| 陈纯,谢华萍,崔敏,甄若楠,张颖,倪莉红,黄影怡,耿进妹,卢惠溪,狄飚,王呜.柯萨奇A6型手足口病耦合脊髓灰质炎疫苗衍生株感染一例调查[J].Chinese journal of Epidemiology,2014,35(1):61-65 |
| 柯萨奇A6型手足口病耦合脊髓灰质炎疫苗衍生株感染一例调查 |
| An investigation on a case of hand—foot.mouth disease caused by coxsackie—virus A6 associated with a vaccine.derired poliovirus CO-infection |
| Received:November 06, 2013 |
| DOI： |
| KeyWord: 手足口病 柯萨奇A6型 疫苗衍生株脊髓灰质炎病毒 |
| English Key Word: Hand-foot-mouth disease Coxsackievirus A6 Vaccine-derived poliovirus |
| FundProject:国家“十二五”科技重大专项(2012ZXl0004213—005)；广州市医药卫生科技项目(20131A011117，20131A010022，2013lAOllll0) |
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| Abstract: |
| 目的调查广州市l例柯萨奇A6型(CA6)手足El病合并脊髓灰质炎病毒(pv)1I型疫苗衍生株(VDPV II)感染病例，明确其感染病原及特征。方法通过现场调查获取病例相关流行病学资料，收集病例标本及其密切接触者粪便标本共16份进行肠道病毒(EV)分离鉴定。对病例就诊医院当月收集手足口病病例标本共21份，采用实时荧光RT-PCR检测手足口病相关病原，并用RT-PCR方法检测PV，CA6及PV阳性标本用RT-PCR方法扩增其VPl区基因片段进一步测序分析。结果该病例临床仅表现为手足13病症状，无急性弛缓性麻痹(AFP)。16份病例及其密切接触者粪便标本均未检出EV，人户主动搜索调查未发现类似病例。在该病例当月就诊医院收集的手足口病病例标本中，EV71阳性4例，CAl6阳性2例，包括该病例在内的其余15例均为CA6阳性，但仅该病例同时检出VDPVlI。对包括该病例在内的9例CA6阳性标本的VPI区扩增测序并进行同源性分析，9株病毒核苷酸同源性为98.9％一100.0％，推导的氨基酸同源性为96.0％～100.0％。遗传进化分析显示该9株属于同一分支。对该病例VDPV株VPl区扩增测序分析，与SabinⅡ相比，有包括U2909A在内的6个位点发生突变，其中2个位点发生氨基酸突变。遗传进化分析显示，该病例VDPV分离株不同于以往发现的VDPV。结论该病例为CA6手足口病合并VDPVII感染，其手足口病症状由CA6感染引起，推测该病例无AFP症状可能是接种脊髓灰质炎疫苗所致。分离的VDPV为当地新发现毒株，但未造成VDPV循环。 |
| English Abstract: |
| Objective To identify the pathogen and characteristics on a case of hand-footmouth disease(HFMD)caused by coxsackie.virus A6(CA6)associated with vaccine—derived poliovirus(VDPV)CO.infection.Methods Field epidemiological study at the epidemic area was conducted and l 6 stool samples including from the patient and close contacts were collected forisolation and identification of the enterovirus(EV).2 l stool samples from patients diagnosed as HFMD were collected in the same hospital at the same month to detect CA l 6，EV71。CA6 and PV by real.time ImPCR or lmPCR.The VPl gene ofthe CA6 was amplified bv RT-PCR and PCR products were sequenced and analyzed.Results The patient showed only HFMD symptoms，but no symptoms related to acute flaccid paralysis(AFP).No EVs were isolated from 1 6 samples collected from the patient and close contacts.And no AFP cases were found by an active search.A total of 2 l samples from patients diagnosed as HFMD were collected in the same hospital at the same month and 4 were found to be EV71.2 were CAl6 and 15(include the patient)were CA6.Only this patient was found to have had VDPV II infection.The CA6 VPl gene was amplified from the HFMD patient and 9 other cases from the same hospital at the same month.Nucleotide sequences of the VP 1 gene among the 9 strains shared 98.9％一l 00.0％in homology and 96.0％一1 00.0％in the deduced amino acid sequences.Phylogenetic analysis of the VPl sequences categorized the strains into the same branch. There were 6 nucleotides changes including U2909A between the VP 1 region of the VDPV strain of the case and Sabin 1I.Results from phylogenetic analysis on the VP 1 sequences indicated that the VDPV strain of the case was different from other VDPVs strains isolated in the world.Conclusion This case was a HFMD which caused bv CA6 CO—infection with VDPV II and the VDPV was newly discovered.HFMD symptoms of the case were caused bv CA6.The reason why this case did not have AFP symptoms was probably due the protective effect of IPV vaccine.No AFP cases were found by the active search for AFP cases conducted in the area.which indicated that VDPV did not cause virus circuiation in this area. |
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