海南省2010～2011年手足口病例病原学监测结果分析

目的分析引起海南省2010-2011年手足口病（Hand-Foot-Mouth Disease,HFMD）暴发流行的主要病原及其变化趋势,为海南省手足口病病例诊断和制定防控措施提供病原学依据。方法依据卫生部发布的《手足口病预防控制指南》进行手足口病例样本的处理和实验室检测。采用实时荧光-聚合酶链式反应（Real-time PCR）进行肠道病毒通用引物、肠道病毒71型（EV71）和柯萨奇病毒A16型（CoxA16）的核酸检测,核酸检测阳性的原始样本接种人横纹肌肉瘤细胞（Human Rhabdomyosarcoma,RD细胞）进行肠道病毒分离培养,选取有代表性的毒株进行病毒基因序列分析。结果 2010年和2011年海南省手足口重症病例中EV71感染率分别为45.52%和19.45%,而CoxA16的感染率仅为6.9%和4.7%;普通病例中的CoxA16感染率分别达到19.63%和24.8%,EV71的感染率分别为16.34%和6.36%。海南省2010年和2011年流行的EV71基因型均为C4a亚型,CoxA16病毒的基因型包括B1a和B1b,CoxA10、CoxA6和CoxA4也扮演着重要的角色,同时存在CoxA5、CoxB1、CoxB2、ECHO 3和ECHO 11等感染病例。引起海南省手足口重症病例的病原以EV71为主,也有少数病例为CoxA16的感染引起,2010年和2011年重症病例中CoxA16的感染率分别为6.9%和4.7%;而且CoxA10和CoxA6感染引起的重症病例比例较之CoxA4感染引起的重症病例的比例更高。结论海南省2010~2011年手足口重症病例仍以EV71感染为主,普通病例中EV71感染率逐渐下降,CoxA16感染率上升。在海南省人群中同时存在多种肠道病毒病原,导致海南省手足口病疫情的高发和重症病例的持续出现,尤其是CoxA10和CoxA6感染易导致重症病例的发生,值得进一步开展相关研究工作。

Analysis of Etiology surveillance results of hand-foot-mouth disease cases in Hainan Province in 2010-2011

Objective To analyze the main virus types and their change trend which caused pandemic of Hand-Foot-Mouth Disease（HFMD）in Hainan province in 2010-2011 in order to provide the etiology basis for diagnosis of HFMD cases and carrying out the control measures of HFMD.Methods According to the Ministry of Health issued ＂Hand-Foot-Mouth Disease Control and Prevention Guide＂,to treat and test specimens of HFMD.The RNA was amplified by real-time fluorescence PCR using the enterovirus universal primer,enterovirus type 71 primer and Coxsackie virus group A type 16 primer.The nucleic acids positive specimens were inoculated to RD cell lines to isolate enteroviruses.The representative virus strains were sequenced and analyzed.Results The infection rate of EV71 in HFMD severe cases in Hainan province in 2010 and 2011 was respectively 45.52% and 19.45%.The infection rate of CoxA16 was only 6.9% and 4.7%.But in HFMD common cases in Hainan province in 2010 and 2011,the infection rate of CoxA16 was respectively 19.63% and 24.8%,the infection rate of EV71 was 16.34% and 6.36%.The result of viruses sequence analysis showed that the main genotype were C4a of EV71,B1a and B1b of CoxA16 which caused pandemic of HFMD in Hainan province in 2010-2011.CoxA10,CoxA6 and CoxA4 also played important role.Some HFMD cases were caused by CoxA5、CoxB1、 CoxB2、ECHO 3 and ECHO 11.Most of HFMD severe cases in Hainan province were caused by EV71.Fewer severe cases were caused by CoxA16.The infection rates of CoxA16 was respectively 6.9% and 4.7% in HFMD severe cases in Hainan province in 2010 and 2011.However the proportion of HFMD severe cases which infected CoxA10 and CoxA6 was higher than that infected other type enterovirus,such as CoxA4.Conclusions The main pathogen was still EV71 in HFMD severe cases in Hainan province in 2010-2011.In the HFMD common cases the infection rate of EV71 was reduced.However the infection rate of CoxA16 was rising.Many pathogens of enterovirus were existed meantime at crowd in Hainan.So the morbidity of HFMD in Hainan was high and HFMD severe cases appeared continuously.Especially CoxA10 and CoxA6 usually cased HFMD severe cases.The further research in this field work was deserved.