武威市2008-2018年儿童手足口病病原学监测结果分析

目的研究武威市儿童2008-2018年手足口病病原学特征及变迁趋势,为制定有效的防控措施提供科学依据。方法收集并分析武威市儿童2008-2018年手足口病病原学监测数据,采集临床诊断病例粪便、肛试子和咽拭子标本,应用RT-PCR法对标本进行肠道病毒核酸检测并分型。结果武威市2008-2018年报告手足口病年均发病率和死亡率分别为46. 51/10万和0. 01/10万。共送检HFMD标本1 369份,阳性率为49. 45%,EV71型、CoxA16型、其他肠道病毒阳性检出率分别为17. 09%、16. 22%、16. 14%,不同型别病原阳性检出率差异无统计学意义(χ~2=0. 55,P> 0. 05),其他肠道病毒阳性检出率总体呈上升趋势,不同年份间肠道病毒阳性检出率及肠道病毒型别构成差异有统计学意义(χ2=97. 67、296. 88,P <0. 05),2017年肠道病毒阳性检出率高于其余年份,2008-2012年以EV71为优势病原,2013-2018年EV71、Cox A16、其他肠道病毒基本上交替成为当地的优势病原。肠道病毒阳性检出率由高到低依次为天祝县(70. 57%)、古浪县(68. 32%)、民勤县(58. 90%)和凉州区(38. 10%),不同地区肠道病毒阳性检出率和肠道病毒型别构成方面差异有统计学意义(χ~2=119. 82、59. 87,P <0. 05),天祝县肠道病毒阳性检出率高于其他县区且Cox A16检出阳性率高于EV71和其他肠道病毒,凉州区EV71检出阳性率高于Cox A16和其他肠道病毒,古浪县、民勤县其他肠道病毒阳性检出率均高于EV71和Cox A16。结论武威市手足口病病原谱已发生变化,其他肠道病毒阳性检出率总体呈现上升趋势,不同地区病原学型别存在差异,应及时掌握病原变迁动态,因地制宜采取防控措施,有效降低手足口病发病率。

Analysis of the results of pathogenic surveillance of HFMD among children in Wuwei from 2008 to 2018

Objective To study the pathogenic characteristics and changing trend of hand-foot-mouth disease( HFMD) among children from 2008 to 2018 in Wuwei,provide scientific basis for the development and vaccination of HFMD vaccine and the formulation of effective prevention and control measures. Methods The monitoring pathogenic data of HFMD disease of children in Wuwei from 2008 to 2018 were collected and analyzed,as well as the samples of feces,anal test and throat swab from clinical diagnosis cases,then Real-time PCR was used to study the enterovirus nucleic acid and genotyping. Results The average annual incidence rate and mortality rate of HFMD in Wuwei from 2008 to 2018 were46. 51/100 000 and 0. 01/100 000 respectively. One thousand three hundred sixty-nine HFMD samples were detected with total positive rate of 49. 45% during 2008 and 2018,positive detection rates of EV71,Cox A16,and other enteroviruses were 17. 09 %,16. 22 %,and 16. 14 %,there was no significant difference in positive detection rate of different types of pathogens( χ2= 0. 55,P > 0. 05). The positive detection rate of other enteroviruses showed an overall upward trend. There were statistically significant differences in the positive rate of enterovirus detection and the composition of enterovirus in different years( χ~2= 97. 67,296. 88,P < 0. 05). The positive detection rate of enteroviruses in 2017 was higher than that in other years. During 2008 and 2012,EV71 was the dominant pathogen. From 2013 to 2018,EV71,Cox A16,and other enteroviruses basically alternated to become local dominant pathogens. The positive rate of enterovirus detection was Tianzhu county( 70. 57%),followed by Gulang county( 68. 32%),Minqin county( 58. 90%) and Liangzhou district( 38. 10%).There were statistically significant differences in the positive rate of virus detection and the composition of enterovirus( χ~2=119. 82 and 59. 87,P < 0. 05). The positive detection rate of enterovirus in Tianzhu county was higher than that in other counties,and the positive rate of Cox A16 was higher than that of EV71 and other enteroviruses. The positive rate of EV71 in Liangzhou district was higher than that of Cox A16 and other enteroviruses. The positive rate of other enteroviruses in Gulang county and Minqin county were higher than those of EV71 and Cox A16. Conclusion The pathogenic spectrum of HFMD has changed in Wuwei,and the positive detection rate of other enteroviruses is on the rise,and there are differences in the pathogenic types in different regions. It is necessary to grasp the dynamic changes of pathogens in time,and take preventive and control measures according to local conditions,so as to effectively reduce the incidence of HFMD.