2010年济南地区手足口病病原及流行特征

目的 探讨2010年济南地区手足口病的病原及流行特征,为手足口病防控提供科学依据.方法 选取济南地区3家代表性医院临床诊断为手足口病的病例为对象,采集患者(包括40例重症病例)发病1周内的粪便、咽拭子等标本共计808例,采用肠道病毒( enterovirus,EV)通用和肠道病毒71型(EV71)、柯萨奇病毒A组16型( coxsackievirus A16,CoxA16)特异性引物进行反转录聚合酶链反应(RT-PCR)鉴定；选取7例病例标本进行EV7I-VP1区基因的扩增和核苷酸序列测定.结果 808例患者标本中,581例检测结果为阳性(71.91％),其中190例为EV71阳性(32.70％),267例为CoxA16阳性(45.96％),124例检测到其他肠道病毒(21.34％)；40例重症患者的感染病原主要为EV71(75.00％).阳性病例中男女性别比为1.42∶1,发病年龄主要集中在4岁以下儿童(85.15％),尤其是2～3岁年龄段(28.34％)；全年均有发病,但发病高峰主要集中于4～5月份(36.14％).7株EV71经基因测序,证实均为C4b基因亚型.结论 济南地区手足口病病原以CoxA16和EV71为主,病例多为4岁以下儿童,重症患者主要由EV71感染引起.

Characteristics of etiology and epidemiology of hand, foot and mouth disease in Jinan City, 2010

Objective To study the characteristics on etiology and epidemiology of hand,foot and mouth disease（HFMD） in Jinan,2010,and provide scientific basis for prevention and control of this disease.Methods Specimens including stool and pharynx swabs were collected from 808 clinically-diagnosed cases of HFMD（including 40 severe cases） in Jinan,2010,and the RT-PCR analysis was used with universal primers within 5＇untranslated region of enterovirus and VP1 region of coxsackievirus A16（CoxA16） and enterovirus 71（EV71） to assay enteroviruses in children with HFMD.The VP1 genes of EV71 from EV71 positive cases were amplified by RT-PCR and sequences were analyzed.Results The positive rate of enterovirus was 71.91%（581/808）.Of the 581 cases,190（32.70%） were positive for EV71,267（45.96%） were positive for CoxA16,and 124（21.34%） were negative for both EV71 and CoxA16.The major pathogen of 40 severe HFMD were EV71（75.00%）.In positive cases,the majority was male;the age of most cases was less than 4 years old（85.15%）,especially in 2-3 years old group（28.34%）;and the high-occurrence season of HFMD was from April to May（36.14%）in Jinan,2010.Gene sequence analysis for 7 strains of EV71 PCR positive products presented as the same C4b.Conclusions The major pathogens of HFMD cases are EV71 and CoxA16 in Jinan.Children less than 4 years old are susceptible to HFMD,and severe cases of HFMD were mainly caused by EV71.