手足口病流行病学及病原学研究
发布时间：2018-07-16 21:06
【摘要】： 目的 本研究的主要目的是通过分析2008年山东省手足口病疫情资料、住院病例个案调查信息和重症病例主动调查资料,描述手足口病流行病学特征,探索病因及其主要危险因素。同时,运用肠道病毒分离鉴定和逆转录-多聚酶链反应(RT—PCR)快速诊断等方法,了解该地区手足口病的分子流行病学特征,并对不同流行区分离到的肠道病毒主要流行毒株进行比较研究,探索病原变迁规律。 材料与方法 所有病例信息来源于来自国家疾病监测信息管理系统。人口资料来自山东省统计局2008山东统计年鉴。个案调查资料来自县级疾控机构上报的住院病例个案调查表。各类临床标本取自各级医疗机构住院病例,共对采集的1837份粪便标本、咽拭子、疱疹液、脑脊液、急性期血和恢复期血标本进行了实验室检测。标本检测方法参照卫生部《手足口病预防控制指南(2008年版)》规定的方法进行;以病毒分离和RT-PCR方法对2008年山东省手足口病临床标本进行了病原学的初步筛查。以上所得结果用Epi info 3.4.3软件进行统计学分析处理。 结果 2008年全省报告手足口病病例32974例,发病率为35.2023/10万。1-12月均有手足口病疫情报告,发病高峰集中在5-7月份。男女性别比为1.80:1,男性发病率显著高于女性;发病年龄集中在5岁以下,尤以2岁组发病率最高,各年龄别发病率之间存在差异性。全省病例分布广泛,全部17个市、140个县(市、区)及90.42%的乡(镇、街办)有病例报告,各市发病率之间存在显著性差异,人口密度高的市辖区手足口病发病率高于人口密度较低的县(市)地区。多数地区疫情以散发为主,局部地区出现聚集性发病。绝大多数病例表现为典型的的手、足、口等部位皮疹,除EV71和Cox A16合并感染所致出现手部皮疹病例数略高于其他型别外,其他不同型别肠道病毒所致病例出现发热、足部皮疹、臀部皮疹、口腔黏膜疹和并发症等症状无显著差异,病例临床症状普遍较轻微,出现并发症者少见,预后良好,无致死病例出现。病原学和分子生物学结果显示2008年引起全省手足口病流行的病原体主要为EV 71和Cox A16,二者所致病例占到了实验室确诊病例的66.00%,其他肠病毒型别占34.00%,其中流行优势毒株为EV 71,而且存在EV 71和Cox A16交叉感染的病例,交叉阳性者占到了实验室确诊病例的24.4%。引起山东省重症病例的肠道病毒型别为EV 71。大多数手足口病病例没有明确的流行学接触史。 结论 2008年山东省手足口病地区分布广泛,多以散发为主,引起手足口病流行的病原体主要为EV 71和Cox A16,流行优势毒株为EV 71,存在EV 71和Cox A16交叉感染的病例。加强监测,做好儿童个人、家庭和托幼机构的防控措施落实是预防手足口病的关键。
[Abstract]:Objective the main purpose of this study was to describe the epidemiological characteristics of hand-foot-mouth disease by analyzing the epidemic data of hand-foot-mouth disease in Shandong Province in 2008, the information of in-patient case investigation and the active investigation of severe cases. To explore the etiology and its main risk factors. At the same time, the molecular epidemiological characteristics of hand, foot and mouth disease in this area were studied by means of isolation and identification of enterovirus and rapid diagnosis by reverse transcription-polymerase chain reaction (RT-PCR). The main enterovirus strains isolated in different epidemic areas were compared and studied to explore the rules of pathogen change. Materials and methods all case information comes from the National Disease Surveillance Information Management system. Population data from Shandong Statistical Bureau 2008 Shandong Statistical Yearbook. Case investigation data from county-level disease control institutions reported inpatient cases questionnaire. 1837 stool specimens, pharynx swabs, herpes fluid, cerebrospinal fluid, acute blood samples and convalescent blood samples were collected from all kinds of medical institutions. The method of specimen detection was carried out according to the method stipulated by the Ministry of Health "guidelines for the Prevention and Control of Hand-foot-mouth Disease (2008)", and the clinical specimens of hand-foot-mouth disease in Shandong Province in 2008 were screened by virus isolation and RT-PCR. The above results were analyzed with Epi info 3.4.3 software. Results 32974 cases of hand-foot-mouth disease were reported in the province in 2008. The incidence of HFMD was 35.2023 / 100,000.JanuaryDecember, the epidemic situation of hand-foot-mouth disease was reported, the peak of which was in May-July. The male / female sex ratio was 1.80: 1, the incidence rate of male was significantly higher than that of female, and the incidence age was mainly under 5 years old, especially in the group of 2 years old. Cases were widely distributed in all 17 cities, 140 counties (cities, districts) and 90.42% of townships (towns, street offices) reported cases. The incidence of HFMD in high population density areas is higher than that in counties (cities) with low population density. In most areas, the epidemic was mainly sporadic, and the local area was characterized by aggregation. Most of the cases showed typical rash of hand, foot, mouth, etc. Except for EV71 and Cox A16 co-infection, the number of cases of hand rash was slightly higher than that of other types, other types of enterovirus caused fever and foot rash. There was no significant difference in the symptoms of rashes oral mucosa rash and complications. The clinical symptoms of the cases were generally mild the complications were rare and the prognosis was good. There were no fatal cases. Etiology and molecular biology showed that EV71 and Cox A16 were the main pathogens causing HFMD epidemic in the province in 2008. The two cases accounted for 66.00% of laboratory confirmed cases, while other enterovirus types accounted for 34.00%. EV71and EV71 and Cox A16 cross infection cases, Cross-positive patients accounted for 24. 4% of laboratory confirmed cases. The type of enterovirus causing severe cases in Shandong Province is EV 71. Most HFMD cases do not have a clear history of epidemiological contact. Conclusion Hand-foot-mouth disease was widely distributed in Shandong Province in 2008 and was mainly sporadic. The main pathogens causing HFMD were EV71 and Cox A16, and the predominant strains were EV71.There were cases of EV71 and Cox A16 cross infection. The key to the prevention of HFMD is to strengthen surveillance and implement the prevention and control measures for individual children, families and child-care institutions.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R725.1;R181.3
本文编号：2127669
[Abstract]:Objective the main purpose of this study was to describe the epidemiological characteristics of hand-foot-mouth disease by analyzing the epidemic data of hand-foot-mouth disease in Shandong Province in 2008, the information of in-patient case investigation and the active investigation of severe cases. To explore the etiology and its main risk factors. At the same time, the molecular epidemiological characteristics of hand, foot and mouth disease in this area were studied by means of isolation and identification of enterovirus and rapid diagnosis by reverse transcription-polymerase chain reaction (RT-PCR). The main enterovirus strains isolated in different epidemic areas were compared and studied to explore the rules of pathogen change. Materials and methods all case information comes from the National Disease Surveillance Information Management system. Population data from Shandong Statistical Bureau 2008 Shandong Statistical Yearbook. Case investigation data from county-level disease control institutions reported inpatient cases questionnaire. 1837 stool specimens, pharynx swabs, herpes fluid, cerebrospinal fluid, acute blood samples and convalescent blood samples were collected from all kinds of medical institutions. The method of specimen detection was carried out according to the method stipulated by the Ministry of Health "guidelines for the Prevention and Control of Hand-foot-mouth Disease (2008)", and the clinical specimens of hand-foot-mouth disease in Shandong Province in 2008 were screened by virus isolation and RT-PCR. The above results were analyzed with Epi info 3.4.3 software. Results 32974 cases of hand-foot-mouth disease were reported in the province in 2008. The incidence of HFMD was 35.2023 / 100,000.JanuaryDecember, the epidemic situation of hand-foot-mouth disease was reported, the peak of which was in May-July. The male / female sex ratio was 1.80: 1, the incidence rate of male was significantly higher than that of female, and the incidence age was mainly under 5 years old, especially in the group of 2 years old. Cases were widely distributed in all 17 cities, 140 counties (cities, districts) and 90.42% of townships (towns, street offices) reported cases. The incidence of HFMD in high population density areas is higher than that in counties (cities) with low population density. In most areas, the epidemic was mainly sporadic, and the local area was characterized by aggregation. Most of the cases showed typical rash of hand, foot, mouth, etc. Except for EV71 and Cox A16 co-infection, the number of cases of hand rash was slightly higher than that of other types, other types of enterovirus caused fever and foot rash. There was no significant difference in the symptoms of rashes oral mucosa rash and complications. The clinical symptoms of the cases were generally mild the complications were rare and the prognosis was good. There were no fatal cases. Etiology and molecular biology showed that EV71 and Cox A16 were the main pathogens causing HFMD epidemic in the province in 2008. The two cases accounted for 66.00% of laboratory confirmed cases, while other enterovirus types accounted for 34.00%. EV71and EV71 and Cox A16 cross infection cases, Cross-positive patients accounted for 24. 4% of laboratory confirmed cases. The type of enterovirus causing severe cases in Shandong Province is EV 71. Most HFMD cases do not have a clear history of epidemiological contact. Conclusion Hand-foot-mouth disease was widely distributed in Shandong Province in 2008 and was mainly sporadic. The main pathogens causing HFMD were EV71 and Cox A16, and the predominant strains were EV71.There were cases of EV71 and Cox A16 cross infection. The key to the prevention of HFMD is to strengthen surveillance and implement the prevention and control measures for individual children, families and child-care institutions.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R725.1;R181.3
【引证文献】
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2 裴耀文;李忠;张华宁;吕慧;孙娜;张岩;王爽;王宇路;王显军;;2009年山东省手足口病病例的病原学检测分析[J];中华疾病控制杂志;2010年08期
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1 裴耀文;李忠;张华宁;吕慧;孙娜;张岩;王爽;王宇路;王显军;;2009年山东省手足口病病例的病原学检测分析[A];华东地区第十次流行病学学术会议暨华东地区流行病学学术会议20周年庆典论文集[C];2010年
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1 尹颖;健康管理理念在手足口病防控中的应用研究[D];南京医科大学;2011年
2 阴珊珊;泰安市肠道传染病发病趋势与流行特征分析[D];泰山医学院;2012年
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