甘肃省2008~2012年手足口病流行特征及病原学研究

发布时间：2018-12-30 11:53

【摘要】：分析甘肃省手足口病流行特征及病原学特征,为制定有效的防控策略提供依据。采用描述性流行病学分析方法对甘肃省手足口病发病资料进行分析,采集的病例临床标本用RT-PCR或Real-time PCR法检测肠道病毒(Human enterovirus,HEV)核酸,用RD和HEp-2细胞分离病毒,阳性病毒株采用RT-PCR方法扩增全长VP1编码区后,进行核苷酸序列测定和分析。结果表明2008~2012年共报告手足口病病例52 550例,包括重症病例205例,死亡病例27例。5年全省发病率依次为22.42/10万、49.29/10万、47.20/10万、27.27/10万和55.84/10万,全省14个市州均有发病,兰州市发病数最高为16 001例,占全省病例的30.45%,发病集中在5~7月,占全年病例的51.69%,男女性别比为1.69∶1,其中5岁以下儿童发病占87.59%。对5 416例病例标本进行了实验室检测,HEV核酸阳性3 322例(阳性率61.34%),其中肠道病毒A组71型(Enterovirus A71,EV 71)占46.96%,柯萨奇病毒A组16型(Coxsackievirus A16,CVA16)占41.57%,其他HEV占11.47%。对186例重症病例进行实验室检测,HEV核酸阳性114例(阳性率61.29%),其中EV 71占82.46%;对25例死亡病例进行实验室检测,均为EV71感染。从3 111份临床标本(咽拭子2123份,粪便705份,疱疹液705份)分离到病毒402株,其中EV71占70.15%,CVA16占27.11%,其它柯萨奇A组病毒占3.98%,柯萨奇B组病毒占2.49%,埃可病毒占1.74%,腺病毒占1.99%。流行HEV的基因型分析结果显示,2008~2012年分离到的194株EV71均为C4基因亚型的C4a进化分支;45株CVA16均为B1基因亚型,其中12株属于B1a进化分支,33株属于B1b进化分支,2012年B1b已成优势亚型。结论是甘肃省手足口病在5岁以下儿童感染率最高,主要病原为EV 71和CVA16,发病率随感染病原型别的不同呈现波浪形变化,不同病原呈现交替流行的现象,重症和病死病例与EV71感染密切相关,同一年度不同地区的病原型别存在差异。
[Abstract]:The epidemic and etiological characteristics of hand, foot and mouth disease in Gansu Province were analyzed in order to provide basis for effective prevention and control strategy. The incidence data of hand, foot and mouth disease in Gansu Province were analyzed by descriptive epidemiological analysis. RT-PCR or Real-time PCR methods were used to detect enterovirus nucleic acid (Human enterovirus,HEV) in clinical samples, and RD and HEp-2 cells were used to isolate the virus. The full-length coding region of VP1 was amplified by RT-PCR, and the nucleotide sequence was determined and analyzed. The results showed that 52,550 hand-foot-mouth disease cases were reported from 2008 to 2012, including 205 severe cases and 27 death cases. The incidence of HFMD in the whole province in 5 years was 22.42 / 100,000, 49.29 / 100,47.20 / 100000, respectively. 27.27 / 100, 000 and 55.84 / 100, 000, all 14 cities and states of the province have the disease. The highest number of cases in Lanzhou is 16 001 cases, which accounts for 30.45% of the cases in the province. The incidence is concentrated between May and July, accounting for 51.69% of the cases in the whole year. The ratio of male to female was 1.69: 1, of which 87.59 was in children under 5 years of age. The positive rate of HEV nucleic acid was 61.34% (3 322 / 5416 cases), among which Enterovirus A 71 (Enterovirus A71 EV71) accounted for 46.96%, Coxsackie virus A group 16 (Coxsackievirus A16), Coxsackie virus A group 16 (Coxsackievirus A16), coxsackievirus A group 16 (Coxsackievirus A16). CVA16 accounted for 41. 57 and other HEV for 11. 47. HEV nucleic acid was positive in 114 cases (61.29%), of which EV 71 accounted for 82.46%, 25 dead cases were detected in laboratory, all of them were EV71 infection. The virus was isolated from 3 111 clinical specimens (2123 throat swabs, 705 feces and 705 herpes fluid), of which EV71 accounted for 70.15% and CVA16 for 27.11%, and other Coxsackie A viruses for 3.98%. Coxsackie B virus accounted for 2.49%, Eco virus 1.74 and adenovirus 1.99%. The genotypic analysis of prevalent HEV showed that the 194 strains of EV71 isolated from 2008 to 2012 were all C4a evolutionary branches of C4 gene subtype. All 45 strains of CVA16 belonged to B1 gene subtype, of which 12 belonged to B1a evolutionary branch and 33 belonged to B1b evolutionary branch. B1b had become the dominant subtype in 2012. Conclusion the infection rate of hand, foot and mouth disease in Gansu Province is the highest in children under 5 years old. The main pathogens are EV 71 and CVA16, and the incidence rates of CVA16, and hand foot and mouth disease are wavy with different prototypes of infection, and different pathogens are alternately prevalent. Severe and death cases were closely related to EV71 infection, and the types of pathogens varied in different regions in the same year.
【作者单位】：甘肃省疾病预防控制中心;中国疾病预防控制中心病毒病预防控制所卫生部医学病毒与病毒病重点实验室;
【基金】：“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项(2012ZX10004-208)
【分类号】：R725.1;R181.3

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