2012年顺义区手足口病聚集性疫情病例及重症病例病原学结果分析

目的：通过对手足口病聚集性病例和重症病例进行病原学检测，发现该地区手足口病原体的类型，为手足口病防控提供病原学依据。方法通过临床医生和流调人员采集符合聚集性疫情的手足口病病例和诊断为重症病例的咽拭子标本，应用RT-PCR方法检测原始样本和分离阳性病毒株中EV、EV71和CoxA16病毒的核酸。结果聚集性疫情病例咽拭子标本共276例，共分离出病毒125例，阳性率为45.29%；其中EV71阳性率为17.75%（49/276），CoxA16阳性率为26.09%（72/276），其他EV阳性率为1.45%（4/276）。重症病例咽式子标本共21例，共分离出病毒8例，阳性率为38.09%；其中EV71阳性率为9.52%（2/21），CoxA16阳性率为23.81%（5/21），其他EV阳性率为4.76%（1/21）。聚集性疫情病例中散居儿童、学生中CoxA16的检出率高于托幼儿童，其差异有统计学意义（χ2=3.843，P=0.050和χ2=8.048，P=0.005）。结论顺义区手足口病聚集性疫情病例和重症病例均以CoxA16病毒感染为主。聚集性疫情病例以托幼儿童为主，重症病例以散居儿童为主。应加强手足口病的病原学监测，为落实防控措施及明确临床诊断提供实验室依据。

Etiological analysis of clustering and severe case of hand,foot and mouth disease in Shunyi District in 2012

Objective To understand the type and distribution of the pathogen according to pathogen detec-tion of clustering and severe case of hand, foot and mouth disease （HFMD）, and to provide scientific evidence for HFMD prevention and control. Methods Throat swab of clinically diagnosed cases with clustering and severe case of HFMD were collected by clinical and epidemiological investigation doctor. Nucleic acid of three types of virus, en-tervirus （EV）, entervirus 71 （EV71） and Coxasckievirus A16 （CoxA16） was detected by RT-PCR both in original sam-ples and isolated positive virus strains. Results Of the 276 diagnosed clustering cases, 125 cases （45.29%） were test-ed positive, including 49 cases （17.75%） of EV71 positive, 72 cases （26.09%） of CoxA16 positive, and 4 cases （1.45%） of EV positive. Of 21 diagnosed severe cases, 8 cases （38.09%） were tested positive, including 2 cases （9.52%） of EV71 positive, 5 cases （23.81%） of CoxA16 positive, and 1 case （4.76%） of EV positive. The positive rate of CoxA16 were significantly higher in scattered children and students than kindergartens children （χ2=3.843, P=0.050 andχ2=8.048, P=0.005）. Conclusion The clustering and severe cases of HFMD are mainly caused by CoxA16 in Shunyi District of Beijing. The clustering cases of HFMD are mainly from kindergartens children, and the severe cas-es of HFMD mainly come from students. The pathogen detection of HFMD should be carried out in hospital, to pro-vide etiology basis for clinical diagnoses of HFMD and for practicable prevention and control.