| 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].Chinese journal of Epidemiology,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 |
| Received:November 22, 2018 |
| DOI：10.3760/cma.j.issn.0254-6450.2019.06.005 |
| KeyWord: 手足口病 哨点监测 病原学 阳性率 并发症 |
| English Key Word: Hand,foot and mouth disease Sentinel surveillance Etiology Positive rate Complication |
| FundProject: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） |
| Author Name | Affiliation | E-mail | | Zhang Zhong | Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China | | | Zheng Yaming | Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Jiang Lili | Yunnan Provincial Center for Disease Control and Prevention, Kunming 650011, China | | | Ji Hong | Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China | | | Chen Guoping | Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China | | | Luo Ping | Shaoyang Municipal Center for Disease Control and Prevention, Shaoyang 422000, China | | | Pan Jingjing | Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China | | | Tian Xiaoling | Inner Mongolia Autonomous Region General Center for Disease Control and Prevention, Hohhot 010031, China | | | Wei Leilei | Jilin Provincial Center for Disease Control and Prevention, Changchun 130062, China | | | Huo Da | Beijing Center for Disease Control and Prevention, Beijing 100013, China | | | Miao Ziping | Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China | | | Zou Xiaoni | Guangdong Women and Children Hospital, Guangzhou 511440, China | | | Chen Jianhua | Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China | | | Liao Qiaohong | Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | | Chang Zhaorui | Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China | changzr@chinacdc.cn |
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| Abstract: |
| 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。 |
| English Abstract: |
| 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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