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2009－2021年全国5岁以下儿童发热伴出疹症候群病原构成及流行特征分析

Analysis on etiological and epidemiological characteristics of rash and fever syndrome in children aged ＜5 years in China, 2009−2021

    摘要
  • 摘要:
    目的 了解我国5岁以下儿童发热伴出疹症候群（RFS）的病原构成及流行特征，为儿童出疹性传染病的诊疗和和科学防控提供参考。
    方法 基于国家传染病监测技术平台RFS监测数据，监测病原包括肠道病毒、麻疹病毒、风疹病毒、水痘–带状疱疹病毒、登革病毒、人细小病毒B19、埃博拉病毒、寨卡病毒、人疱疹病毒6型、EB病毒、A组链球菌、伤寒、副伤寒沙门菌、伯氏疏螺旋体和立克次体。 采用描述性流行病学方法分析2009—2021 年全国 5 岁以下儿童RFS病原构成及流行特征。
    结果 我国5岁以下儿童RFS患者以病毒感染为主，主要是肠道病毒（85.78%）、麻疹病毒（10.03%）和水痘-带状疱疹病毒（1.45%），合计占比为97.26%，风疹病毒等其余病原在2018—2021年占比有所增加。 2009—2021年肠道病毒优势血清型从肠道病毒A组71型（EV-A71）和柯萨奇病毒A组16型（CV-A16）转换为柯萨奇病毒A组6型（CV-A6）和柯萨奇病毒A组10型（CV-A10）。 RFS总体病原检出率在1～2岁年龄组（70.53%）高于其他年龄组（χ2=292.336，P<0.001），南方地区（71.12%）高于北方地区（65.35%）（χ2=305.946，P<0.001）；肠道病毒在1～2岁年龄组患儿、南方地区检出率较高，麻疹病毒在<1岁患儿、北方地区检出率较高，水痘–带状疱疹病毒在北方地区检出率较高。 RFS总体病原在春夏季检出率高于秋冬季（χ2=295.060，P<0.001），其中肠道病毒夏秋季高发，麻疹病毒冬春季高发，水痘–带状疱疹病毒冬季高发，3种病毒南、北方地区季节性分布峰有所差异。
    结论 2009—2021年全国5岁以下儿童RFS患儿以病毒感染为主，尤其以肠道病毒、麻疹病毒和水痘–带状疱疹病毒感染较为常见，RFS患儿病原体感染呈现多样化趋势，肠道病毒优势血清型发生转变，应持续加强对儿童RFS病原谱的监测。

     

    Abstract:
    Objective To understand the etiological and the epidemiological characteristics of rash and fever syndrome (RFS) in children aged ＜5 years in China, and provide evidence for the diagnosis, prevention and control of RFS.
    Methods Based on the data of RFS from National Infectious Disease Surveillance Platform, the pathogens included enterovirus, measles virus, rubella virus, varicella-zoster virus, dengue virus, human parvovirus virus B19, Ebola virus, zika virus, human herpesvirus 6, Epstein-Barr virus, streptococcus group A, Salmonella typhi and Salmonella paratyphoid, borrelia-burgdorferi and rickettsia. The descriptive analysis was used to analyze the compositions of pathogens and the epidemiological characteristics of RFS in children aged ＜5 years in China from 2009 to 2021.
    Results RFS in the children was mainly caused by viruses, which included enterovirus (85.78%) , measles virus (10.03%) and varicella-zoster virus (1.45%), causing 97.26% of the total RFS cases. The cases caused by rubella virus and other pathogens increased from 2018 to 2021. The predominant enterovirus serotypes shifted from EV-A71 and CV-A16 to CV-A6 and CV-A10 during 2009−2021. The highest detection rate of RFS was reported in age group 1−2 years (70.53%) (χ2=292.336, P<0.001) and the detection rate was higher in southern China (71.12%) than in northern China (65.35%) (χ2=305.946, P<0.001). The positive rate of enterovirus was higher in age group 1−2 years and in southern China. The positive rate of measles virus was higher in age group <1 years in northern China. The positive rate of varicella-zoster virus was higher in northern China. The positive rate in spring and summer was higher than that in autumn and winter (χ2=295.060, P<0.001). The positive rate of enterovirus increased in summer and autumn, while the positive rate of measles virus increased in winter and spring, and the positive rate of varicella-zoster virus was highest in winter. The seasonal distribution detection peaks of the three viruses were different in the south and north regions.
    Conclusion Viruses, especially enterovirus, measles virus, and varicella-zoster virus infections, were the main pathogens causing RFS in children under 5 years old in China from 2009 to 2021, diversify was observed in pathogens causing RFS and the predominant enterovirus serotypes shifted, suggesting that it is necessary to further strengthen the surveillance for the etiological characteristics of RFS.

     

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