2009-2012年新疆手足口病流行病学分析

目的探讨新疆手足口病的流行规律，为做好手足口病的预防与控制工作提供科学依据。方法通过国家疾病监测信息系统，对2009--2012年新疆手足口病资料进行流行病学分析。结果4年的监测资料显示，全疆手足口病流行高峰主要集中在每年的夏、秋季，而且是人口密度较大的地、州、市；男性发病数和发病率均明显高于女性，且报告病例数主要集中在0～5岁年龄段；2009年、2011年新疆手足口病以EV71感染为主，2010和2012年以CoxAl6感染为主；共报告手足口病重症（死亡）病例79例，主要在7岁以下年龄组，以散居儿童居多，其中57例为实验室诊断病例，除1例为其他肠道病毒感染、1例为CoxAl6感染以外，其余均为EV71感染。结论新疆手足口病发病地区分布广，以散发为主，人口密度大的地区聚集性病例较多，主要病原为EV71和CoxAl6，并存在其他肠道病毒感染，应加强疾病的监测，提高基层医疗机构的诊疗水平，落实幼儿个人、家庭和托幼机构的防控措施是预防手足口病的关键。     

2010年至2011年上海地区儿童手足口病肠道病毒71感染的流行病学

目的 了解2010年至2011年上海地区手足口病患儿肠道病毒71型(EV71)的临床流行特征.方法 回顾性分析因手足口病住院儿童的临床及病原学资料.患儿粪便EV71采用一步法荧光定量RT-PCR检测.数据处理采用卡方检验.结果 2010年和2011年接受病原学检测的住院患儿中,EV71检出率分别为54.45％ (820/1506)和59.84％(924/1544).在重症和无并发症患儿中EV71检出率2010年分别为86.31％(372/431)和46.67％(448/1075),差异有统计学意义(x2=247.146,P＜0.01);2011年分别为88.78％(380/428)和48.75％(544/1116),差异有统计学意义(x2=201.664,P＜0.01).上海地区手足口病流行高峰期的5至6月份EV71检出率可达60％～67％.1744例检出EV71的手足口病患儿中,男∶女为1.78∶1;6个月以下婴儿最少占0.46％(8/1744),1岁儿童最多占34.92％(609/1744),病例集中分布于1～3岁幼儿,占76.78％(1339/1744));外来流动儿童占72.76％(1269/1744).重症病例年龄及人群分布与EV71感染患儿相平行.9例合并肺水肿或肺出血的危重症手足口病患儿均为EV71感染所致.结论 EV71为近两年上海地区儿童手足口病流行的优势病原,绝大部分重症手足口病以及所有危重症病例均与EV71感染有关.     

肠道病毒71型3D蛋白研究进展

目的EV71感染可引起婴幼儿手足口病,甚至导致死亡。近年来由EV71引发的手足口病一直呈上升的流行趋势。目前中国对于手足口病的疫苗研究已进入临床试验阶段,但EV71引起的重症手足口病的发病机制仍不明确。3D蛋白主要负责病毒的复制过程,是抗病毒药物的靶点之一。本文就EV71的3D蛋白的结构功能及针对其作为靶点的抗病毒药物作一综述。     

2010年广州地区手足口病病例病原学检测结果分析

目的了解2010年广州地区手足口病病例标本中CoxA16和EV71的感染情况。方法采集临床诊断为手足口病患者的粪便,用Real-time PCR同时检测总肠道病毒、CoxA16和EV71。结果共检测手足口病病例标本1 271例,总肠道病毒阳性率为61.32%;其中,CoxA16阳性率占29.82%,EV71阳性率占70.18%。阳性标本主要分布于0~4岁患者阶段,总肠道病毒、CoxA16和EV71阳性数分别为694、209和485。结论 CoxA16和EV71为广州地区2010年手足口病的主要病原病毒,EV71占多数,0~4岁儿童是感染的主要人群。     

重症手足口病患儿合并心衰的危险因素及米力农联合美托洛尔治疗效果分析

目的分析重症手足口病患儿合并心衰的危险因素及米力农联合美托洛尔治疗效果。方法收集2012-04~2015-04该院收治的98例重症手足口病患儿的临床资料,其中并发心衰15例,无心衰83例,分析重症手足口病合并心衰的相关危险因素,观察米力农联合美托洛尔治疗重症手足口病合并心衰患儿的临床效果。结果多因素分析结果显示,呼吸急促、心率上升、血压上升、EV71感染为重症手足口病患儿发生心衰的独立危险因素(P0.05);治疗后,患儿心输出量(CO)、左心室射血分数(LVEF)上升,与治疗前比较差异有统计学意义(P0.05)。结论呼吸急促、血流动力学改变、EV71感染为重症手足口病患儿发生心衰的独立危险因素,采用米力农联合美托洛尔治疗重症手足口病合并心衰患儿,可改善其心功能,提升机体免疫功能。     

手足口病重症病例流行病学特征及影响因素分析

目的探讨手足口病重症病例的发病规律及相关危险因素。方法将2010~2014年本院191例手足口病重症患者作为研究对象。以问卷调查和实验室检测相结合的方式,收集手足口病重症病例相关资料,进行流行病学特征描述和多因素Logistic回归分析。结果本院报告手足口病重症病例发生率为4.16%。发病高峰出现在5~6月份;以3岁以下散居婴幼儿为主(占85.96%),无性别差异(P0.05),但随年龄增长呈下降趋势(P0.05);致病毒株主要为EV71,阳性率为71.73%。经Logistic回归分析,低龄、就医延迟、发热、EV71阳性是重症发病的危险因素。结论手足口病重症发生率较高,以EV71型毒株感染为主。建议加强低龄幼儿预防,及时就诊以减少重症发生。     

家庭内感染手足口危险因素分析

手足口病是由柯萨奇16（CoxAl6）、EV71等肠道病毒引起的传染性疾病，多见于于5岁以下儿童，尤其是3岁以下发病率最高。传染源主要为发病患儿及隐性感染者，主要通过消化道、呼吸道和密切接触等途径传播。     

手足口病预防控制指南（2008年版）

手足口病（Hand—foot—mouthdisease，HFMD）是由多种肠道病毒引起的常见传染病，以婴幼儿发病为主。大多数患者症状轻微．以发热和手、足、口腔等部位的度疹或疱疹为主要特征。少数患者可并发无菌性脑膜炎、脑炎、急性弛缓性麻痹、呼吸道感染和心肌炎等，个别重症患儿病情进展快，易发生死亡。少年儿童和成人感染后多不发病，但能够传播病毒。引起手足口病的肠道病毒包括肠道病毒71型（EV71）和A组柯萨奇病毒（CoxA）、埃可病毒（Echo）的某些血清型。EV71感染引起重症病例的比例较大。肠道病毒传染性强．易引起暴发或流行。为指导各地做好手足口病的预防控制．制定本指南。     

桂林地区重症手足口病135例临床分析

目的探讨2010年广西桂林地区重症手足口病的临床特点及治疗方法。方法对我院135例重症手足口病患儿的临床资料进行回顾性分析。结果病原学检测肠道病毒71型（EV71）病毒核酸阳性61例,其他肠道病毒阳性15例,阴性34例。胸片提示双肺炎症渗出86例,头颅MR I异常41例,脑电图异常19例,心电图异常80例。白细胞计数升高65例,中性粒细胞升高64例,淋巴细胞比例升高27例,血小板计数升高99例。入院前未用激素患者补体C3、C4100%升高,血清总胆汁酸（TBA）54.5%增高。结论本组患儿神经循环系统症状明显;C3、C4升高可作为早期判断手足口病的指标之一;早期识别重症患儿,早期干预治疗尤为重要。     

重症手足口病危险因素分析

目的探讨重症手足口病(hand,foot and mouth disease,HFMD)发生的危险因素,为提前预判病情并选择合适的治疗方案提供思路。方法收集2008年1月—2013年6月我院收治、确诊、系统治疗且有完整病案记录的HFMD患儿116例,其中重症HFMD 39例(重症组),普通HFMD 77例(普通组)。对21项可能与普通HFMD发展为重症HFMD的有关因素进行单因素和多因素logistic回归分析。结果与普通组相比,重症组年龄更小,首次就诊医院类型以社区/个人诊所为主,发病至首次就诊时间间隔更短,发病前1个月内有呼吸道病史的病例更多;重症组发热比例更大,发热程度更重,热程更长,呕吐发生更频繁,而手部疹、口腔溃疡或疱疹较少,更易出现神经症状如嗜睡及手足抖动;重症组血糖更高、外周血WBC计数10.8×109/L及感染肠道病毒71型(enterovirus 71,EV71)例数更多(P0.05)。而性别、是否早产、是否为低体重儿、咳嗽、足部疹和中性粒细胞百分比比较差异无统计学意义(P0.05)。进一步多因素logistic回归分析显示,影响重症HFMD发生的独立危险因素包括年龄1岁、发病至首次就诊时间间隔≤1 d、WBC计数10.8×109/L、呕吐、感染病毒为EV71(OR分别为1.982、2.296、2.359、5.553、13.127,P均0.05)。结论重症HFMD的发生与多因素有关,建议严格筛查各危险因素并提早对病情进行预判。     

An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan

In 1998, an epidemic of enterovirus 71 (EV 71) infection occurred in Taiwan. The purpose of this study was to assess the epidemiology of EV 71 infection in Taiwan. Between March 1998 and December 2005, a total of 1,548 severe cases of hand-foot-mouth disease and herpangina (HFMD/HA) was reported to the Center for Disease Control in Taiwan. A seasonal variation in number of severe cases was observed, with the annual peak in second quarter. Deaths from severe HFMD/HA varied from year to year (chi(2) for trend = 6.781, P = 0.009). Most (92%) cases occurred in children 相似文献   

Enterovirus 71 from fatal and nonfatal cases of hand, foot and mouth disease epidemics in Malaysia, Japan and Taiwan in 1997-1998

Enterovirus 71 (EV71), one of the major causative agents for hand, foot and mouth disease (HFMD), is sometimes associated with severe central nervous system diseases. In 1997, in Malaysia and Japan, and in 1998 in Taiwan, there were HFMD epidemics involving sudden deaths among young children, and EV71 was isolated from the HFMD patients, including the fatal cases. The nucleotide sequences of each EV71 isolate were determined and compared by phylogenetical analysis. EV71 strains from previously reported epidemics belonged to genotype A-1, while those from recent epidemics could be divided into two genotypes, A-2 and B. In Malaysia, genotype A-2 was more prevalent, while in Japan and Taiwan, B genotype was more prevalent. Two isolates from fatal cases in Malaysia and one isolate from a fatal case in Japan were genotype A-2. However, all isolates from three fatal cases in Taiwan belonged to genotype B. The severity of the HFMD did not link directly to certain genotypes of EV71.     

Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Infection by rhinovirus (RV) and enterovirus (EV) in children ranges from asymptomatic infection to severe lower respiratory tract infection (LRTI). This cohort study evaluates the clinical impact of RV/EV species, alone or in codetection with other viruses, in young children with severe LRTI. Seventy-one patients aged less than 5 years and admitted to the Paediatric Intensive Care Unit (PICU) of a reference children’s hospital with RV or EV (RV/EV) LRTI were prospectively included from 1/2018 to 3/2020. A commercial PCR assay for multiple respiratory pathogens was performed in respiratory specimens. In 22/71, RV/EV + respiratory syncytial virus (RSV) was found, and 18/71 had RV/EV + multiple viral detections. Patients with single RV/EV detection required invasive mechanical ventilation (IMV) as frequently as those with RSV codetection, whereas none of those with multiple viral codetections required IMV. Species were determined in 60 samples, 58 being RV. No EV-A, EV-C, or EV-D68 were detected. RV-B and EV-B were only found in patients with other respiratory virus codetections. There were not any associations between RV/EV species and severity outcomes. To conclude, RV/EV detection alone was observed in young children with severe disease, while multiple viral codetections may result in reduced clinical severity. Differences in pathogenicity between RV and EV species could not be drawn.     

An enterovirus 71 epidemic in Guangdong Province of China, 2008: epidemiological, clinical, and virogenic manifestations

Enterovirus 71 (EV71) is shown to be a major causative agent in outbreaks of hand, foot, and mouth disease (HFMD) reported in Guangdong (GD) Province of China in 2008. A total of 48,876 HFMD cases (131 severe and 21 fatal) were reported to the GD HFMD web-based surveillance system, which covers 871 clinics. The main causes of death included central nervous system damage, heart failure, and pulmonary edema. The incidence rate was 52 per 100,000, and the epidemic peak appeared in May and June. EV71 was found in 59% and coxsackievirus A16 in 26% of 936 laboratory-confirmed cases. Other viruses are likely to be responsible for the remaining 15% of cases. Of the 185 EV71 cases collected, 62% were mild, 27% were severe, and the remaining 11% were fatal. A total of 17 EV71 isolates were subjected to nucleotide sequencing of the entire VP1 gene. Phylogenetic analysis showed that the GD EV71 strains belonged to the C4 subgenotype and that EV71 circulates at a national rather than a regional level. A Comparison with the VP1 gene from a different clinical case showed that there was no obvious virulence determinant in this locus. Furthermore, this study found that most deaths occurred in rural areas, thereby indicating that delayed diagnosis and incorrect treatment may play an important role.     

神经元特异性烯醇化酶对手足口病重症病例诊断的临床意义

目的探讨手足口病(hand foot and mouth disease,HFMD)患儿的血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平对重症病例诊断的临床意义。方法收集2011年4月—2012年11月在本院儿内科治疗的320例HFMD患儿的临床资料,按临床表现分为轻症组(235例)和重症组(85例);按血清EV71抗体检测结果分为阳性组(89例)和阴性组(231例)。同时以在本院保健科体检的75名健康儿童为对照组,应用电化学发光法测定血清NSE水平。比较分析HFMD组和对照组、EV71抗体阳性组和阴性组、轻症组和重症组、HFMD并发颅内感染发病期和恢复期的NSE水平。结果血清NSE水平比较,HFMD组高于对照组;EV71抗体阳性组明显高于阴性组;重症组明显高于轻症组;重症颅内感染患儿发病期高于恢复期(P均0.05)。结论 HFMD患儿血清NSE水平升高,尤以EV71抗体阳性组最为明显。NSE水平越高,病情相对越重。NSE水平不仅是反应HFMD病程的可靠指标,也是判断病情加重趋势的有效指标。     

Clinical characteristics of COVID-19 in Osaka,Japan: Comparison of the first–third waves with the fourth wave

BackgroundThe fourth wave of COVID-19 in Osaka Prefecture, Japan, caused a medical crisis. Here, we aim to identify the risk factors for COVID-19 severity and compare patients between the first–third waves and the fourth wave.MethodsWe performed an observational retrospective study of COVID-19 cases at the National Hospital Organization Kinki-Chuo Chest Medical Center.ResultsWe identified 404 patients (median age: 71.0 years [interquartile range: 56.0–80.0]), of whom 199 (49.1%) had mild disease, 142 (35.2%) had moderate disease, and 63 (15.6%) had severe disease. The overall mortality rate was 5.4% (22/404). Based on multivariate logistic regression analysis, cardiovascular disease, fever, dyspnea, and several inflammatory biomarkers were independent risk factors for moderate to severe disease. For every 1 mg/dL increase in C-reactive protein, 10 IU/L increase in lactate dehydrogenase, and 100 ng/mL increase in ferritin, the risk for moderate to severe disease increased by 18.3%, 12.9%, and 8.9%, respectively. Overall disease severity in the fourth wave was higher than in the first–third waves. However, there was no significant difference in mortality. Because of a shortage of beds, four of the 28 severe patients (14.3%) in the fourth wave could not be transferred to the advanced hospital.ConclusionsCardiovascular disease, fever, dyspnea, and several inflammatory biomarkers were risk factors for moderate to severe COVID-19 in our cohort. During the fourth wave, COVID-19 severity worsened, increasing the number of patients who could not be transferred to beds for severe cases, resulting in a medical crisis in Osaka.     

山东省EV71和CoxA16所致手足口病重症病例流行病学及临床特征分析

目的比较EV71和CoxA16所致手足口病重症病例临床症状和体征,为手足口病的诊疗和防控提供依据。方法采用实时荧光定量RT-PCR对重症病例进行病原学分型;收集病例基本信息和临床资料,对2010年确诊的EV71和CoxA16所致手足口病重症病例的临床特征进行比较分析。结果 EV71与CoxA16所致手足口病重症患者主要为3岁以下儿童(占81.61%),患者平均年龄为2.30岁(0.20～16.39岁)。EV71所致重症患者最高体温为(38.75±0.04)℃,CoxA16所致重症患者为(38.60±0.07)℃,差异无统计学意义(t=-1.61,P>0.05);两种病毒所致重症患者口腔部位皮疹、咳嗽、流涕和心率加快发生率差异均有统计学意义(P<0.05),其他症状和体征均一致。结论 CoxA16与EV71所致重症手足口病患者临床特征基本一致,均引起严重并发症。应加强对CoxA16感染的监测和防控。     

Association of Chemotactic Chemokine Ligand 5 Polymorphisms with the Risk of Developing Severe Enterovirus 71 Infection

Respiratory damage is a main manifestation of severe Enterovirus 71 (EV71) infection. Polymorphisms of -403G/A (rs2107538), -28C/G (rs2280788), and In1.1T/C (rs2280789) in chemotactic chemokine ligand 5 (CCL5) have linked with many respiratory diseases. In this study, we explored the possible correlation of CCL5 polymorphisms with severe EV71 infection. Blood samples were obtained from 87 children hospitalized for EV71 infection. Fifty-seven healthy children were enrolled as asymptomatic controls. Genotype and allele frequencies were analyzed by logistic regression analysis. There were statistically significant differences in polymorphisms of CCL5 -403G/A and In1.1T/C for dominant model (P = 0.016; P = 0.027) and additive model (P = 0.010; P = 0.019) between patients with severe EV71 infection and asymptomatic controls. With ordinal logistic regression model analysis, statistically significant differences were found between polymorphisms of CCL5 (-403G/A) (P = 0.034) with the severity of EV71 infection after adjusting for age. The frequency of A-C-C haplotype was significantly higher in EV71 infection patients than controls (P = 0.032). These results suggest that CCL5 -403G/A and In1.1T/C polymorphisms may contribute to severe EV71 infection and individuals with haplotype of A-C-C may exhibit higher risk of developing severe EV71 infection. These findings may provide insights into pathogenic and protective mechanisms of severe EV71 infection.