2013 - 2018年昆明市重症手足口病实验室监测结果分析

目的 了解昆明市2013 - 2018年重症手足口病实验室监测病例的病原学特征和监测病例分布特征。方法 收集本市6年间临床诊断为手足口病重症的病例标本，应用Real Time RT - PCR技术检测肠道病毒通用型( EV - U) 、肠道病毒71型( EV71) 、柯萨奇病毒A组16 型( CVA16)。结果 1 221份标本中，肠道病毒阳性率为61.51%；其中EV71型263份，阳性率21.54%；CVA16型111份，阳性率9.09% ； 非EV71 /CVA16 型的其它肠道病毒377份，阳性率30.88%。本市重症手足口病例每月均有发生，流行时间分布呈单峰模式，集中在4 - 7月份，男性病例数明显高于女性（χ2 = 6.834，P＜0.01），1～3岁发病最多（76.7%）。重症病例报告数居前四位的是官渡区、西山区、五华区和盘龙区。粪便标本阳性率明显高于肛拭和咽拭。结论 昆明市重症手足口病发病分布有明显季节性、人群和地区分布特征，非EV71/CVA16的其他肠道病毒是主要病毒体，重症手足口病发病呈下降趋势。应加强4 - 7月的防控工作及城区1～3岁男童手足口病患的监测工作，并提高 EV71 灭活疫苗的接种率，以降低手足口病重症的发生率。

Analyses of laboratory surveillance results for severe hand-foot-mouth disease from 2013 to 2018 in Kunming

Objective The study aimed to investigate the characteristics of etiology and distribution about monitored severe hand-foot-mouth disease(HFMD) cases in Kunming during 2013-2018. Methods Specimens were collected from patients who were diagnosed as severe HFMD in Kunming from 2013 to 2018. All these strains were amplified by RT-PCR to detect general enterovirus(EV-U), EV71 and CVA16. Results Among 1221 samples, the positive rate of enterovirus was 61.51%.There were 263 cases of EV71, with a positive rate of 21.54%, 111 cases of CVA16, with a positive rate of 9.09% and 377 other enteroviruses, with a positive rate of 30.88%. The severe HFMD occurred every month, especially between April and July, which was characterized by a single peak. The number of cases in male was significantly higher than that of female(χ2=6.834, P<0.01). Most cases occurred between the ages of 1 and 3, accounting for 76.7%. The number of cases detected in Guandu, Xishan, Wuhua and Panlong ranked top four in Kunming. The positive rate of fecal specimen was significantly higher than cloacal and throat swab. Conclusion Incidence of severe HFMD in Kunming differs significantly with season,crowd and district. Other enteroviruses have become dominant epidemic strains. And the incidence of severe HFMD shows a declining trend in Kunming. We should enhance monitoring work about 1-3 year old males in main urban districts and prevention and control measures during April and July. In the meantime, we have to raise EV71 vaccination rates to decrease the morbidity of severe HFMD.