文章摘要
张钟,郑亚明,姜黎黎,嵇红,陈国平,罗平,潘静静,田晓灵,魏雷雷,霍达,缪梓萍,邹晓妮,陈建华,廖巧红,常昭瑞.我国2015-2016年哨点监测手足口病病原学和并发症分析[J].中华流行病学杂志,2019,40(6):627-632
我国2015-2016年哨点监测手足口病病原学和并发症分析
Review on the etiology and complications of hand, foot and mouth disease, using data from the national sentinel surveillance program, in China, 2015-2016
投稿时间:2018-11-22  
DOI:10.3760/cma.j.issn.0254-6450.2019.06.005
中文关键词: 手足口病;哨点监测;病原学;阳性率;并发症
英文关键词: Hand,foot and mouth disease;Sentinel surveillance;Etiology;Positive rate;Complication
基金项目:中国疾病预防控制中心应急反应机制运行(131031001000015001);国家科技重大专项(2018ZX10713-001-006)
作者单位E-mail
张钟 南京市疾病预防控制中心 210003
中国疾病预防控制中心中国现场流行病学培训项目, 北京 100050 
 
郑亚明 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室, 北京 102206  
姜黎黎 云南省疾病预防控制中心, 昆明 650011  
嵇红 江苏省疾病预防控制中心, 南京 210009  
陈国平 安徽省疾病预防控制中心, 合肥 230601  
罗平 邵阳市疾病预防控制中心 422000  
潘静静 河南省疾病预防控制中心, 郑州 450016  
田晓灵 内蒙古自治区综合疾病预防控制中心, 呼和浩特 010031  
魏雷雷 吉林省疾病预防控制中心, 长春 130062  
霍达 北京市疾病预防控制中心 100013  
缪梓萍 浙江省疾病预防控制中心, 杭州 310051  
邹晓妮 广东省妇幼保健院, 广州 511440  
陈建华 甘肃省疾病预防控制中心, 兰州 730000  
廖巧红 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室, 北京 102206  
常昭瑞 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室, 北京 102206 changzr@chinacdc.cn 
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中文摘要:
      目的 分析2015-2016年我国手足口病哨点监测系统的手足口病特征,探讨建立手足口病哨点监测的可行性、优势及不足。方法 数据来源于11个国家级哨点监测点2015年11月至2016年10月手足口病监测数据,描述手足口病的病原特征、代表性和重症病例并发症情况,采用多因素logistic回归分析手足口病哨点监测样本阳性率的相关影响因素。采用SPSS 20.0软件进行统计学分析。结果 共有4 783例手足口病病例样本,其中轻症病例3 390例,重症病例1 390例,死亡3例。肠道病毒(EV)阳性率为81.43%(3 895/4 783),轻症病例优势血清型为其他EV(52.68%,1 482/2 813),重症病例优势血清型为EV71(65.31%,706/1 081)。哨点监测显示的优势血清型与同时期现有监测血清型基本一致。其他EV所致病例中低年龄组儿童所占比例高于EV71和柯萨奇病毒A组16型(Cox A16)(χ2=130.17,P<0.001)。多因素logistic回归结果显示,样本阳性率高与男性、高发月份病例、儿童医院病例、样本为粪便、及时采样有关。不同类型样本阳性率均呈现随发病-采样间隔时间的延长而下降的趋势(粪便趋势χ2=14.47,P<0.001;咽拭子趋势χ2=31.99,P<0.001;肛拭子趋势χ2=24.26,P<0.001)。无菌性脑膜炎、非脑干脑炎、脑干脑炎为重症病例最常见的3种并发症,EV71和其他EV所致重症病例并发症差异无统计学意义。结论 哨点监测发现性别、发病月份、接诊医院类别、标本类型、采样及时性是影响手足口病样本阳性率的5个独立影响因素。哨点监测可以收集这些影响因素以提升监测质量。设立手足口病国家级哨点监测在我国是可行的。
英文摘要:
      Objective To understand the characteristics relating to the etiology and complications of hand, foot and mouth disease (HFMD) based on data from the pilot National Sentinel Surveillance (NSS) program so as to explore the feasibility, advantages and disadvantages of the NSS. Methods Data were extracted from the NSS system, conducted in 11 provinces of China from November 2015 to October 2016. Characteristics regarding the etiology, complications of HFMD and factors related to the positive rates of HFMD specimens were analyzed under the logistic regression method by SPSS 20.0 software. Results A total of 4 783 specimens were collected, including 3 390 from mild, 1 390 from severe and 3 from death cases. The overall positive rate was 81.43% (3 895/4 783). Other enteroviruses (non EV71/Cox A16 enteroviruses) appeared the major serotype (52.68%, 1 482/2 813) for mild infection of the disease while EV71 was for the severe cases (65.31%, 706/1 081). The serotype spectrum revealed by the pilot NSS was almost identical with the existing surveillance system. Other enteroviruses tended to infect younger children (χ2=130.17, P<0.001) than EV71 and Cox A16, in China. The multivariate logistic regression results showed that higher positive rate was associated with specimens which were collected from males, at children' hospitals, in peak seasons, timely and in stools. The positive rates presented downwarding trends with the extension of the onset-sampling interval (χ2=14.47, P<0.001 in stool specimen; χ2=31.99, P<0.001 in throat swab; χ2=24.26, P<0.001 in anal swab). Aseptic meningitis, non-brainstem encephalitis and brainstem encephalitis appeared the top three complications of both EV71-associated and other enteroviruses-associated severe HFMD cases. Conclusions Factors as gender, season/place/timeliness of specimen collection, and types of hospital all appeared independently influenced the positive rates. NSS seemed feasible to be used as an alternative or supplement tool to the existing surveillance program in China.
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