2017－2019年广东省柯萨奇病毒A组6型感染手足口病流行特征分析

吴燕飞; 陈旭光; 刘东妹; 李剑森; 谭小华; 杨芬

doi:10.3784/jbjc.202107060387

2017－2019年广东省柯萨奇病毒A组6型感染手足口病流行特征分析

Epidemiology of hand foot and mouth disease caused by Cox A6 in Guangdong, 2017–2019

摘要

摘要:
目的了解2017—2019年广东省柯萨奇病毒A组6型（Cox A6）感染手足口病流行特征。
方法在广东省21个地市及佛山市顺德区（省直管区）共选取22家哨点医院开展手足口病普通病例Cox A6感染监测，结合手足口病个案及暴发数据，估算Cox A6感染手足口病发病情况并分析人群和时间分布特征。
结果 Cox A6感染阳性率分别为57.1%、23.0%、47.4%。暴发构成比为18.5%（12/65），仅次于Cox A16，主要发生在9月和6月。估算发病率随年龄升高呈下降趋势（趋势χ²=2683320.620，P＜0.001），高发年龄组依次为0～（1650.29/10万）、1～（4092.17/10万）、2～（2057.02/10万）和3～岁组（1530.23/10万）；随月龄增加呈上升趋势（趋势χ²=771.582，P＜0.001），高发月龄依次是11～（4982.7/10万）、10～（4150.7/10万）、9～（3523.2/10万）、8～（2684.97/10万）和7～月龄组（1813.01/10万）。高发月份依次是9（34.99/10万）、7（30.98/10万）、10（28.88/10万）、8（24.18/10万）和6月（22.04/10万）。重症及死亡病例构成比为25.2%（86/341），仅次于肠道病毒71型（EV71）（35.5%，121/341）。
结论 Cox A6已成为广东省手足口病病原的主要型别之一，各年份流行强度不同；暴发疫情强度仅次于Cox A16，Cox A6感染水平高时，暴发疫情增多，主要发生在托幼机构，9月和6月常见；6—10月是高发季节，0～3岁儿童是高危人群，6～11月龄为高发月龄；重症及死亡强度低于EV71，高于Cox A16，但其重症及死亡比例较以往研究增加。

Abstract:
Objective To understand the epidemiological characteristics of hand foot and mouth disease (HFMD) caused by coxsackievirus A6 (Cox A6) in Guangdong province from 2017 to 2019.
Methods A total of 22 sentinel hospitals in 21 cities and Shunde district of Foshan were selected to conduct surveillance for common type of HFMD caused by Cox A6. The incidence of HFMD caused by Cox A6 was estimated and the population and time distribution characteristics of the disease were analyzed based on the case number and outbreak data.
Results The annual proportions of HFMD caused by Cox A6 in Guangdong were 57.1%, 23.0% and 47.4% during 2017–2019. The proportion of HFMD outbreak due to Cox A6 was 18.5% (12/65), ranking only second to that by Cox A16, and HFMD caused by Cox A6 mainly occurred in September and June. The estimated incidence showed a decreasing trend with age (χ²=2683320.620, P<0.001). The incidence was highest in age group 1 year (4092.17/100 000), followed by that age group 2 years (2057.02/100 000), 0 year (1650.29/100 000) and 3 years (1530.23/100 000). There was an increasing trend with month age (χ²=771.582, P<0.001). The incidence was highest in age group 11 months (4982.7/100 000), followed by that in age group 10 months (4150.7/100 000) , 9 months (3523.2/100 000), 8 months (2684.97/100 000) and 7 months (1813.01/100 000). The incidence was highest in September (34.99/100 000), followed by that in July (30.98/100 000), October (28.88/100 000), August (24.18/100 000) and June (22.04/100 000). The proportion of severe and death cases due to Cox A6 was 25.2% (86/341), ranking only second to that by EV71 (35.5%, 121/341).
Conclusion Cox A6 infection has become one of the main types of HFMD in Guangdong, and the epidemic intensity of Cox A6 infection varied from year to year. The outbreak intensity ranked only second to that of Cox A16 infection. When the Cox A6 infection level was high, the number of outbreaks increased, which mainly occurred in child care settings, and Cox A6 infection was common in September and June. Children aged 0–3 years and 6–11 months are at high risk. The intensity of severe disease and death was lower than that of EV71 but higher than that of Cox A16. The proportion of severe and death cases was higher than those reported by previous studies.

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