不同类型肠道病毒感染所致手足口病流行病学调查
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摘要
目的调查不同肠道病毒感染所致手足口病(hand foot mouth disease,HFMD)患儿家庭密切接触者肠道病毒感染情况及其传播因素分析。方法选取杭州市儿童医院2016年4～7月住院的HFMD患儿。对患儿及密切接触的家庭成员进行临床状况评估及病毒学检测,并进行问卷调查。同期收集杭州某医院体检中心体检的正常成人粪便68份及杭州某幼儿园正常幼托儿童粪便400份;采用实时荧光聚合酶链反应(RT-PCR)法进行病毒检测及分型。结果 150例肠道病毒检测阳性的HFMD患儿年龄以1～3岁为主(57.33%)。人肠道病毒71型(HEV71)75例,阳性率50.00%,柯萨奇病毒A16型(CA16)16例,阳性率为10.67%,其他肠道病毒59例,阳性率为39.33%。与75例EV71阳性患儿有密切接触的家庭成员108例,31份粪便样本中EV71病毒核酸阳性,占28.70%(31/108);与16例CA16阳性患儿有密切接触的家庭成员28例,9份粪便样本CA16病毒核酸阳性,占32.14%(9/28);与59例肠道病毒通用型阳性患儿有密切接触的家庭成员81例,21份粪便样本肠道病毒通用型病毒核酸阳性,占25.93%(21/81);同期检测的正常成人粪便肠道病毒核酸均阴性;检测的正常幼托儿童粪便1份肠道病毒阳性。而家庭成员中有幼托儿童且该幼托儿童近期有患病,是引起HFMD家庭聚集性传播的危险因素。结论不同类型肠道病毒感染所致HFMD家庭传播率差异无统计学意义;家庭因素只是HFMD传播中的一种因素。
Objective To understand the epidemiological characteristics of hand-foot-mouth disease(HFMD) caused by different types of enterovirus, and to observe the virus transmission among family members. Methods Children with HFMD hospitalized from April 2016 to July 2016 in Hangzhou children′s Hospital were enrolled into the study.Clinical evaluation, virological assay and questionnaire-based interviews were performed among patients and their close family contacts.Meanwhile, fecal samples were also collected from healthy adults(68 samples) and from healthy kids(400 samples).Real-time polymerase chain reaction(RT-PCR) was used for the virus identification.Data were analyzed by chi square test and logistic regression. Results A total of 150 patients had laboratory-confirmed enterovirus infection.The male to female ratio was 1.5∶1 and 57.33% of patients were 1-3 years old kids.50.00%, 10.67% and 39.33% were positive for human enterovirus 71(HEV71), Coxsackie virus group-A type-16(CVA16) and other enteroviruses.Out of total 108, 28 and 21 fecal samples collected from family members closely contacted with 75 cases of EV71,16 cases of CVA16 and 59 cases of other enteroviruses positive children, 31(28.70%), 9(32.14%) and 21(25.93%) were PCR positive for EV71 virus, CA16 virus and other enteroviruses.While, 68 fecal samples from healthy adults were all enterovirus negative, and only 1 enterovirus positive sample was found in 400 fecal samples from healthy children.Having a day care child who had HFMD in the family was a risk factor for HFMD intrafamilial transmission. Conclusions There was no significant difference in the family transmission of HFMD caused by different types of enterovirus.Family factor is one of the major factors affecting the transmission of HFMD.
Objective To understand the epidemiological characteristics of hand-foot-mouth disease(HFMD) caused by different types of enterovirus, and to observe the virus transmission among family members. Methods Children with HFMD hospitalized from April 2016 to July 2016 in Hangzhou children′s Hospital were enrolled into the study.Clinical evaluation, virological assay and questionnaire-based interviews were performed among patients and their close family contacts.Meanwhile, fecal samples were also collected from healthy adults(68 samples) and from healthy kids(400 samples).Real-time polymerase chain reaction(RT-PCR) was used for the virus identification.Data were analyzed by chi square test and logistic regression. Results A total of 150 patients had laboratory-confirmed enterovirus infection.The male to female ratio was 1.5∶1 and 57.33% of patients were 1-3 years old kids.50.00%, 10.67% and 39.33% were positive for human enterovirus 71(HEV71), Coxsackie virus group-A type-16(CVA16) and other enteroviruses.Out of total 108, 28 and 21 fecal samples collected from family members closely contacted with 75 cases of EV71,16 cases of CVA16 and 59 cases of other enteroviruses positive children, 31(28.70%), 9(32.14%) and 21(25.93%) were PCR positive for EV71 virus, CA16 virus and other enteroviruses.While, 68 fecal samples from healthy adults were all enterovirus negative, and only 1 enterovirus positive sample was found in 400 fecal samples from healthy children.Having a day care child who had HFMD in the family was a risk factor for HFMD intrafamilial transmission. Conclusions There was no significant difference in the family transmission of HFMD caused by different types of enterovirus.Family factor is one of the major factors affecting the transmission of HFMD.
引文
[1] 黄月霞,曾洁,罗序峰.中山市散发手足口病患儿家庭因素的调查研究[J].中国医药卫生,2015,5(5):192-195.
[2] 赵仕勇,林先耀,滕淑,等.肠道病毒71型感染手足口病患儿的肠道排毒时间及传播机制的初步探[J].疾病监测,2015,30(1):23-26.
[3] Xing W,Liao Q,Viboud C,et al.Hand,foot,and mouth disease in China,2008-12:an epidemiological study[J].Lancet Infect Dis,2014,14(4):308-318.
[4] 罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015,49(2):184-188.
[5] 周俊,吴亦栋,陈晓玲,等.2013年杭州市手足口病患儿及其接触人群流行病学调查[J].浙江大学学报(医学版),2014 (2):212-217.
[6] 陈纯,王鸣,郝元涛.手足口病流行特征与传播规律研究现状[J].国际流行病学传染病学杂志,2011,38(6):421-424.
[7] Wang J,Teng Z,Cui X,et al.Epidemiological and serological surveillance of hand-foot-and-mouth disease in Shanghai,China,2012-2016[J].Emerg Microbes Infect,2018,7(1):8.
[8] Chang LY,Tsao KC,Hsia SH,et al.Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan[J].JAMA,2004,291(2):222-227.
[9] Huang WC,Shih WL,Yang SC,et al.Predicting severe enterovirus 71 infection:Age,comorbidity,and parental behavior matter[J].J Microbol Immunol Infect,2017,50(1):10-16.
[10] Song X,Stockwell DC,Floyd T,et al.Improving hand hygiene compliance in health care workers:Strategies and impact on patient outcomes[J].Am J Infect Control,2013,41(10):e101-e105.
[11] Liao Q,Lam WW,Cowling BJ,et al.Parental perspectives on hand,foot,and mouth disease among children in Hong Kong:a longitudinal study[J].Epidemiol Infect,2018,146(3):324-332.
[12] Li Y,Dang S,Deng H,et al.Breastfeeding,previous Epstein-Barr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].Eur J Pediatr,2013,172(5):661-666.
[13] Song X,Stockwell DC,Floyd T,et al.Improving hand hygiene compliance in health care workers:Strategies and impact on patient outcomes[J].Am J Infect Control,2013,41(10):e101-e105.
[14] Li Y,Dang S,Deng H,et al.Breastfeeding,previous Epstein-Barr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].Eur J Pediatr,2013,172(5):661-666.
[15] Wang XF,Lu J,Liu XX,et al.Epidemiological features of hand,foot and mouth disease outbreaks among chinese preschool children:a meta-analysis[J].Iran J Public Health,2018,47(9):1234-1243.
[16] Shi C,Liu J,Shi P,et al.Epidemiological characteristics and influential factors of hand,foot,and mouth disease reinfection in Wuxi,China,2008-2016[J].BMC Infect Dis,2018,18(1):472.
[17] 孙立梅,林锦炎,曾汉日,等.手足口病患者家庭密切接触者肠道病毒感染及环境污染状况调查[J].中华传染病杂志,2012,30(6):339-342.
[18] 文育英.健康教育在手足口病患儿家属中的应用[J].护理实践与研究,2008,6(12):114-115.
[19] 刘晓伟.对小儿手足口病家庭预防的调查与探讨[J].中国疗养医学,2011,20(1):89-90.
[20] Doherty WJ,Barid MA.Family therapy and family medicine[M].New York:Guilford press,2003:138-159.
[2] 赵仕勇,林先耀,滕淑,等.肠道病毒71型感染手足口病患儿的肠道排毒时间及传播机制的初步探[J].疾病监测,2015,30(1):23-26.
[3] Xing W,Liao Q,Viboud C,et al.Hand,foot,and mouth disease in China,2008-12:an epidemiological study[J].Lancet Infect Dis,2014,14(4):308-318.
[4] 罗莉,邢薇佳,廖巧红,等.儿童肠道病毒71型和柯萨奇病毒A16型感染血清流行病学研究进展[J].中华预防医学杂志,2015,49(2):184-188.
[5] 周俊,吴亦栋,陈晓玲,等.2013年杭州市手足口病患儿及其接触人群流行病学调查[J].浙江大学学报(医学版),2014 (2):212-217.
[6] 陈纯,王鸣,郝元涛.手足口病流行特征与传播规律研究现状[J].国际流行病学传染病学杂志,2011,38(6):421-424.
[7] Wang J,Teng Z,Cui X,et al.Epidemiological and serological surveillance of hand-foot-and-mouth disease in Shanghai,China,2012-2016[J].Emerg Microbes Infect,2018,7(1):8.
[8] Chang LY,Tsao KC,Hsia SH,et al.Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan[J].JAMA,2004,291(2):222-227.
[9] Huang WC,Shih WL,Yang SC,et al.Predicting severe enterovirus 71 infection:Age,comorbidity,and parental behavior matter[J].J Microbol Immunol Infect,2017,50(1):10-16.
[10] Song X,Stockwell DC,Floyd T,et al.Improving hand hygiene compliance in health care workers:Strategies and impact on patient outcomes[J].Am J Infect Control,2013,41(10):e101-e105.
[11] Liao Q,Lam WW,Cowling BJ,et al.Parental perspectives on hand,foot,and mouth disease among children in Hong Kong:a longitudinal study[J].Epidemiol Infect,2018,146(3):324-332.
[12] Li Y,Dang S,Deng H,et al.Breastfeeding,previous Epstein-Barr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].Eur J Pediatr,2013,172(5):661-666.
[13] Song X,Stockwell DC,Floyd T,et al.Improving hand hygiene compliance in health care workers:Strategies and impact on patient outcomes[J].Am J Infect Control,2013,41(10):e101-e105.
[14] Li Y,Dang S,Deng H,et al.Breastfeeding,previous Epstein-Barr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].Eur J Pediatr,2013,172(5):661-666.
[15] Wang XF,Lu J,Liu XX,et al.Epidemiological features of hand,foot and mouth disease outbreaks among chinese preschool children:a meta-analysis[J].Iran J Public Health,2018,47(9):1234-1243.
[16] Shi C,Liu J,Shi P,et al.Epidemiological characteristics and influential factors of hand,foot,and mouth disease reinfection in Wuxi,China,2008-2016[J].BMC Infect Dis,2018,18(1):472.
[17] 孙立梅,林锦炎,曾汉日,等.手足口病患者家庭密切接触者肠道病毒感染及环境污染状况调查[J].中华传染病杂志,2012,30(6):339-342.
[18] 文育英.健康教育在手足口病患儿家属中的应用[J].护理实践与研究,2008,6(12):114-115.
[19] 刘晓伟.对小儿手足口病家庭预防的调查与探讨[J].中国疗养医学,2011,20(1):89-90.
[20] Doherty WJ,Barid MA.Family therapy and family medicine[M].New York:Guilford press,2003:138-159.