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。 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 1st–3rd 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 1st–3rd 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. -
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 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 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) 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 -
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