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

刘天, 肖新宇, 吴杨, 童叶青, 官旭华. 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[J]. 疾病监测, 2023, 38(10): 1198-1204. doi: 10.3784/jbjc.202212160538
引用本文: 刘天, 肖新宇, 吴杨, 童叶青, 官旭华. 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[J]. 疾病监测, 2023, 38(10): 1198-1204. doi: 10.3784/jbjc.202212160538
Liu Tian, Xiao Xinyu, Wu Yang, Tong Yeqing, Guan Xuhua. Epidemiological characteristics of reinfection of pathogens causing hand, foot and mouth disease and influential factors in Jingzhou, Hubei, 2009−2022[J]. Disease Surveillance, 2023, 38(10): 1198-1204. doi: 10.3784/jbjc.202212160538
Citation: Liu Tian, Xiao Xinyu, Wu Yang, Tong Yeqing, Guan Xuhua. Epidemiological characteristics of reinfection of pathogens causing hand, foot and mouth disease and influential factors in Jingzhou, Hubei, 2009−2022[J]. Disease Surveillance, 2023, 38(10): 1198-1204. 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
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

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

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  • 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。
  • 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

    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

    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

    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

    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)
    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
    病例数(例)HR95% CIP病例数(例)HR95%CIP
    EV71疫苗接种72 3170.970.94~1.010.10064 3960.970.93~1.000.089
    性别72 31764 396
     男性(参考组)
     女性0.980.88~1.090.7390.950.85~1.060.319
    年龄组(岁)72 31764 396
     ≤3(参考组)
     >30.470.41~0.54<0.0010.530.45~0.63<0.001
    人群分类72 31764 396
     散居儿童(参考组)
     幼托儿童0.610.54~0.69<0.0010.820.70~0.970.018
     学生0.080.03~0.26<0.0010.140.05~0.45<0.001
     其他0.000.00~Inf0.9760.000.00~Inf0.978
    地区72 31764 396
     非中心城区(参考组)
     中心城区1.741.57~1.93<0.0011.861.67~2.08<0.001
    是否重症72 31764 396
     否(参考组)
     是0.670.17~2.690.5750.560.14~2.230.410
    首次感染年份流行毒株64 39664 396
     EV71(参考组)
     Cox A161.681.35~2.09<0.0011.901.21~239<0.001
     其他型1.491.26~1.76<0.0011.561.31~1.85<0.001
    病原学a220
     EV71(参考组)
     Cox A161.911.25~2.930.003
     其他型0.930.64~1.360.707
    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
  • [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.
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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

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