2011－2021年湖北省荆州市手足口病流行特征及病原学监测分析

刘天; 肖新宇; 吴杨; 陈琦; 阮德欣; 姚梦雷; 侯清波; 黄继贵; 陈红缨

doi:10.3784/jbjc.202206220284

2011－2021年湖北省荆州市手足口病流行特征及病原学监测分析

doi: 10.3784/jbjc.202206220284

刘天^1,,
肖新宇^{2, 3,},
吴杨⁴,
陈琦⁴,
阮德欣¹,
姚梦雷¹,
侯清波¹,
黄继贵¹,
陈红缨^4, ,

1.
荆州市疾病预防控制中心传染病防治所, 湖北荆州 434000
2.
荆州市疾病预防控制中心, 湖北荆州 434000
3.
湖北一线现场流行病学培训项目, 湖北武汉 430079
4.
湖北省疾病预防控制中心, 湖北武汉 430079

详细信息

作者简介:
刘天，男，湖北省荆州市人，主管医师，主要从事急性传染病防制工作，Email：jzcdclt@163.com

肖新宇，女，湖北省荆州市人，助理医师，主要从事急性传染病防制工作，Email：981699403@qq.com

通讯作者:
陈红缨，Tel：0716–8100252 ，Email：348166087@qq.com

中图分类号: R211; R373
计量
- 文章访问数: 445
- HTML全文浏览量: 228
- PDF下载量: 89
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-22
- 网络出版日期: 2023-03-17
- 刊出日期: 2023-04-30

Epidemiological and etiological characteristics of hand foot and mouth disease in Jingzhou, Hubei, 2011−2021

Liu Tian^1
,,
Xiao Xinyu^{2, 3
,},
Wu Yang⁴,
Chen Qi⁴,
Ruan Dexin¹,
Yao Menglei¹,
Hou Qingbo¹,
Huang Jigui¹,
Chen Hongying^{4
, ,}

1.
Department for Infectious Disease Control and Prevention, Jingzhou Prefectural Center for Disease Control and Prevention, Jingzhou 434000, Hubei, China
2.
Jingzhou Center for Disease Control and Prevention, Jingzhou 434000, Hubei, China
3.
Hubei Frontline Field Epidemiology Training Program, Wuhan 430079, Hubei, China
4.
Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, Hubei, China

More Information

Corresponding author: Chen Hongying, Email: 348166087@qq.com

摘要

摘要: 目的描述2011—2021年湖北省荆州市手足口病（HFMD）流行病学特征，分析重症病例危险因素，为该地区HFMD防制提供科学依据。方法自《中国疾病预防控制信息系统》收集荆州市HFMD病例、病原学监测结果、聚集性和暴发疫情资料。采用描述性流行病学方法描述HFMD三间分布特征，计算发病率、重症率、占比、标本检测阳性率及亚型占比。采用logistic回归分析HFMD重症的危险因素。结果 2011—2021年荆州市累计报告HFMD 62 521例，年均发病率100.87/10万，重症数146例，重症率0.23%，死亡5例，病死率0.80/万，重症死亡率3.42%。发病率随年份无明显趋势变化（$ {{{r}}_{\rm{s}}} $=−0.21，P=0.539）；重症率随年份呈下降趋势（$ {{{r}}_{\rm{s}}} $=−0.66，P= 0.031）。 HFMD发病呈双峰型特点（4—6月和11—12月）；县（市/区）发病率介于51.85/10万～140.23/10万，高发地区随年份不断变化；人群分类以散居儿童（69.58%）和幼托儿童（28.18%）为主，男性（59.01/10万）发病率高于女性（41.66/10万，RR=1.42，95%CI：1.39～1.44）；以5岁以下儿童（96.08%）为主。男性相较女性、低年龄儿童、中心城区相较江南片区、流行季节、发病至就诊时间长更易进展为重症病例（均比值比>1，均P<0.05）。肠道病毒71型（ EV71）为重症病例（53.57%）和死亡病例（80.00%）主要病原。报告聚集性疫情89起和暴发疫情5起，发生场所以幼托机构（87起，92.55%）为主。病原学监测阳性率为70.88%（3 488/4 921）；其中EV71、柯萨奇病毒A组16型、其他型分别占16.66%、27.24%、56.10%，其他型占比随年份增加呈上升趋势（$ {{{r}}_{\rm{s}}} $=0.75，P=0.007）。结论荆州市HFMD维持较高发病水平，近年来重症率明显下降。荆州市HFMD有明显时空异质性。其他型肠道病毒已成为荆州市HFMD主要病原。
- 手足口病 /
- 儿童 /
- 暴发 /
- 重症 /
- 病原学
Abstract: Objective To describe the epidemiological characteristics of hand foot and mouth disease (HFMD) in Jingzhou, Hubei Province, from 2011 to 2021, analyze the risk factors for severe cases, and provide scientific evidence for the prevention and control of HFMD in Jingzhou. Methods The incidence data, etiological surveillance results and epidemic data of HFMD in Jingzhou during this period were collected from “China Disease Prevention and Control Information System” for a descriptive epidemiological analysis, and the incidence rate, severe case rate or proportion, positive rate of sample detection and subtype proportion were calculated. Logistic regression analysis was used to identify the risk factors for severe HFMD. Results From 2011 to 2021, a total of 62 521 cases of HFMD were reported in Jingzhou, with an average annual incidence rate of 100.87/100 000. In these cases, 146 were severe ones, with a severe case rate of 0.23%, 5 were death ones, the case fatality rate was 0.80/10 000, and severe case mortality rate was 3.42%. There was no significant difference in the annual incidence rate ($ {{{r}}_{\rm{s}}} $=−0.21, P=0.539). The severe case rate showed a downward trend with year ($ {{{r}}_{\rm{s}}} $=−0.66, P=0.031). Two annual incidence peaks of HFMD were observed (April-June and November-December). The incidence of HFMD in counties in Jingzhou (districts) ranged from 51.85/100 000 to 140.23/100 000, and the areas with high-incidences changed with year. The cases were mainly children living scatteredly (69.58%) and children attending child care settings (28.18%), and the incidence rate in boys (59.01/100 000) was higher than that in girls (41.66/100000, RR=1.42, 95%CI: 1.39–1.44). Most HFMD cases were children under 5 years old (96.08%). Severe cases were more likely to occur in boys, young children, children living in area on south bank of the Yangtze River and children with longer interval between onset and medical treatment and in epidemic season (OR>1, P<0.05). EV71 was the main pathogen of severe cases (53.57%) and death cases (80.00%). A total of 89 case clusters and 5 outbreaks were reported, mainly in child care settings (87, 92.55%). The positive rate of pathogen detection was 70.88% (3 488/4 921). The pathogens detected included EV71 (16.66%), Cox A16 (27.24%) and other enteroviruses (56.10%). The proportion of other enteroviruses showed an upward trend with year ($ {{{r}}_{\rm{s}}} $=0.75, P=0.007). Conclusion The incidence of HFMD in Jingzhou remained at a high level. In recent years, the incidence rate of severe HFMD dropped significantly. HFMD had obvious spatiotemporal heterogeneity and other enteroviruses had become the main pathogens of HFMD in Jingzhou.
- Hand foot and mouth disease /
- Children /
- Outbreak /
- Severe case /
- Etiology

HTML全文

图 1 2011－2021年荆州市手足口病发病率、重症率季节指数分布

Figure 1. Seasonal index of incidence rate and severe rate of HFMD in Jingzhou, 2011−2021

下载: 全尺寸图片幻灯片

图 2 2011－2021年荆州市0～9岁儿童手足口病发病率分布

Figure 2. Incidence of HFMD in children aged 0−9 years in Jingzhou, 2011−2021

下载: 全尺寸图片幻灯片

图 3 2011－2021年荆州市手足口病重症病例危险因素分析

注：蓝点表示OR值点估计值，黄色线段表示OR值的95%置信区间，红色参考线对应OR值为1的位置

Figure 3. Risk factors for severe cases of HFMD in Jingzhou, 2011−2021

下载: 全尺寸图片幻灯片

图 4 2011－2021年荆州市手足口病病原学监测

Figure 4. Etiological surveillance of HFMD in Jingzhou, 2011−2021

下载: 全尺寸图片幻灯片

表 1 2011－2021年荆州市手足口病疫情概况

Table 1. Epidemic situation of HFMD in Jingzhou, 2011−2021

年份	病例数（例）	重症数（例）	死亡数（例）	发病率（/10万）	重症率（%）	病死率（/万）
2011	3 563	5	1	62.60	0.14	2.81
2012	9 022	19	3	158.17	0.21	3.33
2013	3 710	11	0	65.02	0.30	0.00
2014	7 027	41	1	123.01	0.58	1.42
2015	5 895	16	0	102.90	0.27	0.00
2016	8 581	32	0	150.39	0.37	0.00
2017	5 258	10	0	92.28	0.19	0.00
2018	6 780	4	0	120.18	0.06	0.00
2019	7 450	6	0	133.27	0.08	0.00
2020	1 886	1	0	33.86	0.05	0.00
2021	3 349	1	0	64.02	0.03	0.00
合计	62 521	146	5	100.87	0.23	0.80

下载: 导出CSV

参考文献(28)

[1]	Chan JHY, Law CK, Hamblion E, et al. Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review[J]. Hong Kong Med J, 2017, 23(2): 177–190. DOI: 10.12809/hkmj166098.
[2]	国家卫生健康委员会. 2021年全国法定传染病疫情概况[EB/OL]. (2022-04-22)[2022-06-14]. http://www.nhc.gov.cn/jkj/s3578/202204/4fd88a291d914abf8f7a91f6333567e1.shtml. National Health Commission of the People's Republic of China. National overview of notifiable infectious diseases in China in 2021[EB/OL]. (2022-04-22)[2022-06-14]. http://www.nhc.gov.cn/jkj/s3578/202204/4fd88a291d914abf8f7a91f6333567e1.shtml.
[3]	Tan YW, Chu JJH. Protecting the most vulnerable from hand, foot, and mouth disease[J]. Lancet Infect Dis, 2021, 21(3): 308–309. DOI: 10.1016/S1473−3099(20)30452−7.
[4]	Yu HJ, Cowling BJ. Remaining challenges for prevention and control of hand, foot, and mouth disease[J]. Lancet Child Adolesc Health, 2019, 3(6): 373–374. DOI: 10.1016/S2352−4642(19)30065−3.
[5]	Solomon T, Lewthwaite P, Perera D, et al. Virology, epidemiology, pathogenesis, and control of enterovirus 71[J]. Lancet Infect Dis, 2010, 10(11): 778–790. DOI: 10.1016/S1473−3099(10)70194−8.
[6]	Xing WJ, Liao QH, Viboud C, et al. Hand, foot, and mouth disease in China, 2008-12: an epidemiological study[J]. Lancet Infect Dis, 2014, 14(4): 308–318. DOI: 10.1016/S1473−3099(13)70342−6.
[7]	卫生部办公厅. 关于印发《手足口病诊疗指南（2010年版）》的通知[EB/OL]. (2010-04-20)[2023-02-27]. http://www.nhc.gov.cn/yzygj/s3593g/201306/6d935c0f43cd4a1fb46f8f71acf8e245.shtml. National Health and Family Planning Commission of the People's Republic of China. Diagnosis and treatment guidelines for hand, foot and mouth disease (2010 edition)[EB/OL]. (2010-04-20)[2023-02-27]. http://www.nhc.gov.cn/yzygj/s3593g/201306/6d935c0f43cd4a1fb46f8f71acf8e245.shtml.
[8]	中华人民共和国国家卫生和计划生育委员会. 关于发布《丙型肝炎诊断》等7项卫生行业标准的通告[EB/OL]. (2018-03-28)[2023-02-27]. http://www.nhc.gov.cn/fzs/s7852d/201803/f78712f30cd04c08b53acfdcc1998562.shtml. National Health and Family Planning Commission. Announcement on the release of 7 health industry standards including “Hepatitis C Diagnosis”[EB/OL]. (2018-03-28)[2023-02-27]. http://www.nhc.gov.cn/fzs/s7852d/201803/f78712f30cd04c08b53acfdcc1998562.shtml.
[9]	Cleveland RB, Cleveland WS, McRae JE, et al. STL: a seasonal-trend decomposition procedure based on loess[J]. J Off Stat, 1990, 6(1): 3–73.
[10]	Xie C, Wen HY, Yang WW, et al. Trend analysis and forecast of daily reported incidence of hand, foot and mouth disease in Hubei, China by Prophet model[J]. Sci Rep, 2021, 11(1): 1445. DOI: 10.1038/s41598−021−81100−2.
[11]	陈琦, 邢学森, 吴杨, 等. 湖北省2009-2015年手足口病流行病学和病原学分析[J]. 中华流行病学杂志,2017,38(4):441–445. DOI:10.3760/cma.j.issn.0254−6450.2017.04.006. Chen Q, Xing XS, Wu Y, et al. Hand, foot and mouth disease in Hubei province, 2009–2015: an epidemiological and etiological study[J]. Chin J Epidemiol, 2017, 38(4): 441–445. DOI: 10.3760/cma.j.issn.0254−6450.2017.04.006.
[12]	张静. 2008-2017年中国手足口病流行趋势和病原变化动态数列分析[J]. 中华流行病学杂志,2019,40(2):147–154. DOI:10.3760/cma.j.issn.0254−6450.2019.02.005. Zhang J. Trend of epidemics and variation of pathogens of hand, foot and mouth disease in China: a dynamic series analysis, 2008–2017[J]. Chin J Epidemiol, 2019, 40(2): 147–154. DOI: 10.3760/cma.j.issn.0254−6450.2019.02.005.
[13]	Zhao YY, Jin H, Zhang XF, et al. Case-fatality of hand, foot and mouth disease associated with EV71: a systematic review and meta-analysis[J]. Epidemiol Infect, 2015, 143(14): 3094–3102. DOI: 10.1017/S095026881500028X.
[14]	Chen B, Yang Y, Xu XF, et al. Epidemiological characteristics of hand, foot, and mouth disease in China: A Meta-analysis[J]. Medicine, 2021, 100(20): e25930. DOI: 10.1097/MD.0000000000025930.
[15]	Jiang L, Jiang HC, Tian X, et al. Epidemiological characteristics of hand, foot, and mouth disease in Yunnan province, China, 2008–2019[J]. BMC Infect Dis, 2021, 21(1): 751. DOI: 10.1186/s12879−021−06462−4.
[16]	Wang J, Hu T, Sun DP, et al. Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009–2016[J]. Sci Rep, 2017, 7(1): 8900. DOI: 10.1038/s41598−017−09196−z.
[17]	Wang YH, Zhao H, Ou R, et al. Epidemiological and clinical characteristics of severe hand-foot-and-mouth disease (HFMD) among children: a 6-year population-based study[J]. BMC Public Health, 2020, 20(1): 801. DOI: 10.1186/s12889−020−08961−6.
[18]	任敏睿, 崔金朝, 聂陶然, 等. 2008—2018年中国手足口病重症病例流行病学特征分析[J]. 中华流行病学杂志,2020,41(11):1802–1807. DOI:10.3760/cma.j.cn112338−20200201−00063. Ren MR, Cui JC, Nie TR, et al. Epidemiological characteristics of severe cases of hand, foot, and mouth disease in China, 2008–2018[J]. Chin J Epidemiol, 2020, 41(11): 1802–1807. DOI: 10.3760/cma.j.cn112338−20200201−00063.
[19]	潘浩, 郑雅旭, 毛盛华, 等. 上海市手足口病重症病例危险因素研究[J]. 中华流行病学杂志,2012,33(8):763–767. DOI:10.3760/cma.j.issn.0254−6450.2012.08.002. Pan H, Zheng YX, Mao SH, et al. A case-control study on risk factors that associated with severe hand-foot-mouth disease in Shanghai[J]. Chin J Epidemiol, 2012, 33(8): 763–767. DOI: 10.3760/cma.j.issn.0254−6450.2012.08.002.
[20]	Mao LX, Fu XM, Wu J, et al. The dynamics of the hand, foot and mouth disease epidemic from 2008 to 2016 in Zhenjiang city, China[J]. Future Microbiol, 2018, 13(9): 1029–1040. DOI: 10.2217/fmb−2018−0063.
[21]	Zhang DM, Li RL, Zhang WJ, et al. A case-control study on risk factors for severe hand, foot and mouth disease[J]. Sci Rep, 2017, 7: 40282. DOI: 10.1038/srep40282.
[22]	Ni XF, Li X, Xu C, et al. Risk factors for death from hand-foot-mouth disease: a meta-analysis[J]. Epidemiol Infect, 2020, 148: e44. DOI: 10.1017/S0950268819002279.
[23]	Mao QY, Wang YP, Bian LL, et al. EV-A71 vaccine licensure: a first step for multivalent enterovirus vaccine to control HFMD and other severe diseases[J]. Emerg Microbes Infect, 2016, 5(7): e75. DOI: 10.1038/emi.2016.73.
[24]	Hong J, Liu FF, Qi HC, et al. Changing epidemiology of hand, foot, and mouth disease in China, 2013–2019: a population-based study[J]. Lancet Reg Health West Pac, 2022, 20: 100370. DOI: 10.1016/j.lanwpc.2021.100370.
[25]	Yang BY, Liu FF, Liao QH, et al. Epidemiology of hand, foot and mouth disease in China, 2008 to 2015 prior to the introduction of EV-A71 vaccine[J]. Euro Surveill, 2017, 22(50): 16–00824. DOI: 10.2807/1560−7917.ES.2017.22.50.16−00824.
[26]	Hu LJ, Maimaiti H, Zhou L, et al. Changing serotypes of hand, foot and mouth disease in Shanghai, 2017–2019[J]. Gut Pathog, 2022, 14(1): 12. DOI: 10.1186/s13099−022−00485−1.
[27]	Liu FF, Ren MR, Chen SM, et al. Pathogen spectrum of hand, foot, and mouth disease based on laboratory surveillance-China, 2018[J]. China CDC Weekly, 2020, 2(11): 167–171. DOI: 10.46234/ccdcw2020.044.
[28]	Yu FY, Zhu RN, Jia LP, et al. Sub-genotype change and recombination of coxsackievirus A6s may be the cause of it being the predominant pathogen for HFMD in children in Beijing, as revealed by analysis of complete genome sequences[J]. Int J Infect Dis, 2020, 99: 156–162. DOI: 10.1016/j.ijid.2020.07.010.