2017年北京儿童医院就诊北京地区疱疹性咽颊炎病例分析
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摘要
目的了解北京儿童医院就诊北京地区疱疹性咽颊炎流行特征和病原学情况,为疱疹性咽颊炎的防控提供依据。方法收集2017年在北京儿童医院就诊治疗的北京地区疱疹性咽颊炎患者的基本信息及病原学监测资料,运用描述性流行病学方法进行分析。结果共纳入符合条件的疱疹性咽颊炎病例6 922例,疾病流行高峰为6—9月,<5岁儿童占86.04%。病原学监测阳性率53.42%(86/161),以其他肠道病毒为主(47/86,54.65%),其次为柯萨奇病毒A组6型(Cox A6)(28/86,32.56%),Cox A10(7/86,8.14%),肠道病毒71型(EV71)(3/86,3.49%)和Cox A16(1/86,1.16%)。7月阳性率最高(76.92%),不同月份阳性率差异有统计学意义(χ~2=29.98,P<0.05),夏秋季病例报告数较多同时肠道病毒阳性率也较高,两者间呈正相关有统计学意义(rs=0.294,P<0.05)。结论 2017年北京儿童医院就诊北京地区疱疹性咽颊炎流行高峰为夏秋季,易感人群为<5岁儿童,病原体主要为其他肠道病毒和Cox A6,引起疱疹性咽颊炎的部分肠道病毒(EV71、Cox A16、Cox A6)可同时引起手足口病,应重视疱疹性咽颊炎,参考手足口病进行疾病预防控制。
Objective To understand the epidemiological and etiological characteristics of herpangina of Beijing area detected in Beijing children's hospital and provide evidence for the prevention and control of pergangina. Methods The epidemiological and etiological data of herpangina cases were obtained from the surveillance hospital of Beijing area in 2017 for a descriptive epidemiological analysis. Results The data of 6 922 herpangina cases who met the inclusion criteria were analyzed, the incidence peak of herpangina was from June to September. Up to 86.04% of herpangina cases were under 5 years old. The positive rate of pathogen surveillance was 53.42%(86/161), the positive rate of other enteroviruses was highest(54.65%), followed by coxsackievrius A6(Cox A6)(32.56%), Cox A10(7/86,8.14%),entervirus 71(EV71)(3/86,3.49%),Cox A16(1/86,1.16%). The highest pathogen detection rate was in July(76.92%), there were significant differences in pathogen detection rate among different months(χ~2=29.98,P<0.05). Both the reported case number and pathogen detection rate were higher in summer and autumn, showing a positive correlation(rs=0.294, P<0.05). Conclusion The incidence peak of herpangina occurred in summer and autumn,children under 5 years of age were susceptible,and the pathogens were mainly other enteroviruses and Cox A6, some pathogens(EV71, Cox A16, Cox A6) could cause hand foot and mouth disease(HFMD). Close attention should be paid to herpangina and the prevention and control of herpangina can refer to HFMD′s.
Objective To understand the epidemiological and etiological characteristics of herpangina of Beijing area detected in Beijing children's hospital and provide evidence for the prevention and control of pergangina. Methods The epidemiological and etiological data of herpangina cases were obtained from the surveillance hospital of Beijing area in 2017 for a descriptive epidemiological analysis. Results The data of 6 922 herpangina cases who met the inclusion criteria were analyzed, the incidence peak of herpangina was from June to September. Up to 86.04% of herpangina cases were under 5 years old. The positive rate of pathogen surveillance was 53.42%(86/161), the positive rate of other enteroviruses was highest(54.65%), followed by coxsackievrius A6(Cox A6)(32.56%), Cox A10(7/86,8.14%),entervirus 71(EV71)(3/86,3.49%),Cox A16(1/86,1.16%). The highest pathogen detection rate was in July(76.92%), there were significant differences in pathogen detection rate among different months(χ~2=29.98,P<0.05). Both the reported case number and pathogen detection rate were higher in summer and autumn, showing a positive correlation(rs=0.294, P<0.05). Conclusion The incidence peak of herpangina occurred in summer and autumn,children under 5 years of age were susceptible,and the pathogens were mainly other enteroviruses and Cox A6, some pathogens(EV71, Cox A16, Cox A6) could cause hand foot and mouth disease(HFMD). Close attention should be paid to herpangina and the prevention and control of herpangina can refer to HFMD′s.
引文
[1]Li W,Gao HH,Zhang Q,et al.Large outbreak of herpangina in children caused by enterovirus in summer of 2015 in Hangzhou,China[J].Sci Rep,2016,6:35388.DOI:10.1038/srep35388.
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[3]Mirand A,Henquell C,Archimbaud C,et al.Outbreak of hand,foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010,France:a large citywide,prospective observational study[J].Clin Microbiol Infect,2012,18 (5):E110-118.DOI:10.1111/j.1469-0691.2012.03789.x.
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[5]蔡春林,姚相杰,卓菲,等.深圳地区疱疹性咽峡炎疫情的柯萨奇病毒A4型VP1区基因特征分析[J].中华医学杂志,2015,95(16):1226-1229.DOI:10.3760/cma.j.issn.0376-2491.2015.16.009.Cai CL,Yao XJ,Zhou F,et al.Gene characterization of the VP1region of coxsackievirus A4 from herpangina cases in Shenzhen of China[J].Natl Med J China,2015,95(16):1226-1229.DOI:10.3760/cma.j.issn.0376-2491.2015.16.009.
[6]Chen L,Yang H,Wang C,et al.Genomic characteristics of coxsackievirus A8 strains associated with hand,foot and mouth disease and herpangina[J].Arch Virol,2016,161(1):213-217.DOI:10.1007/s00705-015-2646-1.
[7]Chansaenroj J,Auphimai C,Puenpa J,et al.High prevalence of coxsackievirus A2 in children with herpangina in Thailand in2015[J].Virus Dis,2017,28(1):111-114.DOI:10.1007/s13337-017-0366-8.
[8]孙景異,肖征,崔海洋.两起Cox A4引起的幼儿园疱疹性咽峡炎暴发疫情调查[J].中国学校卫生,2015,36(4):631-632.DOI:10.16835/j.cnki.1000-9817.2015.04.056.Sun JY,Xiao Z,Cui HY,et al.Investigation of two coxsackievirus A4 herpangina outbreak in kindergartens[J].Chin J Sch Health,2015,36(4):631-632.DOI:10.16835/j.cnki.1000-9817.2015.04.056.
[9]武晶,杨军勇,董晓根,等.2016年北京市丰台区两起柯萨奇病毒A组10型引起的幼儿园疱疹性咽峡炎暴发疫情调查[J].疾病监测,2017,32(2):168-170.DOI:10.3784/j.issn.1003-9961.2017.02.020.Wu J,Yang JY,Dong XG,et al.Investigation of two coxsachievirus A10 caused herpangina outbreaks in child care settings in Fengtai,Beijing[J].Dis Surveill,2017,32(2):168-170.DOI:10.3784/j.issn.1003-9961.2017.02.020.
[10]曾汉日,郑焕英,刘冷,等.2015年广东省广州地区疱疹性咽峡炎病原学特征分析[J].中华实验和临床病毒学杂志,2017,31(5):409-413.DOI:10.3760/cma.j.issn.1003-9279.2017.05.007.Zeng HR,Zheng HY,Liu L,et al.Etiological characteristics of herpangina cases in Guangzhou city in Guangdong province,2015[J].Chin J Exp Clin Virol,2017,31(5):409-413.DOI:10.3760/cma.j.issn.1003-9279.2017.05.007.
[11]周俊,吴亦栋,岳美娜,等.2016年杭州市儿童常见肠道病毒型别感染流行病学调查[J].中华传染病杂志,2018,36(3):160-163.DOI:10.3760/cma.J.issn.1000-6680.2018.03.008.Zhou J,Wu YD,Yue MN,et al.Epidemiological survey of common enterovirus infections among children in Hangzhou,2016[J].Chin J Infect Dis,2018,36(3):160-163.DOI:10.3760/cma.J.issn.1000-6680.2018.03.008.
[12]刘丹,王静,顾霍铮,等.基于临床症状和病原学特征的手足口病与疱疹性咽峡炎流行病学分析[J].中国初级卫生保健,2018,32(6):48-50.DOI:10.3969/j.issn.1001-568X.2018.06.0018.Liu D,Wang J,Gu HZ,et al.Epidemiological analysis of hand,foot and mouth disease and herpangina based on the clinical symptoms and etiological features[J].Chin Prim Health Care,2018,32(6):48-50.DOI:10.3969/j.issn.1001-568X.2018.06.0018.
[13]陈向前,施学文,曹青.手足口病流行期疱疹性咽峡炎的病原及临床分析[J].临床儿科杂志,2013,31(5):429-432.DOI:10.3969/j.issn.1000-3606.2013.05.008.Chen XQ,Shi XW,Cao Q.Pathogens and clinical analysis of herpangina during outbreak of hand,foot and mouth disease[J].JClin Pediatr,2013,31(5):429-432.DOI:10.3969/j.issn.1000-3606.2013.05.008.
[14]许爽,刘金香,吴东林,等.长春地区儿童疱疹性咽峡炎病原研究[J].中国卫生检验杂志,2016,26(3):391-393.Xu S,Liu JX,Wu DL,et al.Pathogenic study on herpangina among children in Changchun[J].Chin J Health Lab Technol,2016,26(3):391-393.
[15]Yao X,Bian LL,Lu WW,et al.Epidemiological and etiological characteristics of herpangina and hand,foot and mouth diseases in Jiangsu,China,2013-2014[J].Hum Vaccin Immunother,2017,13(4):823-830.DOI:10.1080/21645515.2016.1236879.
[16]王玉洁,杨洪,姚相杰,等.2015年深圳地区疱疹性咽峡炎的病原学与流行病学特征分析[J].中华疾病控制杂志,2016,20(8):759-763.DOI:10.16462/j.cnki.zhjbkz.2016.08.002.Wang YJ,Yang H,Yao XJ,et al.The etiological and epidemiological characteristics of herpangina cases in Shenzhen city,2015[J].Chin J Dis Control Prev,2016,20(8):759-763.DOI:10.16462/j.cnki.zhjbkz.2016.08.002.
[17]Osterback R,Vuorinen T,Linna M,et al.Coxsackievirus A6 and hand,foot,and mouth disease,Finland[J].Emerg Infect Dis,2009(9):1485-1488.DOI:10.3201/eid1509.090438.
[18]曾汉日,陆靖,李晖,等.广东省2008-2013年柯萨奇A6型肠道病毒的流行及其基因特征分析[J].中华微生物和免疫学杂志,2014,34(10):742-746.DOI:10.3760/cma.j.issn.0254-5101.2014.10.003.Zeng HR,Lu J,Li H,et al.Epidemic and genetic characteristics of coxsackievirus A6 strains isolated in Guangdong province from year 2008 to 2013[J].Chin J Microbiol Immunol,2014,34(10):742-746.DOI:10.3760/cma.j.issn.0254-5101.2014.10.003.
[19]牛伟红,杨丽萍,秦明月,等.150例疱疹性咽峡炎临床资料总结及分析[J].中国医药导刊,2014,16(4):661-662.Niu WH,Yang LP,Qin MY,et al.Summary and analysis of the clinical data of 150 cases of herpangina[J].Chin J Med Guide,2014,16(4):661-662.
[2]Chang PC,Chen SC,Chen KT.The current status of the disease caused by enterovirus 71 infections:epidemiology,pathogenesis,molecular epidemiology,and vaccine development[J].Int JEnviron Res Public Health,2016,13(9):890.DOI:10.3390/ijerph13090890.
[3]Mirand A,Henquell C,Archimbaud C,et al.Outbreak of hand,foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010,France:a large citywide,prospective observational study[J].Clin Microbiol Infect,2012,18 (5):E110-118.DOI:10.1111/j.1469-0691.2012.03789.x.
[4]霍达,李洁,王小莉,等.2016年北京市疱疹性咽峡炎流行情况及病原体构成分析[J].国际病毒性杂志,2017,24(5):309-312.DOI:10.3760/cma.j.issn.1673-4092.2017.05.005.Huo D,Li J,Wang XL,et al.The epidemiological characteristics of herpangina and its pathogen distribution in Beijing,2016[J].Int J Virol,2017,24(5):309-312.DOI:10.3760/cma.j.issn.1673-4092.2017.05.005.
[5]蔡春林,姚相杰,卓菲,等.深圳地区疱疹性咽峡炎疫情的柯萨奇病毒A4型VP1区基因特征分析[J].中华医学杂志,2015,95(16):1226-1229.DOI:10.3760/cma.j.issn.0376-2491.2015.16.009.Cai CL,Yao XJ,Zhou F,et al.Gene characterization of the VP1region of coxsackievirus A4 from herpangina cases in Shenzhen of China[J].Natl Med J China,2015,95(16):1226-1229.DOI:10.3760/cma.j.issn.0376-2491.2015.16.009.
[6]Chen L,Yang H,Wang C,et al.Genomic characteristics of coxsackievirus A8 strains associated with hand,foot and mouth disease and herpangina[J].Arch Virol,2016,161(1):213-217.DOI:10.1007/s00705-015-2646-1.
[7]Chansaenroj J,Auphimai C,Puenpa J,et al.High prevalence of coxsackievirus A2 in children with herpangina in Thailand in2015[J].Virus Dis,2017,28(1):111-114.DOI:10.1007/s13337-017-0366-8.
[8]孙景異,肖征,崔海洋.两起Cox A4引起的幼儿园疱疹性咽峡炎暴发疫情调查[J].中国学校卫生,2015,36(4):631-632.DOI:10.16835/j.cnki.1000-9817.2015.04.056.Sun JY,Xiao Z,Cui HY,et al.Investigation of two coxsackievirus A4 herpangina outbreak in kindergartens[J].Chin J Sch Health,2015,36(4):631-632.DOI:10.16835/j.cnki.1000-9817.2015.04.056.
[9]武晶,杨军勇,董晓根,等.2016年北京市丰台区两起柯萨奇病毒A组10型引起的幼儿园疱疹性咽峡炎暴发疫情调查[J].疾病监测,2017,32(2):168-170.DOI:10.3784/j.issn.1003-9961.2017.02.020.Wu J,Yang JY,Dong XG,et al.Investigation of two coxsachievirus A10 caused herpangina outbreaks in child care settings in Fengtai,Beijing[J].Dis Surveill,2017,32(2):168-170.DOI:10.3784/j.issn.1003-9961.2017.02.020.
[10]曾汉日,郑焕英,刘冷,等.2015年广东省广州地区疱疹性咽峡炎病原学特征分析[J].中华实验和临床病毒学杂志,2017,31(5):409-413.DOI:10.3760/cma.j.issn.1003-9279.2017.05.007.Zeng HR,Zheng HY,Liu L,et al.Etiological characteristics of herpangina cases in Guangzhou city in Guangdong province,2015[J].Chin J Exp Clin Virol,2017,31(5):409-413.DOI:10.3760/cma.j.issn.1003-9279.2017.05.007.
[11]周俊,吴亦栋,岳美娜,等.2016年杭州市儿童常见肠道病毒型别感染流行病学调查[J].中华传染病杂志,2018,36(3):160-163.DOI:10.3760/cma.J.issn.1000-6680.2018.03.008.Zhou J,Wu YD,Yue MN,et al.Epidemiological survey of common enterovirus infections among children in Hangzhou,2016[J].Chin J Infect Dis,2018,36(3):160-163.DOI:10.3760/cma.J.issn.1000-6680.2018.03.008.
[12]刘丹,王静,顾霍铮,等.基于临床症状和病原学特征的手足口病与疱疹性咽峡炎流行病学分析[J].中国初级卫生保健,2018,32(6):48-50.DOI:10.3969/j.issn.1001-568X.2018.06.0018.Liu D,Wang J,Gu HZ,et al.Epidemiological analysis of hand,foot and mouth disease and herpangina based on the clinical symptoms and etiological features[J].Chin Prim Health Care,2018,32(6):48-50.DOI:10.3969/j.issn.1001-568X.2018.06.0018.
[13]陈向前,施学文,曹青.手足口病流行期疱疹性咽峡炎的病原及临床分析[J].临床儿科杂志,2013,31(5):429-432.DOI:10.3969/j.issn.1000-3606.2013.05.008.Chen XQ,Shi XW,Cao Q.Pathogens and clinical analysis of herpangina during outbreak of hand,foot and mouth disease[J].JClin Pediatr,2013,31(5):429-432.DOI:10.3969/j.issn.1000-3606.2013.05.008.
[14]许爽,刘金香,吴东林,等.长春地区儿童疱疹性咽峡炎病原研究[J].中国卫生检验杂志,2016,26(3):391-393.Xu S,Liu JX,Wu DL,et al.Pathogenic study on herpangina among children in Changchun[J].Chin J Health Lab Technol,2016,26(3):391-393.
[15]Yao X,Bian LL,Lu WW,et al.Epidemiological and etiological characteristics of herpangina and hand,foot and mouth diseases in Jiangsu,China,2013-2014[J].Hum Vaccin Immunother,2017,13(4):823-830.DOI:10.1080/21645515.2016.1236879.
[16]王玉洁,杨洪,姚相杰,等.2015年深圳地区疱疹性咽峡炎的病原学与流行病学特征分析[J].中华疾病控制杂志,2016,20(8):759-763.DOI:10.16462/j.cnki.zhjbkz.2016.08.002.Wang YJ,Yang H,Yao XJ,et al.The etiological and epidemiological characteristics of herpangina cases in Shenzhen city,2015[J].Chin J Dis Control Prev,2016,20(8):759-763.DOI:10.16462/j.cnki.zhjbkz.2016.08.002.
[17]Osterback R,Vuorinen T,Linna M,et al.Coxsackievirus A6 and hand,foot,and mouth disease,Finland[J].Emerg Infect Dis,2009(9):1485-1488.DOI:10.3201/eid1509.090438.
[18]曾汉日,陆靖,李晖,等.广东省2008-2013年柯萨奇A6型肠道病毒的流行及其基因特征分析[J].中华微生物和免疫学杂志,2014,34(10):742-746.DOI:10.3760/cma.j.issn.0254-5101.2014.10.003.Zeng HR,Lu J,Li H,et al.Epidemic and genetic characteristics of coxsackievirus A6 strains isolated in Guangdong province from year 2008 to 2013[J].Chin J Microbiol Immunol,2014,34(10):742-746.DOI:10.3760/cma.j.issn.0254-5101.2014.10.003.
[19]牛伟红,杨丽萍,秦明月,等.150例疱疹性咽峡炎临床资料总结及分析[J].中国医药导刊,2014,16(4):661-662.Niu WH,Yang LP,Qin MY,et al.Summary and analysis of the clinical data of 150 cases of herpangina[J].Chin J Med Guide,2014,16(4):661-662.