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中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 466 -471. doi: 10.3877/cma.j.issn.1674-1358.2018.05.009

所属专题： 文献；

论著

2015年徐州市及周边地区手足口病流行特征及病原学分析
纵书芳1,†(), 孙浩淼1, 尹力扬1, 张春侠1, 石银月1, 纵淑丽2()   
  1. 1. 221002　徐州市，徐州市儿童医院感染性疾病科
    2. 221002　徐州市，徐州市儿童医院新生儿内科
  • 收稿日期:2017-11-28 出版日期:2018-10-15
  • 通信作者: 纵书芳, 纵淑丽
  • 基金资助:
    徐州市科技发展项目(No. KC15SH056)

Epidemiological characteristics and etiological analysis of hand, foot and mouth disease in Xuzhou and the surrounding area in 2015

Shufang Zong1(), Haomiao Sun1, Liyang Yin1, Chunxia Zhang1, Yinyue Shi1, Shuli Zong2,†()   

  1. 1. Infectious Diseases Department, Xuzhou Children’s Hospital, Xuzhou 221002, China
    2. Department of Newborn Medicine, Xuzhou Children’s Hospital, Xuzhou 221002, China
  • Received:2017-11-28 Published:2018-10-15
  • Corresponding author: Shufang Zong, Shuli Zong
  • About author:
    Correspongding author: Zong Shufang, Email:
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纵书芳, 孙浩淼, 尹力扬, 张春侠, 石银月, 纵淑丽. 2015年徐州市及周边地区手足口病流行特征及病原学分析[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(05): 466-471.

Shufang Zong, Haomiao Sun, Liyang Yin, Chunxia Zhang, Yinyue Shi, Shuli Zong. Epidemiological characteristics and etiological analysis of hand, foot and mouth disease in Xuzhou and the surrounding area in 2015[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(05): 466-471.

目的

分析手足口病(HFMD)住院患儿病原体类型及流行特征，为手足口病防治提供参考依据。

方法

收集2015年度徐州市儿童医院手足口病住院患儿的临床资料，分析患儿人口学特征、发病特点、临床表现，并进行问卷调查。采集患儿粪便标本，提取病毒RNA后采用荧光定量PCR法对样本进行肠道病毒71(EV71)型、柯萨奇病毒A16(CoxA16)型病原学检测。

结果

2015年度本院共收治手足口病患儿2 792例，其中男1 842例，女950例；重症10例，死亡3例；年龄72 d～11岁。3～7月份为手足口病高发期，入组患者共发病1 738例(62.24%)，4月达到顶峰，发病425例(15.22%)。发病人群集中在1～3岁幼儿(1 471例、52.68%)，且以散童及幼托为主，其中留守儿童占29.98%(837/2 792)，二次感染患儿占19.99%(558/2 792)。患儿近3个月患呼吸道或消化道疾病，营养状态差以及家长文化程度相对低的患儿在本院手足口病人群中所占比例较高，分别为39.68%(1 108/2792)、59.81%(1 670/2 792)和64.97%(1 814/2 792)。病原学检测显示：EV71阳性率为56.23%(1 570/2 792)，CoxA16阳性率为13.83%(386/2 792)，其他肠道病毒阳性率为30.59%(854/2 792)。收集HFMD合并病毒性脑炎患儿家长大便标本共102例，病原学检测显示其中44例(43.14%)EV71阳性。

结论

2015年徐州市及周边地区手足口病患儿仍较多，并以EV71感染为主；留守儿童及二次感染患儿中重症患者比例较高且病情更重；成人隐性感染可能成为另一种重要的传染源。

关键词: 手足口病, 病原学, 流行特征, 留守儿童, 二次感染
Objective

To investigate the pathogen types and epidemic characteristics of the hospitalized children with hand, foot and mouth disease (HFMD), and to provide reference for the prevention and treatment of HFMD.

Methods

The clinical data of the hospitalized children with HFMD in Xuzhou Children’s Hospital during 2015 were collected, the demographic characteristics and clinical manifestations were analyzed, and an epidemiological investigation was carried out. The fecal samples were collected and virus RNA was detected by real-time fluorescence quantitative PCR for enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16).

Results

During 2015, a total of 2 792 cases with HFMD were collected, including 1 842 males and 950 females, 10 severe cases and 3 death cases. The age was from 72 days to 11 years old. Patients with HFMD mainly concentrated around March to July. A total of 1 738 cases (62.24%) were diagnosed and the peak was reached in April with 425 diagnosed cases (15.22%). The children with HFMD were concentrated among 1-3 years old (1 471 cases, 52.68%), and residentially-scattered children and childcare were the main targets of HFMD, among which stay-at-home children and secondary children accounted for 30% (837/ 2 792) and 20% (558/2 792), respectivly. Children suffered from respiratory or digestive tract diseases (39.68%, 1 108/2 792) within the last three months, poor nutritional status (59.81%, 1 670/2 792) and lower educational level of parents (64.97%, 1 814/2 792) were susceptible to HFMD. Etiological examination showed that the positive rate of EV71 was 56.2% (1 570/2 792), the positive rate of CoxA16 was 13.1% (368/ 2 792), and that of other enterovirus was 30% (854/2 792). The fecal specimens (102 cases) of the parents whose children suffered from HFMD and viral encephalitis were collected, and 44 samples were positive for EV71.

Conclusions

In Xuzhou and the surrounding areas, there were still more children with HFMD in 2015, and EV71 infection was the main infection. The proportion of severe patients in stay-at-home children and children with secondary infection was higher and the disease was more serious. The latent infection in adults might become another important source of infection.

Key words: Hand, foot and mouth disease, Eetiology, Epidemic characteristics, Left-behind children, Second infection
表1 2015年度本院手足口病患者收治例数和病原体分布[例(%)]
月份 例数 EV71(+) CoxA16(+) 其他病毒
1 149 68(4.33) 26(7.11) 55(6.41)
2 162 67(4.27) 20(5.46) 75(8.75)
3 307 175(11.15) 42(11.47) 90(10.50)
4 425 294(18.73) 53(14.48) 78(9.10)
5 343 198(12.61) 34(9.28) 111(12.95)
6 354 232(14.97) 43(11.74) 79(9.21)
7 309 213(13.57) 34(9.28) 62(7.23)
8 183 106(6.75) 24(6.55) 53(6.30)
9 126 61(3.88) 26(7.10) 39(4.55)
10 115 49(3.12) 21(5.70) 45(5.48)
11 153 57(3.63) 21(5.73) 75(8.75)
12 166 50(3.18) 24(6.55) 92(10.73)
合计 2 792 1 570(56.23) 368(13.18) 854(30.59)
图1 2015年1月至12月本院手足口病患儿发病月份分布
表2 入组不同年龄和性别手足口病患者的病原体分布[例(%)]
指标 EV71(+)(1 570例) CoxA16(+)(368例) 其他病毒(854例)
年龄(岁) ? ? ?
? 0～1 53(3.38) 38(10.33) 131(15.34)
? 1～3 1 024(65.22) 132(35.87) 315(36.89)
? 3～5 296(18.85) 31(8.42) 102(11.94)
? ≥ 5 197(12.55) 167(45.38) 306(35.83)
性别 ? ? ?
? 男 1 036(37.11) 184(6.59) 622(22.28)
? 女 534(19.13) 184(6.59) 232(8.31)
表3 影响手足口病病情及预后的因素[例(%)]
影响因素 普通病例(1 667) 合并中枢系统感染(1 125) χ2值 P值
病原体类型 ? ? 608.75 < 0.001
? EV71 628(37.67) 942(83.73) ? ?
? CoxA16 270(16.20) 98(8.71) ? ?
? 其他病毒 769(46.13) 85(7.56) ? ?
出现皮疹后就诊时间(d) ? ? 64.27 < 0.001
? ≤ 1 349(20.94) 153(13.60) ? ?
? 1～3 933(55.97) 742(65.96) ? ?
? ≥ 3 385(23.09) 230(20.44) ? ?
二次感染 ? ? 227.35 < 0.001
? 是 168(10.08) 390(34.67) ? ?
? 否 1 499(89.92) 735(65.33) ? ?
留守儿童 ? ? 237.96 < 0.001
? 是 285(17.10) 552(49.07) ? ?
? 否 1 382(82.90) 573(50.93) ? ?
营养状况 ? ? 253.77 < 0.001
? 差 668(40.07) 1 002(89.07) ? ?
? 良好 999(59.93) 123(10.93) ? ?
近3个月健康状况 ? ? 278.34 < 0.001
? 差 1 241(74.45) 1 021(90.76) ? ?
? 良好 426(25.55) 104(9.24) ? ?
合并疾病类型 ? ? 205.79 < 0.001
? 呼吸道和(或)胃肠道疾病 522(31.31) 586(52.09) ? ?
? 患其他疾病 719(68.69) 435(47.91) ? ?
家庭居住地 ? ? 147.16 < 0.001
? 市区 411(24.66) 115(10.22) ? ?
? 县乡及市郊区 346(20.76) 129(11.47) ? ?
? 农村 940(56.39) 881(78.31) ? ?
父母文化程度 ? ? 159.28 < 0.001
? 低(高中及以下) 927(55.61) 887(78.84) ? ?
? 高(大专及以上) 740(44.39) 238(21.16) ? ?
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