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

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

  • 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_\rms =−0.21,P=0.539);重症率随年份呈下降趋势( r_\rms =−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_\rms =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。

     

    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_\rms =−0.21, P=0.539). The severe case rate showed a downward trend with year ( r_\rms =−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_\rms =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.

     

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