2009-2015 年中国青海省手足口病的流行病学特征及空间聚集性分析。
Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009-2015.
机构信息
Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China.
International Emerging Infections Program, Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China.
出版信息
BMC Infect Dis. 2018 Dec 5;18(1):624. doi: 10.1186/s12879-018-3509-7.
BACKGROUND
Hand, Foot, and Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the epidemiology of HFMD can help develop and better target interventions, including the use of pediatric EV-A71 vaccination.
METHODS
We obtained data from the national surveillance system for HFMD cases with onset dates from 2009 to 2015. We defined probable cases as patient with skin papular or vesicular rashes on the hands, feet, mouth, or buttocks and confirmed cases as patients with the above symptoms along with laboratory-based enterovirus detection. We generated overall and age-specific annual incidence rates and described the temporal variability and seasonality of HFMD in Qinghai Province. We identified spatial clustering of HFMD incidence at the county level using the Local Indicator of Spatial Associationand an alpha level of 0.05.
RESULTS
During the study period, 14,480 HFMD probable or confirmed cases were reported in Qinghai Province. Of the 2158 (14.9%) with laboratory confirmation, 924 (42.6%) were caused by CV-A16 and 830 (38.2%) were caused by EV-A71. The majority (89%) of all case-patients were ≤ 5 years of age and male (61.5%). The overall mean annual HFMD incidence rate was 36.4 cases per 100,000 populations, while the incidence rate for children ≤5 years of age was 379.5 cases per 100,000. Case reports peaked during the months of May through July. HFMD was predominantly caused by EV-A71, except in 2010 and 2014 when CV-A16 was the predominant causative agent. High incidence rates of HFMD were clustered (Moran's I = 0.59, P < 0.05) in the eastern region of the province.
CONCLUSION
HFMD remains an important cause of childhood disease in Qinghai Province, occurring in an acyclical pattern of increased incidence, primarily due to CV-A16 circulation every three years. Incidence is also seasonal and tends to spatially cluster in the eastern region of the province. Since approximately 40% of confirmed HFMD cases were due to EV-A71, EV-A71 vaccination is likely to have a positive impact on the HFMD disease burden. Routine analysis of local surveillance data is crucial for describing disease occurrence and changes in etiology.
背景
手足口病（HFMD）主要由肠道病毒 71 型（EV-A71）或柯萨奇病毒 A16 型（CV-A16）引起，婴幼儿风险最高。描述 HFMD 的流行病学有助于制定和更好地针对干预措施，包括使用儿科 EV-A71 疫苗。
方法
我们从 2009 年至 2015 年的全国 HFMD 病例监测系统中获取数据。我们将疑似病例定义为在手、脚、口或臀部出现皮肤丘疹或水疱疹的患者，将确诊病例定义为出现上述症状并经实验室检测证实存在肠道病毒的患者。我们生成了总体和年龄特异性年度发病率，并描述了青海省 HFMD 的时间变异性和季节性。我们使用局部空间关联指标和 0.05 的 alpha 水平识别了县级 HFMD 发病率的空间聚类。
结果
在研究期间，青海省报告了 14480 例 HFMD 疑似或确诊病例。在 2158 例（14.9%）有实验室确认的病例中，924 例（42.6%）由 CV-A16 引起，830 例（38.2%）由 EV-A71 引起。所有病例患者中，89%（89%）年龄在 5 岁以下，男性占 61.5%。总体平均年 HFMD 发病率为 36.4 例/10 万人，而≤5 岁儿童的发病率为 379.5 例/10 万人。病例报告在 5 月至 7 月期间达到高峰。HFMD 主要由 EV-A71 引起，除 2010 年和 2014 年 CV-A16 为主要病原体外。该省东部地区 HFMD 发病率高（Moran's I=0.59，P<0.05）。
结论
HFMD 仍然是青海省儿童疾病的重要原因，其发病率呈周期性增加模式，主要是由于 CV-A16 每三年循环一次。发病率也具有季节性，且往往在该省东部地区呈空间聚类。由于约 40%的确诊 HFMD 病例由 EV-A71 引起，因此 EV-A71 疫苗接种可能对 HFMD 疾病负担产生积极影响。定期分析当地监测数据对于描述疾病发生和病因变化至关重要。
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