2009—2011年上海市宝山区手足口病病原学研究

目的]探讨2009—2011年上海市宝山区手足口病病原学特征及诊断意义。方法]2009年3月—2011年12月连续采集手足口病临床诊断病例的咽拭子、大便样本或肛拭子和疱疹液进行肠道病毒71型(enterovirus 71,EV71)、柯萨奇病毒A组16型(coxsackievirus A16,CoxA16)和其他肠道病毒核酸检测。结果]2009—2011年肠道病毒的总检出率分别为59.00%、72.44%和79.00%,重症(死亡)病例中EV71型肠道病毒的阳性检出率为90.91%,明显高于普通病例(χ2=45.97,P<0.001)和聚集性病例的检出率(χ2=56.85,P<0.001);咽拭子、肛拭子或大便样本、疱疹液、咽漱液标本肠道病毒阳性检出率分别为68.02%、86.67%、71.43%、25.00%;咽拭子标本与肛拭子或大便标本和疱疹液标本检测结果符合率为83.53%和100.00%;发病0~4d肠道病毒核酸检出率为79.73%,5~10d肠道病毒核酸检出率为45.61%,差异有统计学意义(χ2=30.91,P<0.001)。结论]2009—2011年宝山区手足口病感染的主要病原是EV71型和CoxA16型肠道病毒,肠道病毒的检出率逐年提升,且每年的优势型别有所不同;手足口病重症(死亡)病例的主要病原为EV71型肠道病毒;咽拭子、肛拭子或大便样本、疱疹液都有较高的诊断价值;病后4d内采集标本对手足口病诊断效果较好。

Etiological Surveillance of Hand, Foot and Mouth Disease in Baoshan District of Shanghai, 2009-2011

Objective ] To identify the etiologieal characteristics and diagnostic significanee of hand, foot and mouth disease （HFMD） in Baoshan District of Shanghai by data collected from 2009 to 2011. Methods ] Specimens of throat swabs, anal swabs or faeces and herpes fluids of patients with HFMD were eollected from March 2009 to December 2011 to detect nucleic acid of enterovirus 71 （EV71）, coxsaekievirus A16 （CoxA16） and other enterovirus. Results ] From 2009 to 2011, the total positive enterovirus rates of all samples were 59.00%, 72.44% and 79.00% respectively. The positive rate of EV71 in the severe or fatal eases was 90.91%, significantly higher than those of the general eases （~=45.97, P〈0.001） and the elustered eases 0（2=56.85, P〈 0.001）. The positive rates of enterovirus in throat swabs, anal swabs or faeces, herpes fluids and pharyngeal aspirates were 68.02%, 86.67%, 71.43%, and 25.00% respectively. The eoincidenee rate of throat swabs and anal swabs or faeces was 83.53%; and that of throat swabs and herpes was 100.00%. There was a significant difference in the positive rates of nucleic acid between specimens collected 0-4days and 5-10days after onset （79.73% versus 45.61%, 2＇2=30.91, P〈 0.001）. Conclusion ] The main pathogens that caused HFMD in Baoshan District from 2009-2011 were EV71 and CoxA16. The detection rates increased year by year with varied dominant pathogens for each year. Severe or fatal HFMD eases were mainly caused by EV71 in this area. Throat swabs, anal swabs or faeces, and herpes fluids show a high diagnostic value on HFMD monitoring. Colleeting HFMD specimens within 4 days after onset is proposed for HFMD diagnosis.