肠道病毒 71 型、柯萨奇病毒 A16 型或柯萨奇病毒 A6 型所致手足口病患者的病毒脱落：系统评价和荟萃分析。
Virus Shedding in Patients With Hand, Foot and Mouth Disease Induced by EV71, CA16 or CA6: Systematic Review and Meta-analysis.
机构信息
From the Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu.
Department of Microbiology Laboratory, Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China.
出版信息
Pediatr Infect Dis J. 2021 Apr 1;40(4):289-294. doi: 10.1097/INF.0000000000002985.
BACKGROUND
As the highly contagious hand, foot and mouth disease (HFMD) spreads rapidly among children, isolation is the most effective way to control its spread. However, studies on the duration of virus shedding of the HFMD-related enterovirus and a reasonable quarantine period for HFMD patients are inconsistent.
METHODS
We undertook a systematic review and meta-analysis evaluating the viral shedding of patients with HFMD caused by Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) and coxsackievirus A6.
RESULTS
A total of 17 observational studies evaluating 626 participants were included. In the first 5 weeks after onset, the pooled virus positive rate in specimens of EV71-related patients decreased from 0.79 (P < 0.001 for heterogeneity) to 0.38 (P < 0.001 for heterogeneity). The positive rate of CVA16 was reduced from 0.91 (P < 0.001 for heterogeneity) to 0.29 (P < 0.001 for heterogeneity). The positive rates of CVA16 and coxsackievirus A6 were approximately 50% in the third week after onset, while a 50% positive rate appeared in the fourth week in EV71 related cases.
CONCLUSIONS
We found the positive rates of virus shedding were still high among the patients released from quarantine, and the duration of viral shedding was inconsistent among HFMD patients caused by different serotypes. Our findings provide comprehensive evidence for a possible flexible quarantine period according to the serotype.
背景
手足口病（HFMD）具有高度传染性，在儿童中迅速传播，隔离是控制其传播的最有效方法。然而，关于 HFMD 相关肠道病毒的病毒脱落持续时间和 HFMD 患者合理隔离期的研究结果并不一致。
方法
我们进行了一项系统评价和荟萃分析，评估了由肠道病毒 71 型（EV71）和柯萨奇病毒 A16 型（CVA16）和柯萨奇病毒 A6 引起的 HFMD 患者的病毒脱落情况。
结果
共纳入了 17 项观察性研究，涉及 626 名参与者。在发病后 5 周内，EV71 相关患者的标本病毒阳性率从 0.79（异质性 P < 0.001）降至 0.38（异质性 P < 0.001）。CVA16 的阳性率从 0.91（异质性 P < 0.001）降至 0.29（异质性 P < 0.001）。CVA16 和柯萨奇病毒 A6 的阳性率在发病后第 3 周约为 50%，而 EV71 相关病例的第 4 周阳性率为 50%。
结论
我们发现解除隔离的患者的病毒脱落率仍然较高，不同血清型引起的 HFMD 患者的病毒脱落持续时间不一致。我们的研究结果为根据血清型制定灵活的隔离期提供了全面的证据。
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