海南省琼南地区2012—2021年手足口病病原学特征分析

目的 分析海南省琼南地区2012—2021年手足口病的病原学特征,为琼南地区手足口病防控措施的制定提供依据。方法 收集手足口病患者咽拭子或肛拭子标本共3 359份,采用荧光定量PCR进行肠道病毒核酸检测分型,使用统计软件SPSS进行统计分析。结果 3 359份标本中共检出肠道病毒（HEV）阳性标本1 588份,总阳性率为47.28％,EV71、CoxA16 和其他肠道病毒构成比分别为 15.37％、23.11％和61.52％,以其他肠道病毒感染为主;2012—2021年的HEV阳性率总体呈V型变化趋势,总阳性率最高为2021年,为66.77%,最低为2016年,为29.32%,不同年份各类病原构成比差异有统计学意义（χ²=394.705,P<0.001）;10年间,海南省琼南地区的 EV71类型手足口病感染率呈逐年下降趋势,有3个监测年度以CoxA16为优势流行毒株,有7个监测年度以其他肠道病原流行为主,为61.52%;2020—2021年期间以CoxA6型（51.55%）和CoxA16型（30.70%）为主。阳性病例数主要集中在3—12月份,7月份左右为最高峰。男女性别阳性率差异无统计学意义（χ²=0.364,P>0.05）,0~3岁年龄组阳性标本数最多,占总阳性数的84.13%。琼南地区五指山市阳性率最高,为62.61％,三亚市阳性率最低,为37.75%。肛拭子标本的阳性率高于咽拭子标本,两者差异有统计学意义（χ²=78.081,P<0.001）。结论 其他肠道病原在海南省琼南地区流行逐渐增强,提示应关注、加强对开展其他肠道病毒病原学的检测和分型,有助于本地区手足口病的预防和控制。

Etiological characteristics analysis of hand-foot-mouth disease in South Hainan, 2012-2021

Objective To analyze the etiology of throat swabs or anal swabs from patients with hand-foot-mouth disease in South of Hainan from 2012-2021, and provide effective prevention and control measures for the diagnosis and treatment of hand-foot-mouth disease in the region. Methods We collected 3 359 throat swabs or anal swabs from patients with hand-foot-mouth disease. Fluorescence quantitative PCR was used for enterovirus detection typing, statistical software were used for statistical analysis. Results A total of 1 588 positive samples for enterovirus (HEV) were detected in 3 359 samples, with a total positive rate of 47.28%. The proportions of EV71, CoxA16 and other enteroviruses were 15.37%, 23.11% and 61.52%, and other enterovirus infections were the main ones; the positive rate of HEV from 2012 to 2021 showed a V-peak trend, the highest total positive rate was in 2021, accounting for 66.77%, and the lowest was 2016, accounting for 29.32%, the difference in the composition ratio of various types of pathogens in different years was statistically significant (χ²=394.705,P<0.001); In the past 10 years, the EV71 type of hand-foot-mouth disease infection in South Hainan showed a downward trend year by year. CoxA16 was the dominant epidemic strain in 3 monitoring years, and other enteric pathogens were predominant in 7 monitoring years, accounting for 61.52%; CoxA6 (51.55%) and CoxA16 (30.70%) were dominant in 2020-2021. The number of positive cases was mainly concentrated in March-December, with the peak around July. There was no difference in the positive rate between men and women (χ²=0.364,P>0.05), 0-3 years old age group had the largest number of positive specimens, accounting for 84.13% of the total number of positives. Wuzhishan City in South Hainan had the highest positive rate, accounting for 62.61%, and Sanya City had the lowest positive rate, accounting for 37.75%. The positive rate of anal swabs was higher than that of throat swabs, and the difference was statistically significant (χ²=78.081, P<0.001). Conclusion The prevalence of other enteroviruses in South Hainan is gradually increasing, suggesting that attention should be paid to and strengthening the detection and typing of other enterovirus pathogens, which is helpful for the prevention and control of hand, foot and mouth disease in this area.