2010－2020年广西壮族自治区梧州市手足口病流行特征及病原学特征分析

潘燕兰; 黄浩; 崔哲哲

doi:10.3784/jbjc.202211110497

2010－2020年广西壮族自治区梧州市手足口病流行特征及病原学特征分析

Epidemiological and etiological characteristics of hand foot and mouth disease in Wuzhou, Guangxi, 2010−2020

摘要

摘要:
目的分析2010—2020 年广西壮族自治区梧州市手足口病流行特征和病原学特征，为今后制定预防措施及精准防控提供依据。
方法收集2010—2020年中国疾病预防控制中心传染病报告信息管理系统中梧州市所有手足口病病例个案资料，采用描述性流行病学方法分析手足口病的三间分布、病原构成及变化，采用Joinpoint回归模型分析发病率、重症率、病死率和重症比例的变化趋势。
结果 2010—2020年梧州市手足口病年均报告发病率为314.91/10万，年均重症率为14.18/10万，病死率为0.02%，发病率、重症率在2017年后均呈逐年下降［年度变化率（APC）=−29.56%，APC=−80.99%，均P＜0.05］，病死率在2016年后显著下降（APC=−91.26%，P＜0.05）。梧州市手足口病发病存在明显的季节性和空间相自关性，发病高峰主要集中在4—7月和9—11月，万秀区和长洲区是发病高发区，岑溪市是重症病例和死亡病例高发地，苍梧县和龙圩区重症比例呈逐年上升（APC = 0.59%，APC = 0.88％，均P＜0.05）。发病人群男性高于女性（1.54∶1），发病年龄以5岁以下散居和托幼儿童为主（89.91%），重症病例更好发于3岁以下散居儿童（81.30%）。农村重症和病死率均高于城镇（χ²= 455.532、χ²= 11.093，均P＜0.001），在2017年后农村和城镇重症比例均呈逐年下降（城镇APC=−63.25%，P=0.217；农村APC=−75.32%，P=0.178）。梧州市手足口病多种病原体并存流行，优势病原体不断变迁，2018年后肠道病毒71型（EV71）阳性检出率逐渐降低，而柯萨奇病毒A组6型（CA6）和柯萨奇病毒A组10型（CA10）是继EV71后引起重症病例的重要优势毒株。
结论梧州市手足口病发病率、重症率和病死率整体呈逐年下降，但重症率仍较高。重症病例存在明显的聚集区域，病原体由EV71转为CA6和CA10，防控形势严峻。应加强重点人群手足口病知识健康宣教及重点区域防控工作，进一步加强流行毒株监测和分析。

Abstract:
Objective To analyze the epidemiological and etiological characteristics of hand foot and mouth disease (HFMD) in Wuzhou, Guangx Zhuang autonomous region, from 2010 to 2020i, and provide evidence for the formulation of preventive measures and strategy.
Methods The incidence data of HFMD in Wuzhou were collected from the national infectious diseases reporting system. Descriptive epidemiological method was used to analyze the case distributions, pathogen constituent and change of HFMD. JoinPoint regression model was used to analyze the trends of the incidence rate, severity rate and case fatality rate of HFMD.
Results From 2010 to 2020, the annual reported average incidence rate of HFMD was 314.91/100,000 in Wuzhou, the annual average rate of severe cases was 14.18/100,000, and the annual average case fatality rate was 0.02%. Both the incidence rate and severe case rate showed downward trends after 2017 annual rate of change (APC)=−29.56%, APC=−80.99%, all P＜0.05, and the case fatality rate decreased significantly after 2016 (APC=−91.26%, P＜0.05). The incidence of HFMD in Wuzhou showed obvious seasonality and spatial correlation. The annual incidence peaks mainly occurred during April-July and September-November. Wanxiu and Changzhou were the hot spot areas, while Cenxi had the highest severe case and case fatality rates, Cangwu and Longxu had increasing proportions of severe cases. The incidence in men was higher than that in women (1.54∶1). The cases was mainly children under 5 years old in or outside child cares settings (89.91%), and the severe cases were mainly children under 3 years old outside child care settings (81.30%). Both the proportion of severe case and the case fatality rate were higher in rural area than in urban area (χ²=455.532, χ²=11.093, all P＜0.001), and the proportions of severe cases in both rural area and urban area showed decreasing trends after 2017 (urban area APC=−63.25%, P=0217; rural area APC=−75.32%, P=0.178). In Wuzhou, a variety of pathogens of HFMD coexisted and the predominant pathogens constantly changed. After 2018, the positive detection rate of enterovirus 71 (EV71) gradually decreased, and coxsackievirus A6 (CA6) and CA10 became the predominant pathogens causing severe cases instead of EV71.
Conclusion The incidence, severe case rate and case fatality rate of HFMD showed downward trends in Wuzhou during 2010−2020, but the severe cases rate remained high. There were obvious clustering of severe cases, and the predominant pathogens has changed from EV71 to CA6 and CA10. The prevention and control of HFMD is still challenging. It is necessary to strengthen the health education about HFMD in key populations and HFMD prevention and control in key areas, and improve the pathogen surveillance and analysis.

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