2020－2021年某哨点医院疱疹性咽峡炎流行特征及相关肠道病毒VP1基因特征分析

李润; 刘嘉婧; 吴文成; 张靖翊; 崔晓青; 袁芳; 滕峥; 王嘉瑜

doi:10.3784/jbjc.202305290252

2020－2021年某哨点医院疱疹性咽峡炎流行特征及相关肠道病毒VP1基因特征分析

Characteristics and VP1 gene of herpangina-related enterovirus detected in a sentinel hospital in Shanghai, 2020–2021

摘要

摘要:
目的分析2020—2021年上海市某哨点医院疱疹性咽峡炎（HA）标本病例信息的流行病学及主要病原体VP1基因特征，为HA防控提供参考依据。
方法采集2020—2021年上海市某哨点医院HA病例标本及信息进行描述性统计分析；采用实时荧光定量聚合酶链式反应（PCR）开展肠道病毒血清型鉴定，对阳性标本进行病毒分离、VP1基因测序及基因进化、核苷酸及氨基酸同源性分析。
结果 155例HA标本中肠道病毒阳性病例95例，3～6岁学龄前儿童发病率最高，占确诊病例的57.9%。柯萨奇病毒（Coxsackievirus, Cox）A组6型、Cox A4分别为2020和2021年引起HA的主要优势血清型，检出率分别为33.7%、29.5%，未发现肠道病毒（Enterovirus, EV）71型、Cox A5等其他肠道病毒血清型感染病例。基于VP1基因区段，Cox A4、Cox A6、EV71、Cox A10和Cox A16基因型分别为C2 Cluster1、D3、C4a、C、B1b，自HA标本中分离的毒株与我国主要流行株的核苷酸同源性分别为92.6%～96.1%、89.7%～97.0%、92.0%～94.6%、90.7%～97.0%和92.2%～93.7%，氨基酸同源性分别为92.9%～96.2%、97.2%～99.7%、98.3%～99.3%、91.1%～97.1%和96.0%～97.1%。
结论 2020—2021年上海市某哨点医院HA易感人群以3～6岁学龄前儿童为主；Cox A6、Cox A4是HA的主要血清型；2021年，Cox A4成为引起HA最主要的血清型；所分离肠道病毒与我国大陆地区优势流行株具有较高同源性。持续开展HA病原谱变化和病毒基因组特征监测对了解病毒传播及防控策略的制定具有参考意义。

Abstract:
Objective To analyze the epidemiological and VP1 gene characteristics of the main pathogens detected in herpangina cases in a sentinel hospital in Shanghai, 2020−2021, and provide reference data for the prevention and control of herpangina.
Methods Clinical samples and basic information of herpangina cases were collected in a sentinel hospital in Shanghai from 2020 to 2021 for a descriptive statistical analysis. Real-time quantitative polymerase chain reaction (PCR) was used for enterovirus serotype identification. The positive samples were subjected to virus isolation, VP1 gene sequencing, gene evolution analysis, and nucleotide and amino acid homology analysis.
Results In 155 clinical samples of herpangina cases, 95 were positive for enteroviruses. The incidence rate was highest in preschool children aged 3−6 years with the cases accounting for 57.9% of the total confirmed cases. Coxsackievirus (Cox) A6 and Cox A4 were the predominant serotypes causing herpangina in 2020 and 2021 respectively, with detection rates of 33.7% and 29.5%. No cases of enterovirus (EV) 71 or Cox A5 infections were found. Based on the VP1 gene segment, the genotypes of Cox A4, Cox A6, EV71, Cox A10, and Cox A16 were C2 Cluster1, D3, C4a, C, and B1b, respectively. The nucleotide homologies between the strains isolated from the herpangina cases and the main circulating strains in China were 92.6%−96.1%, 89.7%−97.0%, 92.0%−94.6%, 90.7%−97.0%, and 92.2%−93.7%, respectively. The amino acid homologies were 92.9%−96.2%, 97.2%−99.7%, 98.3%−99.3%, 91.1%−97.1%, and 96.0%−97.1%, respectively.
Conclusion During 2020−2021, the surveillance in a sentinel hospital in Shanghai indicated that preschool children aged 3−6 years were the most susceptible population to herpangina. Cox A6 and Cox A4 were the main serotypes causing herpangina, Cox A4 became the predominant serotype in 2021. The isolated enteroviruses showed high homologies with the predominant circulating strains in China. Continuous surveillance for the pathogen spectrum changes of herpangina and virus genomic characteristics has reference value for understanding virus transmission and formulating prevention and control strategies.

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