2009～2011年上海市手足口病流行病学和病原学特征

摘要

为分析2009～2011年上海地区手足口病流行病学特征和病原构成，从国家疾病监测信息报告管理系统获取上海市2009～2011年手足口病流行病学资料；采用实时荧光反转录聚合酶链反应（RT-PCR ）对来自上海18个区（县）的6676例手足口病病例标本进行肠道病毒核酸检测，对其中257份标本进行病毒分离；对27份人肠道病毒71型（HEV71）毒株进行VP1基因序列全长测定和分析。结果显示，2009～2011年上海市18个区（县）均有手足口病病例报道，地区分布无显著差异；≤5岁的婴幼儿为疾病高发年龄段；4～11月为发病高峰期。HEV71和柯萨奇病毒 A组16型（CA16）为主要病原，不同地区病原构成有所不同。实时荧光RT-PCR对6676例病例标本进行核酸检测，其中肠道病毒通用核酸检测阳性率为69．61％，HEV71和CA16阳性率分别为38．83％和21．26％。对257份HEV71核酸阳性标本进行病毒分离，获得毒株57株，分离阳性率为22．18％。对其中27株进行VP1基因全长测序，均属C4a基因亚型。%The present paper aims to investigate the epidemiological and etiological characteristics of hand , foot and mouth disease (HFMD) in Shanghai from 2009 to 2011 .The data from the National Notifiable Disease Surveillance System were analyzed .A total of 6 676 clinical samples were collected and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to determine the pathogens .The results showed that 18 districts/counties had reported HFMD cases ;The children ≤5 years old were the most susceptible population ;The peak of HFMD epidemic was from April to November ;Human enterovirus 71 (HEV71 ) and coxsackievirus A16 (CA16 ) were the major pathogens for this epidemic , but the constituent ratio of HEV71 and CA16 was different in different months and regions . Out of the 6 676 patients ,4 647 cases were positive for enterovirus by real-time RT-PCR ,The positive rate was 69 .61% . Among them 1 419 were CA16 (the overall positive rate of 21 .26% ) and 2 592 were HEV71 (the overall positive rate of 38 .83% ) .257 HEV71 samples were cultured with human rhabdomyosarcoma (RD) cells , and 57 HEV71 strains were obtained and 27 of these were subjected to sequence analysis . The complete sequences of VP1-encoding region in several identified HEV71 strains were analyzed . BLAST sequence analysis showed that all the 27 isolated HEV71 strains from 2009 to 2011 were classified into C4a .