2015年徐州市及周边地区手足口病流行特征及病原学分析

目的分析手足口病(HFMD)住院患儿病原体类型及流行特征，为手足口病防治提供参考依据。 方法收集2015年度徐州市儿童医院手足口病住院患儿的临床资料，分析患儿人口学特征、发病特点、临床表现，并进行问卷调查。采集患儿粪便标本，提取病毒RNA后采用荧光定量PCR法对样本进行肠道病毒71(EV71)型、柯萨奇病毒A16(CoxA16)型病原学检测。 结果2015年度本院共收治手足口病患儿2 792例，其中男1 842例，女950例；重症10例，死亡3例；年龄72 d～11岁。3～7月份为手足口病高发期，入组患者共发病1 738例(62.24%)，4月达到顶峰，发病425例(15.22%)。发病人群集中在1～3岁幼儿(1 471例、52.68%)，且以散童及幼托为主，其中留守儿童占29.98%(837/2 792)，二次感染患儿占19.99%(558/2 792)。患儿近3个月患呼吸道或消化道疾病，营养状态差以及家长文化程度相对低的患儿在本院手足口病人群中所占比例较高，分别为39.68%(1 108/2792)、59.81%(1 670/2 792)和64.97%(1 814/2 792)。病原学检测显示：EV71阳性率为56.23%(1 570/2 792)，CoxA16阳性率为13.83%(386/2 792)，其他肠道病毒阳性率为30.59%(854/2 792)。收集HFMD合并病毒性脑炎患儿家长大便标本共102例，病原学检测显示其中44例(43.14%)EV71阳性。 结论2015年徐州市及周边地区手足口病患儿仍较多，并以EV71感染为主；留守儿童及二次感染患儿中重症患者比例较高且病情更重；成人隐性感染可能成为另一种重要的传染源。

Epidemiological characteristics and etiological analysis of hand,foot and mouth disease in Xuzhou and the surrounding area in 2015

ObjectiveTo investigate the pathogen types and epidemic characteristics of the hospitalized children with hand, foot and mouth disease (HFMD), and to provide reference for the prevention and treatment of HFMD. MethodsThe clinical data of the hospitalized children with HFMD in Xuzhou Children’s Hospital during 2015 were collected, the demographic characteristics and clinical manifestations were analyzed, and an epidemiological investigation was carried out. The fecal samples were collected and virus RNA was detected by real-time fluorescence quantitative PCR for enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16). ResultsDuring 2015, a total of 2 792 cases with HFMD were collected, including 1 842 males and 950 females, 10 severe cases and 3 death cases. The age was from 72 days to 11 years old. Patients with HFMD mainly concentrated around March to July. A total of 1 738 cases (62.24%) were diagnosed and the peak was reached in April with 425 diagnosed cases (15.22%). The children with HFMD were concentrated among 1-3 years old (1 471 cases, 52.68%), and residentially-scattered children and childcare were the main targets of HFMD, among which stay-at-home children and secondary children accounted for 30% (837/ 2 792) and 20% (558/2 792), respectivly. Children suffered from respiratory or digestive tract diseases (39.68%, 1 108/2 792) within the last three months, poor nutritional status (59.81%, 1 670/2 792) and lower educational level of parents (64.97%, 1 814/2 792) were susceptible to HFMD. Etiological examination showed that the positive rate of EV71 was 56.2% (1 570/2 792), the positive rate of CoxA16 was 13.1% (368/ 2 792), and that of other enterovirus was 30% (854/2 792). The fecal specimens (102 cases) of the parents whose children suffered from HFMD and viral encephalitis were collected, and 44 samples were positive for EV71. ConclusionsIn Xuzhou and the surrounding areas, there were still more children with HFMD in 2015, and EV71 infection was the main infection. The proportion of severe patients in stay-at-home children and children with secondary infection was higher and the disease was more serious. The latent infection in adults might become another important source of infection.