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通过对2014~2015年重庆市手足口病(Hand-foot-mouth disease,HFMD)的流行病学、肠道病毒(Enterovirus,EV)病原构成和肠道病毒71型(Enterovirus A71,EV-A71)VP1区编码基因分析,为制定重庆市HFMD防控策略提供科学依据。2014~2015年全市报告HFMD共100176例,其中重症284例,死亡37例;全市39个区县(自治县)均有病例报告,且主城区报告发病率(298.83/10万)显著高于郊区(103.37/10万),5岁及以下的儿童占报告发病数95.64%,3岁及以下占83.21%,每年的4~7月为发病高峰期,每年的10~11月为发病小高峰期。重症和死亡病例在3岁和5岁及以下的年龄组中分别占86.97%、94.59%和96.83%、100%。其中重症病例主要集中在万州区、梁平县、涪陵区3个区县中,占全部重症病例的74.65%;死亡病例分布广泛,散在17个区县内。7503份HFMD临床标本的EV核酸检测结果,EV-A71、CV-A16、非EV-A71/CV-A16其他EV分别占23.54%、33.21%、43.25%;非EV-A71/CV-A16的其他EV成为导致重庆市HFMD的优势病原,但重症和死亡病例仍以EV-A71为绝对优势病原。对55株2014年和2015年重庆EV-A71代表毒株VP1编码序列测定和分析,提示54株均属于C4a,1株属于B5。本研究为重庆市制订HFMD防控策略,降低EV-A71引起的重症和死亡提供了重要的流行病学和病原学基础资料。
The epidemiology, Enterovirus (EV) pathogen and Enterovirus A71 (EV-A71) in Hand-foot-mouth disease (HFMD) VP1 gene coding analysis, to provide a scientific basis for the prevention and control of HFMD in Chongqing. There were 100,176 cases of HFMD in 2014-2015, of which 284 cases were severe and 37 cases were dead. There were case reports in 39 districts and counties (autonomous counties) in the city and the reported incidence of the main urban area was 298.83 / 100,000 was significantly higher than that of the suburbs 103.37 / 100000). Children aged 5 and below accounted for 95.64% of the reported cases, while those aged 3 and below accounted for 83.21% of the cases. The annual incidence was from April to July and the peak from October to November was the peak. Severe and fatal cases accounted for 86.97%, 94.59% and 96.83% and 100% respectively in the age groups of 3 years, 5 years and younger. The severe cases mainly concentrated in Wanzhou District, Liangping County, Fuling District, 3 districts and counties, accounting for 74.65% of all severe cases; deaths were widely distributed, scattered in 17 districts and counties. The results of EV nucleic acid test in 7503 HFMD clinical specimens showed that 23.54%, 33.21% and 43.25% of EV-A71, CV-A16 and other non-EV-A71 / CV- EV became the predominant pathogen of HFMD in Chongqing, but EV-A71 was still the predominant pathogen in critically ill and death cases. A total of 55 strains of EV-A71 from Chongqing in 2014 and 2015 were sequenced and analyzed, which indicated that 54 strains belonged to C4a and 1 belonged to B5. This study provided an important epidemiological and etiological basis for the development of HFMD prevention and control strategies in Chongqing in order to reduce the severity and mortality caused by EV-A71.