2009－2022年湖北省荆州市手足口病再感染病例流行病学特征及危险因素分析

刘天; 肖新宇; 吴杨; 童叶青; 官旭华

doi:10.3784/jbjc.202212160538

2009－2022年湖北省荆州市手足口病再感染病例流行病学特征及危险因素分析

doi: 10.3784/jbjc.202212160538

刘天^1,,
肖新宇²,
吴杨³,
童叶青³,
官旭华^3, ,

1.
荆州市疾病预防控制中心, 湖北荆州 434000
2.
荆州区疾病预防控制中心, 湖北荆州 434000
3.
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

通讯作者:
官旭华，Tel：027−87652170；Email：552371433@qq.com

中图分类号: R211；R373
计量
- 文章访问数: 165
- HTML全文浏览量: 91
- PDF下载量: 50
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-16
- 网络出版日期: 2023-08-18
- 刊出日期: 2023-11-07

Epidemiological characteristics of reinfection of pathogens causing hand, foot and mouth disease and influential factors in Jingzhou, Hubei, 2009−2022

1.
Jingzhou Prefectural Center for Disease Control and Prevention, Jingzhou 434000, Hubei, China
2.
Jingzhou District Center for Disease Control and Prevention, Jingzhou 434000, Hubei, China
3.
Hubei Center for Disease Control and Prevention, Wuhan 430079, Hubei, China

More Information

Corresponding author: Guan Xuhua, Email: 552371433@qq.com

摘要

摘要: 目的分析湖北省荆州市手足口病（HFMD）再感染病例的流行病学特征及危险因素，为预防HFMD再感染提供科学依据。方法自传染病监测系统收集2009年1月1日至2022年6月30日荆州市HFMD个案资料，经数据清洗、整理获得再感染HFMD病例数据库，采用描述性流行病学方法描述再感染病例流行病学特征。采用Cox比例风险回归分析再感染可能的危险因素，风险比（HR）及其95%置信区间（CI）作为测量指标。结果荆州市累计报告1 440例HFMD再感染者，再感染率为1.99%，再感染累计发生风险为2.00%。感染2次者1 394例（96.81%）、3次者45例（3.12%）、4次者1例（0.07%）。男性（864例，2.01%）与女性（576例，1.97%）再感染率差异无统计学意义（P>0.05）。第1～3次感染中位数年龄分别为1.75（1.17～2.67）、3.25（2.42～4.08）和 3.71（2.92～5.13）岁；人群分类分别以散居儿童（78.96%）、散居儿童和幼托儿童（43.54%和53.12%）、幼托儿童（56.52%）为主；重症病例数分别为2、3和0例。相邻2次感染发病时间间隔中位数分别为1.09（0.53～1.99）年、1.06（0.61～1.54）和0.60年。首次感染肠道病毒71型（EV71）后，第2次可再感染EV71、柯萨奇病毒A组16型（Cox A16）和其他型。 Cox比例风险回归显示：年龄<3岁（HR=0.53，95%CI：0.45～0.63）相较年龄≥3岁、散居儿童相较幼托儿童（HR=0.82，95%CI：0.70～0.97）和学生（HR=0.14，95%CI：0.05～0.45）、中心城区（HR=1.86，95%CI：1.67 ～2.08）相较非中心城区、首次感染年份流行毒株为Cox A16（HR=1.90，95%CI：1.51～2.39）和其他型（HR=1.56，95%CI：1.31～1.85）相较EV71、首次感染Cox A16较EV71发生HFMD再感染风险大（HR=1.91，95%CI：1.25～2.93），差异有统计学意义。结论荆州市HFMD再感染存在明显时间和人群异质性，应以此为指导采取干预措施。
- 手足口病 /
- 再感染 /
- 流行特征 /
- 影响因素
Abstract: Objective To analyze the epidemiological characteristics of reinfection of pathogens causing hand, foot and mouth disease (HFMD) and influential factors in Jingzhou, Hubei province, and provide scientific evidence for the prevention of HFMD. Methods The incidence data of HFMD in Jingzhou from January 1, 2009 to June 30, 2022 were collected from the infectious disease surveillance system, and the information of the reinfection cases were obtained. Descriptive epidemiological method was used to analyze the epidemiological characteristics of the reinfection cases. Cox proportional hazards regression analysis to identify risk factors for the reinfection. Results A total of 1 440 cases of reinfection of pathogens causing HFMD were reported in Jingzhou during this period, the reinfection rate was 1.99%, and the cumulative risk for the reinfection was 2.00%. A total of 1 394 cases were infected for two times (96.81%), 45 cases were infected for three times (3.12%), and 1 case was infected for four times (0.07%). There was no significant difference in the reinfection rate between boys (864 cases, 2.01%) and girls (576 cases, 1.97%) (P>0.05). The median of age of the cases infected for the 1^st–3^rd time was 1.75 years (1.17–2.67 years), 3.25 years (2.42–4.08 years), and 3.71 years (2.92–5.13 years), respectively. The cases of 1^st–3^rd infections were mainly children outside child care settings (78.96%), children in and outside child care settings (53.12% and 43.54%), and children in child care settings (56.52%) with number of severe cases 2, 3 and 0, respectively. The median time interval between two consecutive infections was 1.09 years (0.53–1.99 years), 1.06 years (0.61–1.54 years) and 0.60 years, respectively. After the first infection with enterovirus 71 (EV71), EV71, coxsackievirus 16 (Cox A16) and other types could be infected for the second time. Cox proportional hazards regression showed that the risk for the reinfection was higher in children aged <3 years compared with those aged ≥3 years [hazard ratio (HR)=0.53, 95%CI: 0.45–0.63], in children outside child care settings compared with children in child care settings (HR=0.82, 95%CI: 0.70–0.97) and students (HR=0.14, 95%CI: 0.05–0.45), in children living in central urban area compared with those living in non-central urban area (HR=1.86, 95%CI: 1.67–2.08), in children infected with Cox A16 (HR=1.90, 95%CI: 1.51–2.39) and other types (HR=1.56, 95%CI: 1.31–1.85) for the first time compared with those infected with EV71 and in children infected with Cox A16 for the first time (HR=1.91, 95%CI: 1.25–2.93) compared with those infected with EV71, the differences were significant. Conclusion There were obvious temporal and population heterogeneity in the reinfection of pathogens causing HFMD in Jingzhou, and intervention measures should be taken based on the findings in this study.
- Hand, foot and mouth disease /
- Reinfection /
- Epidemiological characteristic /
- Influential factor

HTML全文

图 1 2009－2022年荆州市手足口病再感染病例数据清洗和分析过程

Figure 1. Data process in analysis on reinfection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

下载: 全尺寸图片幻灯片

图 2 2009－2022年荆州市手足口病再感染病例发病时间间隔分布

Figure 2. Intervals between consecutive infection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

下载: 全尺寸图片幻灯片

图 3 2009－2022年荆州市手足口病再感染病例流行曲线

Figure 3. Incidence curve of reinfection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

下载: 全尺寸图片幻灯片

图 4 2009－2022年荆州市手足口病再感染的累积风险

注：EV71. 肠道病毒71型；Cox A16. 柯萨奇病毒A组16型

Figure 4. Cumulative risk for reinfection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

下载: 全尺寸图片幻灯片

表 1 2009－2022年荆州市手足口病再感染病例流行病学特征

Table 1. Epidemiological characteristics of cases of reinfection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

特征	第1次感染（n=1 440）		第2次感染（n=1 440）		第3～4次感染（n=46）
特征	病例数（例）	占比（%）	病例数（例）	占比（%）	病例数（例）	占比（%）
年龄组（岁）
<0.5	10	0.69	0	0.00	0	0.00
0.5～	203	14.10	19	1.32	0	0.00
1～	628	43.61	203	14.10	2	4.35
2～	583	40.49	1 051	72.99	31	67.39
5～	16	1.11	165	11.46	13	28.26
≥10	0	0.00	2	0.14	0	0.00
人群分类
散居儿童	1 137	78.96	627	43.54	15	32.61
幼托儿童	300	20.83	765	53.12	26	56.52
学生	3	0.21	48	3.33	5	10.87
重症
否	1 438	99.86	1 437	99.79	46	100.00
是	2	0.14	3	0.21	0	0.00
病原学结果^a
肠道病毒71型	162	73.64	137	75.27	5	83.33
柯萨奇病毒A组16型	25	11.36	24	13.19	0	0.00
其他型	33	15.00	21	11.54	1	16.67
注：a. 第1、第2和第3～4次感染的检测数分别为220、182和6例

下载: 导出CSV

表 2 2009－2022年荆州市手足口病再感染病例首次感染和第2次感染病原学情况

Table 2. Etiology of the first infection and the second infection of pathogens causing hand, foot and mouth disease, 2009−2022

首次感染病毒	第2次感染病毒	病例数（例）	占比（%）
EV71	EV71	48	76.19
EV71	Cox A16	4	6.35
EV71	其他型	4	6.35
Cox A16	Cox A16	2	3.17
Cox A16	其他型	1	1.59
其他型	EV71	3	4.76
其他型	Cox A16	1	1.59
注：EV71. 肠道病毒71型；Cox A16. 柯萨奇病毒A组16型

下载: 导出CSV

表 3 2009－2022年荆州市手足口病再感染影响因素的Cox比例风险回归分析

Table 3. Cox proportional hazards regression analysis on influential factors for reinfection of pathogens causing hand, foot and mouth disease in Jingzhou, 2009−2022

变量	单因素分析				多因素分析
变量	病例数（例）	HR值	95% CI	P值	病例数（例）	HR值	95%CI	P值
EV71疫苗接种	72 317	0.97	0.94～1.01	0.100	64 396	0.97	0.93～1.00	0.089
性别	72 317				64 396
男性（参考组）
女性		0.98	0.88～1.09	0.739		0.95	0.85～1.06	0.319
年龄组（岁）	72 317				64 396
≤3（参考组）
＞3		0.47	0.41～0.54	<0.001		0.53	0.45～0.63	<0.001
人群分类	72 317				64 396
散居儿童（参考组）
幼托儿童		0.61	0.54～0.69	<0.001		0.82	0.70～0.97	0.018
学生		0.08	0.03～0.26	<0.001		0.14	0.05～0.45	<0.001
其他		0.00	0.00～Inf	0.976		0.00	0.00～Inf	0.978
地区	72 317				64 396
非中心城区（参考组）
中心城区		1.74	1.57～1.93	<0.001		1.86	1.67～2.08	<0.001
是否重症	72 317				64 396
否（参考组）
是		0.67	0.17～2.69	0.575		0.56	0.14～2.23	0.410
首次感染年份流行毒株	64 396				64 396
EV71（参考组）
Cox A16		1.68	1.35～2.09	<0.001		1.90	1.21～239	<0.001
其他型		1.49	1.26～1.76	<0.001		1.56	1.31～1.85	<0.001
病原学^a	220
EV71（参考组）
Cox A16		1.91	1.25～2.93	0.003
其他型		0.93	0.64～1.36	0.707
注：HR. 风险比；CI. 置信区间； a. 由于大量缺失，仅作单因素分析比较，未纳入多因素分析；Inf.正无穷大

下载: 导出CSV

参考文献(21)

[1]	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.
[2]	Ooi MH, Wong SC, Lewthwaite P, et al. Clinical features, diagnosis, and management of enterovirus 71[J]. Lancet Neurol, 2010, 9(11): 1097–1105. DOI: 10.1016/S1474−4422(10)70209−X.
[3]	Zhao JJ, Jiang FC, Zhong LF, et al. Age patterns and transmission characteristics of hand, foot and mouth disease in China[J]. BMC Infect Dis, 2016, 16(1): 691. DOI: 10.1186/s12879−016−2008−y.
[4]	Griffin DE. Immune responses during measles virus infection[J]. Curr Top Microbiol Immunol, 1995, 191: 117–134. DOI: 10.1007/978−3−642−78621−1_8.
[5]	Memoli MJ, Han A, Walters KA, et al. Influenza A reinfection in sequential human challenge: Implications for protective immunity and “Universal” vaccine development[J]. Clin Infect Dis, 2020, 70(5): 748–753. DOI: 10.1093/cid/ciz281.
[6]	Chen GP, Wu JB, Wang JJ, et al. Epidemiological characteristics and influential factors of hand, foot and mouth disease (HFMD) reinfection in children in Anhui province[J]. Epidemiol Infect, 2016, 144(1): 153–160. DOI: 10.1017/S0950268815001107.
[7]	Shi C, Liu J, Shi P, et al. Epidemiological characteristics and influential factors of hand, foot, and mouth disease reinfection in Wuxi, China, 2008-2016[J]. BMC Infect Dis, 2018, 18(1): 472. DOI: 10.1186/s12879−018−3385−1.
[8]	Huang J, Liao QH, Ooi MH, et al. Epidemiology of recurrent hand, foot and mouth disease, China, 2008–2015[J]. Emerg Infect Dis, 2018, 24(3): 432–442. DOI: 10.3201/eid2403.171303.
[9]	Peng Y, Yu B, Kong DG, et al. Reinfection hazard of hand-foot-mouth disease in Wuhan, China, using cox-proportional hazard model[J]. Epidemiol Infect, 2018, 146(10): 1337–1342. DOI: 10.1017/S0950268818001322.
[10]	谢忠杭, 王灵岚, 严延生, 等. 福建省4岁以下儿童手足口病再次罹患特征的队列分析[J]. 中华流行病学杂志,2014,35(10):1109–1114. DOI:10.3760/cma.j.issn.0254−6450.2014.10.007. Xie ZH, Wang LL, Yan YS, et al. A cohort study on the characteristics of the recurrent epidemics on hand, foot and mouth disease, in Fujian province[J]. Chin J Epidemiol, 2014, 35(10): 1109–1114. DOI: 10.3760/cma.j.issn.0254−6450.2014.10.007.
[11]	Qiu Q, Zhou JX, Cheng YB, et al. Kinetics of the neutralising antibody response in patients with hand, foot, and mouth disease caused by EV-A71: A longitudinal cohort study in Zhengzhou during 2017-2019[J]. eBioMedicine, 2021, 68: 103398. DOI: 10.1016/j.ebiom.2021.103398.
[12]	Klein MH. EV71 vaccines: a first step towards multivalent hand, foot and mouth disease vaccines[J]. Expert Rev Vaccines, 2015, 14(3): 337–340. DOI: 10.1586/14760584.2015.993385.
[13]	Duan XX, Chen ZH, Li XZ, et al. Virus shedding in patients with hand, foot and mouth disease induced by EV71, CA16 or CA6: Systematic review and meta-analysis[J]. Pediatr Infect Dis J, 2021, 40(4): 289–294. DOI: 10.1097/INF.0000000000002985.
[14]	Kua JA, Pang JX. The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study[J]. PLoS One, 2020, 15(8): e0236711. DOI: 10.1371/journal.pone.0236711.
[15]	Wang ZC, Liu T, Li JM, et al. Risk factors for hand, foot, and mouth disease caused by Coxsackievirus A6 in children under 6 years of age in Tianjin, China: a case-control study[J]. Jpn J Infect Dis, 2021, 74(5): 437–442. DOI: 10.7883/yoken.JJID.2020.983.
[16]	Zhang DM, Li ZY, Zhang WJ, et al. Hand-washing: The main strategy for avoiding hand, foot and mouth disease[J]. Int J Environ Res Public Health, 2016, 13(6): 610. DOI: 10.3390/ijerph13060610.
[17]	Ruan F, Yang T, Ma HL, et al. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing[J]. Pediatrics, 2011, 127(4): e898–e904. DOI: 10.1542/peds.2010−1497.
[18]	Huang RF, Wei JT, Li ZW, et al. Spatial-temporal mapping and risk factors for hand foot and mouth disease in northwestern inland China[J]. PLoS Negl Trop Dis, 2021, 15(3): e0009210. DOI: 10.1371/journal.pntd.0009210.
[19]	Gao YB, Wang HW, Yi SY, et al. Spatial and temporal characteristics of hand-foot-and-mouth disease and their influencing factors in Urumqi, China[J]. Int J Environ Res Public Health, 2021, 18(9): 4919. DOI: 10.3390/ijerph18094919.
[20]	Xu CD, Xiao GX. Spatiotemporal risk mapping of hand, foot and mouth disease and its association with meteorological variables in children under 5 years[J]. Epidemiol Infect, 2017, 145(14): 2912–2920. DOI: 10.1017/S0950268817001984.
[21]	Wang XF, Lu J, Liu XX, et al. Epidemiological features of hand, foot and mouth disease outbreaks among Chinese preschool children: A meta-analysis[J]. Iran J Public Health, 2018, 47(9): 1234–1243.