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2013－2022年广东省深圳市手足口病流行特征和病原学分析

Epidemiological and etiological characteristics of hand, foot and mouth disease in Shenzhen, Guangdong, 2013−2022

    摘要
  • 摘要:
    目的 分析2013—2022年广东省深圳市手足口病流行特征及病原学特征，为今后制定防控措施提供科学依据。
    方法 收集2013—2022年中国疾病预防控制信息系统中深圳市手足口病病例个案数据和突发公共卫生事件相关信息资料，以及同期深圳市手足口病病原学哨点监测数据，采用Joinpoint回归模型分析发病率、重症率变化趋势，采用描述性流行病学方法分析流行特征，利用核密度分析深圳市手足口病空间分布特征。
    结果 2013—2022年深圳市年均发病率为375.10/10万，年均重症率为44.98/10万；2013—2015年发病率呈逐年上升趋势年度变化百分比（APC）=26.12%，2015年出现拐点，2015—2019年发病率逐年下降（APC=−2.58%），2019年出现转折点后下降趋势增加（APC=−41.95%）；2013—2015年重症率呈逐年下降趋势（APC=−22.52%），2015年出现拐点，2015—2018年呈快速下降趋势（APC=−54.72%），2018年出现拐点后呈缓慢下降趋势（APC=−1.91%）。 深圳市手足口病高发人群主要为0～5岁年龄组儿童，占总发病人群的 93.65%（442 140/472 134）；从职业分布来看，以散居儿童的占比最多，占总发病病例数的74.86%（353 462/472 134）。 手足口病发病表现出季节性特征，呈现双峰型或单峰型流行。 空间分布上，发病最多的区主要是宝安和龙岗区，发病较少的区主要是福田区、罗湖区、坪山区、盐田区和大鹏新区。 2016年后深圳市手足口病报告病例以及重症病例中肠道病毒71型（EV-A71）的比例显著减少，到2022年分别降至0.16%、0.00%。 到2022年，柯萨奇病毒A组6型（CVA6）和A组16型（CVA16）成为手足口病普通病例以及重症病例的优势病原体，分别在普通病例和重症病例中占63.81%、18.73%和50.00%、16.67%。
    结论 2013—2022年广东省深圳市手足口病呈现出明显的季节性和地域、人群聚集的特征，2015年后发病率和重症率均出现下降趋势。 手足口病优势病原体发生明显变化，EV-A71比例迅速下降，CVA6成为优势病原体，未来需加强对高发地区的防控工作和促进多价疫苗开发与接种普及, 从而减轻手足口病给社会来的负担。

     

    Abstract:
    Objective To understand the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) in Shenzhen from 2013 to 2022 and provide evidence for the development of HFMD prevention and control measures in the future.
    Methods The incidence data of HFMD and information related to public health emergencies in Shenzhen during 2013−2022 were collected from Chinese Disease Control and Prevention Information System and the sentinel etiological surveillance data of HFMD in Shenzhen during the same period were collected. Joinpoint regression model was used to analyze the trend of incidence rate and proportion of severe cases. Descriptive epidemiological methods were used to analyze the epidemiological characteristics and kernel density was used to analyze the spatial distribution of HFMD in Shenzhen.
    Results  From 2013 to 2022, the average annual incidence rate of HFMD was 375.10/100000 in Shenzhen, and the average annual rate of severe cases was 44.98/100000. The annual incidence rate showed an upward trend from 2013 to 2015 annual percentage change (APC)=26.12%, and the annual incidence rate decreased from 2015 to 2019 (APC=−2.58%), then decreased more obviously (APC=−41.95%); the annual rate of severe cases showed a downward trend from 2013 to 2015 (APC=−22.52%), and showed a rapid downward trend from 2015 to 2018 (APC=−54.72%), then showed a slow downward trend (APC=−1.91%). Children aged 0 to 5 years were at high risk, with the cases accounting for 93.65% of the total (442 140/472 134). The cases in children living scatteredly accounted for the highest proportion (74.86%, 353 462/472 134). The incidence of HFMD showed seasonality with one or two peaks. The incidences were high in Bao'an and Longgang districts and low in Futian, Luohu, Pingshan, Yantian, and Dapeng districts. After 2016, the proportions of reported HFMD cases and severe cases caused by EV-A71 decreased significantly to 0.16% and 0.00%, respectively, in 2022. CVA6 and CVA16 gradually became the predominant pathogens in common and severe cases of HFMD, accounting for 63.81% and 18.73% (CVA6), and 50.00% and 16.67% (CVA16), respectively, in 2022.
    Conclusion During 2013−2022, the incidence of HFMD in Shenzhen showed obvious seasonality, area and population clustering, and the incidence rate of HFMD and the rate of severe cases showed decreasing trends after 2015. The predominant pathogens of HFMD shifted from EV-A71 to CVA6. It is necessary to strengthen the prevention and control of HFMD in the area with high-incidence, promote the development and vaccination of multivalent vaccines to reduce the burden of HFMD on society.

     

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