肠道病毒71型感染手足口病患儿的肠道排毒时间及传播机制的初步探讨

目的 探讨肠道病毒71型(EV71)感染手足口病患儿的肠道排毒时间及传播机制,为科学防控手足口病提供参考. 方法 采集咽拭子或粪便标本用实时荧光定量反转录聚合酶链反应法进行病毒核酸检测,对实验室确诊的65例EV71感染手足口病患儿进行追踪和随访,直至患儿大便病毒转阴为止.同时调查与58名EV71核酸阳性患儿有密切接触史家庭成员(每位患儿2名)116人,其中36人采集咽拭子,80人采集粪便标本.采集手足口病病区医务人员粪便标本31人,其中医生10人,护士21人. 结果 25例普通型EV71感染患儿第1~6周大便病毒核酸阳性率分别为100%、88.4%、59.4%、22.3%、22.3%、0,持续最长时间为6周.40例EV71重症组患儿第1～10周大便病毒核酸阳性率分别为100%、97.0%、79.5%、60.6%、35.3%、25.2%、16.8%、16.8%、8.4%、0,持续最长时间为10周.31名医务人员粪便未检出EV71及柯萨奇病毒A组16型(Cox A16)核酸.80名有患儿密切接触史人员中,22份粪便标本EV71核酸阳性,占27.5%;36份咽拭子标本除1例EV71核酸阳性其余均阴性,阳性者均无自觉症状. 结论 EV71感染手足口病患儿恢复期肠道排毒时间长,成为隐性感染者,易造成手足口病流行和传播.建议延长手足口病患者,特别是重症手足口病患者管理时限.EV71感染手足口病患儿家庭成员易成为隐性感染者,可造成手足口病传播.

Survey of virus shedding and spread mechanism in children infected with EV71

Objective To understand the virus shedding and spread mechanism in children infected with EV71 and provide evidence for the prevention and control of hand foot and mouth disease (HFMD). Methods Throat swabs and stool samples were collected to detect EV71 nucleic acid with fluorescent PCR, and 65 children with laboratory confirmed EV71 infection were followed up until no virus was detected in their stool samples. At the same time, 116 family members (close contacts) of 58 sick children with positive results in EV71 detection were surveyed by detecting their throat swabs and stool samples. And 31 stool samples were collected from medical staff providing medical care to the sick children. Results The positive rate of EV71 in 25 infected children was 100%, 88.4%, 59.4%, 22.3%, 22.3%, and 0%, respectively, from 1st week to 6th week, and the EV71 positive rate in 40 children with severe infection was 100%, 97.0%, 79.5%, 60.6%, 35.3%, 25.2%, 16.8%, 16.8%, 8.4% and 0%, respectively, from 1st week to 10th week. No EV71 or Cox A16 were detected in 31 medical staff. Among the stool samples collected from 80 close contacts, 22 were EV71 positive (27.5%). Among the throat samples collected from 36 close contacts, 35 were EV71 negative. The positive persons had no obvious HFMD symptoms. Conclusion Virus shedding may last for several weeks in children infected with EV71, This phenomenon is called latent infection, which can facilitate the transmission of HFMD. It is suggested to conduct longer time management for HFMD patients and strengthen the monitoring for the family members of HFMD patients.