民医院2020年10月至2022年2月收治的116例EV-A71感染的手足口病患儿的病历资料进行回顾性分析,根据病情严重程度将其分为轻症组(86例)和重症组(30例),收集并整理所有受试者的临床基础资料,采用logistic多因素回归分析EV-A71感染手足口病患儿发生重症的危险因素。结果重症组居住地城乡接合部、发病至确诊时间>3 d、发热最高温度≥39℃、监护人受教育程度初中及以下占比高于轻症组(P<0.05)。logistic多因素回归分析结果显示,居住地城乡接合部、发病至确诊时间>3 d、发热最高温度≥39℃、监护人受教育程度初中及以下均为EV-A71感染手足口病患儿发生重症的危险因素(P<0.05)。结论重症患儿居住地以城乡接合部为主,发病3 d内确诊是预防病情进展的关键期,发热最高温度≥39℃是重症的早期识别指标之一,监护人受教育程度初中及以下不利于患儿病情防控。对居住地城乡接合部的重点地区及监护人受教育程度偏低的重点人群积极开展健康教育宣传活动,践行早发现、早诊断、早治疗的治疗方案是减少重症病例发生的有效措施。

广西重症手足口病患儿接受重症监护及出现死亡的危险特征分析

目的:分析重症手足口病(HFMD)患儿在不同临床症状和体征下,进入重症监护室(ICU)及死亡的风险,为重症HFMD患儿接受重症监护与不同临床转归的危险体征识别提供参考。方法:在2014-2018年间,通过现场调查方法,对广西各县(市、区)重症住院的HFMD确诊患儿进行了连续的个案调查;采用Epidata软件对调查资料进行双录入;使用二分类logistic回归分析,比较重症HFMD患儿不同的临床症状和体征与其死亡或被收入ICU的风险(比值比,OR),明确哪些临床症状体征导致患儿更可能进入ICU及更容易死亡。结果:2014—2018年共调查广西各县(市、区)重症HFMD病例1 500例,男女性别比例为1.78∶1;发病年龄中位数为1.85岁(0~11岁)。与未出现这些症状的患儿相比,共济失调、谵妄、口唇紫绀、面色苍灰、嗜睡、无力麻痹、肢体抖动、易惊是患儿进入ICU的危险症状体征(OR分别为4.924、4.515、2.781、2.750、2.311、2.162、2.139、1.361)。血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐是预示死亡风险增加的危险症状(OR分别为19.045、5.438、3.175、3.031、2.621)。结论:重症HFMD患儿如出现共济失调、谵妄、口唇紫绀等症状,其病情进一步发展为危重症的概率更高,并需接受重症监护治疗;如出现血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐等症状时,应重点关注病情是否恶化而导致死亡。

深圳市宝安区手足口病经济负担及影响因素

目的:了解深圳市宝安区2021年手足口病经济负担并分析其影响因素。方法:收集某三级甲等医院2021年9月1日—12月1日就诊的1 225例手足口病病人,设计调查问卷,采用电话询问及医院信息系统查询收集资料,评估手足口病造成的经济负担并分析其影响因素。结果:1 225例病人中,门诊病人1 195例(97.55%),住院病人30例(2.45%),无重症病例。1 195例手足口病门诊病人的总体经济负担为422.57(336.70,604.54)元/例,30例手足口病住院病人的总体经济负担为(4 386.88±1 624.61)元/例。年龄、报销类型以及诊疗次数是手足口病门诊病人总体经济负担的影响因素(P<0.05)。结论:手足口病住院病人经济负担高于门诊病人,年龄、报销类型以及诊疗次数是手足口病门诊病人经济负担的影响因素。早发现、早诊断、早治疗能有效降低疾病经济负担。

上海市长宁区儿童家长肠道病毒71型灭活疫苗接种意愿及影响因素分析

目的 了解上海市长宁区托幼机构儿童家长为孩子接种肠道病毒71型灭活疫苗(EV71疫苗)的意愿并分析影响因素,为推广EV71疫苗接种提出建议。方法 采用随机抽样的方式抽取长宁区托幼机构就读的儿童,向儿童家长发放问卷进行调查。结果 有75.40%的家长愿意为孩子接种EV71疫苗。Logistic回归分析,不认为EV71会产生强烈副作用、疫苗犹豫量表得分越高、主动获取知识得分越低的家长更愿意为孩子接种EV71疫苗。结论 家长为儿童接种EV71疫苗的意愿受到对EV71疫苗副作用的认知、疫苗犹豫和主动获取知识情况的影响,应对家长开展相关健康教育,以提升接种率。

重症手足口病患儿发生神经源性肺水肿的影响因素分析

目的分析重症手足口病(HFMD)患儿并发神经源性肺水肿(NPE)的影响因素,探究早期预测NPE的实验室指标。方法选取2019年6月至2022年6月郑州大学附属儿童医院ICU收治的符合入组条件的重症HFMD患儿184例,根据患儿病情分为重症HFMD合并NPE组和重症HFMD无NPE组。记录两组患儿入院时临床表现以及血常规、C反应蛋白、血糖、神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100B)、N末端脑钠肽前体(NT-proBNP)等实验室结果,采用SPSS 21.0软件进行数据分析,应用单因素分析比较两组患儿的临床资料;对可能的影响因素进行logistic多元回归分析。结果184例重症HFMD患儿中,重症HFMD无NPE组患儿163例,重症HFMD合并NPE组患儿共21例。单因素结果分析显示,两组患儿在年龄、白细胞水平、NT-proBNP水平方面差异有统计学意义(P<0.05),多因素logistic回归分析显示,NT-proBNP水平是影响重症HFMD并发NPE的独立影响因素。受试者工作特征(ROC)曲线分析显示当NT-proBNP截断值为758.9 ng·L^(-1),灵敏度为85.7%,特异度为92.6%,对于合并NPE的重症HFMD诊断效能最高。结论血清NT-proBNP水平是影响重症HFMD并发NPE的独立影响因素,其检测有助于早期识别重症HFMD并发NPE。

An epidemiological analysis of the Beijing 2008 Hand-Foot-Mouth epidemic

This paper presents an empirical analysis of the epidemiological data concerning the 18445 HFMD-infected cases in Beijing in 2008.The main findings are as follows.(i) Seasonal variations in incidence were observed,with a peak observed during the summer season,especially in May.Male patients outnumber female patients by 1.57:1.(ii) Most cases occurred in children 4 years old or younger.Outperforming Weibull distribution and Gamma distribution as to model fitness when analyzing patient ages,log-normal distribution indicates that the estimated mean age is 3.4 years.(iii) The age distribution seems to indicate cyclic peaks with roughly one-year intervals.(iv) Correlation analyses (ρ=0.9864) show that time of birth in different months has an impact on the chance of being infected by HFMD.Birth month seems to present a high risk factor on infants and young children.(v) The morbidity rate is 132.7/100000 during the HFMD epidemic in Beijing in 2008.The morbidity map shows that the risks of HFMD infection in areas close to the city center and suburbans are much lower than those in the urban-rural transition zones.Spatial risks inferred from the morbidity map demonstrate a clear circular pattern.(vi) The prevention and control measures taken by the public health departments seem to be effective during the summer season,resulting in the early ending of the epidemic (one month earlier than the natural season) and reduced outbreak size.

广东省2009-2012年手足口病流行趋势分析

[目的]分析广东省2009-2012年手足口病在三间分布和病原构成上的流行病学特征及其变化趋势.[方法]利用广东省2009-2012年手足口病监测数据、广东省人口数据和地理资料,对全省的手足口病时间趋势、人群分布特征以及病原构成等进行分析,继而运用Moran＇s Ⅰ确证相邻区县发病率的空间自相关性和异质性,并纳入贝叶斯空间模型,估算各年各区县发病的相对危险度（RR）,探索全省手足口病发病风险变化的空间模式.[结果]广东省手足口病病例数（9.3万～ 33.1万）和发病率（9.75/万～32.08/万）逐年上升,年内呈双峰分布.男性高发,男女发病率之比（1.75～ 1.90）逐年下降;不同类型病例均主要集中于5岁以下儿童,以1 ～＜2岁组儿童所占比例和发病率最高;EV71感染者的重症率（22.62％～ 34.11％）和病死率（0.93％～3.83％）均比COX A16感染者（重症率：1.32％～3.48％;病死率：0.00％）要高.各年Moran＇s Ⅰ在0.39 ～ 0.51之间.珠三角地区的发病率和相对危险度最高,且逐年上升.[结论]在2009-2012年之间,广东省手足口病流行强度逐年增强.不同时间、不同性别、不同年龄组发病率均存在较大差异.手足口病的发病率存在中等强度的空间自相关性和异质性,珠三角区域是该病高发病高风险区域,且每年的空间风险分布格局有所变化.

常州市手足口病相关危险因素流行病学调查

目的:探讨常州市人群发生手足口病(hand-foot-mouth disease,HFMD)的危险因素。方法:采用病例-对照研究方法,在常州市选择经临床明确诊断的108例手足口病患者和按年龄、性别频数匹配的108名对照,采用单因素分析和多因素Logistic回归分析,分析HFMD的主要危险因素。结果:单因素分析发现5个暴露因素与HFMD发生有关;多因素分析显示HFMD有2个主要危险因素和1个保护因素,分别是居住在农村(0R=2.191,95%CI:1.174～4.088)、有饮用生水习惯(0R=2.441,95%CI:1.050～5.675)、幼儿饭前便后洗手(OR=0.505,95%CI:0.259～0.983)。结论:幼儿良好的环境卫生、家长及个人良好的卫生习惯是预防手足口病的重要因素,为今后健康宣传教育提供了重要的理论支持。

手足口病重症病例的流行特征及危险因素

目的:分析手足口病重症病例的流行特征及相关危险因素。方法:对用Real-timeRT-PCR方法确诊的780例手足口病患儿,对比重症病例和普通病例,分析重症病例的流行特征及危险因素。结果:780例患儿中,重症和普通病例两组平均年龄分别为(1.6±0.9)岁和(3.0±1.9)岁(P﹤0.001);重症病例多发于1～2岁(51.8%)、夏季(61.4%)和唐山北部地区(58.5%);EV71感染并发重症手足口病的相对危险度(RR)高于普通病例(P<0.001)。结论:手足口病为唐山地区常见的儿童疾病,年龄1～2岁、感染EV71是引起手足口病重症病例的主要危险因素。

郴州市2010年手足口病流行病学特征及病原学监测分析

目的分析2010年郴州市手足口病流行病学特征,明确手足口病病原体主要型别,为该病的防制提供科学依据。方法采用描述流行病学方法分析流行特征;应用rRT-PCR方法检测手足口病标本,进行病毒型别鉴定。结果 2010年郴州市共报告手足口病5 904例,发病率为132.67/10万,其中重症病例61例,死亡病例9例,发生聚集性病例10起。发病时间主要集中在4～7月份,病例以0～5岁散居儿童为主,男性多于女性(性别比2.19︰1.00)。疫情以散发为主,局部地区高发。病原学监测提示,2010年郴州市手足口病肠道病毒检出阳性率为72.78%,其中EV71阳性率为40.15%,CoxA16阳性率为13.53%,其他肠道病毒阳性率为19.10%。轻症病例与重症病例(包括死亡病例)肠道病毒检出阳性率、EV71型病毒检出阳性率差异均有统计学意义。结论手足口病的发病存在明显季节、地区、性别、年龄差异,5岁以内婴幼儿是郴州市手足口病防控工作重点,病原体主要为EV71型,易导致重症或死亡病例,EV71病毒感染可能与手足口病的流行强度有关。

手足口病心肺衰竭危险因素分析及其风险评分模型的建立

目的分析手足口病患儿心肺衰竭危险因素,建立风险模型及风险评分系统,为心肺衰竭患儿的早期识别和早期治疗提供依据。方法回顾性分析2010年10月—2011年9月住院的199例手足口病患儿的临床资料。患儿分为心肺衰竭组和非心肺衰竭组。以性别、年龄、最高体温、心率、呼吸、血压、EV71感染、皮疹、嗜睡、频繁呕吐、呼吸节律、肢体无力、抽搐、出现皮疹至神经系统受累时间、外周血白细胞计数、淋巴细胞百分比、随机血糖等17项临床指标作为发生心肺衰竭的可能影响因素,利用单因素分析进行筛选,然后多因素Logistic回归分析,在此基础上建立风险模型并进行预测,用灵敏度、特异度、一致率和ROC曲线下面积来评价模型的预测效果。结果经多因素分析,最高体温、频繁呕吐、随机血糖和呼吸节律不规整4个因素为手足口病发生心肺衰竭的独立危险因素,根据多因素Logistic回归分析的结果建立Logistic回归预测模型。对模型的预测概率进行ROC曲线分析,曲线下面积为0.994。根据该模型,对现有的数据进行预测,模型的敏感度为94.12%(64/68),特异度为97.71%(128/132),一致率为94.48%(192/199)。结论手足口病心肺衰竭模型可定量评估手足口病患儿发生心肺衰竭的风险。

2011-2014年福建省手足口病相关病原柯萨奇病毒A组4型的分子流行病学分析

目的分析福建省手足口病患者中柯萨奇病毒A组4型(Coxsackievirus A4,CVA4)的流行病学、基因变异及遗传进化等特征。方法应用细胞培养方法获得病毒分离株,RT-PCR方法进行分子分型及扩增CVA4血清型完整VP1区全长序列,并进行序列变异及遗传进化分析。结果 2011-2014年,从福建省手足口病其它肠道病毒病例标本中分子分型33例CVA4病例,在407例的其它肠道病毒病例中的构成比为8.1%,其中2012年31例,2014年2例。CVA4病例在性别、年龄组分布特征,与一般手足口病流行特征相比,没有特异性。VP1区序列差异比较表明,2011-2014年福建省CVA4分离株之间VP1核苷酸及氨基酸序列相似性分别在92.6%~100%、95.7%~100%;与原型株及国外地方株的核苷酸序列相似性较低,分别为83.7%~85.4%、82.1%~89.1%,氨基酸序列相似性分别为96.1%~99.0%、90.4%~99.6%;与国内地方株核苷酸及氨基酸序列相似性较高,分别为87.9%~99.2%、96.1%~100%。进化树结果表明福建CVA4分离株与原型株及国外代表株的遗传距离远,与国内代表株的遗传距离近。福建CVA4分离株在进化树的分布呈多个分支。结论 CVA4已成为近年来福建省除EV71、CVA16、CVA6、CVA10外导致手足口病的又一重要病原体。福建CVA4分离株与国内地方株同进化共循环,在福建省各个地区同时流行多条亲缘关系接近的传播链。

湖南省2008年手足口病流行病学特征分析

目的分析湖南省2008年手足口病疫情流行病学特征,明确手足口病病原体主要型别,为制定预防控制措施提供依据。方法采用描述性流行病学方法分析疫情三间分布特征;采集手足口病临床诊断病例的疱疹液、咽拭子、肛拭子、粪便等标本,应用RT-PCR方法检测原始样本和分离阳性毒株中的EV、EV71和CoxA16病毒的核酸,用RD、Hep-2细胞对粪便标本进行病毒分离。结果湖南省2008年共报告27 133例手足口病病例,死亡11例,报告发病率为42.66/10万;全年每月均有病例报告,其中5～7月为发病高峰。病例广泛分布于全省121个县市区,以散发为主。病例男女性别比1.81∶1;以5岁以下年龄组儿童为主,占总病例数的89.43%,其中3岁以下(含3岁)年龄组儿童占总病例数的79.33%。采集了标本的719例病例中,肠道病毒检出阳性率为42.56%,其中EV71阳性者占总阳性的78.10%,且一般(轻症)病例肠道病毒检出阳性率(42.11%)与重症和死亡病例肠道病毒检出阳性率(51.43%)差异无统计学意义(χ2=1.18,P=0.28),但一般(轻症)病例中EV71病毒检出阳性率(32.31%)与重症和死亡病例EV71病毒检出阳性率(51.43%)差异有统计学意义(χ2=5.48,P=0.02)。病例咽拭子、疱疹液、粪便或肛拭子检出的阳性率较高,均在50.00%以上,而脑脊液、血液样本中未检出阳性。59份临床诊断病例粪便样本中分离出肠道病毒10株,其中EV71型病毒7株,CoxA16型病毒3株。结论手足口病在湖南省境内常年发生,5～7月是高发时期;病原体主要为EV71型肠道病毒,易导致重症病例甚至死亡病例;咽拭子、疱疹液、粪便/肛拭子是手足口病实验室诊断较敏感标本。

手足口病的流行病学特征及预防

本文对手足口病的定义、病原学、临床症状、诊断与鉴别诊断、流行特征、流行过程、手足口病感染的影响因素以及预防措施等进行了综述,重点对手足口病与皮肤科常见疾病的鉴别诊断进行了描述,并对手足口病的三间分布以及影响因素进行了探讨,同时详细地介绍了手足口病的预防措施。