Surveillance for severe hand, foot, and mouth disease from 2009 to 2015 in Jiangsu province: epidemiology, etiology, and disease burden
Surveillance for severe hand, foot, and mouth disease from 2009 to 2015 in Jiangsu province: epidemiology, etiology, and disease burden
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DOI：
10.1186/s12879-018-3659-7
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发表时间：
2019-01-22
影响因子：
3.7
通讯作者：
Jin, Yu
中科院分区：
文献类型：
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作者：
Ji, Hong;Fan, Huan;Jin, Yu
背景：严重手足口病是由多种肠道病毒引起的儿童常见病。这种疾病增加了5岁以下儿童的负担。我们的目的是确定中国江苏省严重手足口病患者的流行病学、中枢神经系统并发症和病因学。方法收集2009 - 2015年手足口病重症病例的流行病学、临床和实验室资料。分析重症手足口病的中枢神经系统并发症、年重症发病率、死亡率、重症- picu入院率、重症-住院率等，以评估重症手足口病的疾病负担。所有分析均按时间、地区、人群、中枢神经系统受累情况和血清型进行分层。从EV-A71、CV-A16、CV-A6、CV-A10等肠病毒分离株中扩增VP1基因。使用MEGA5.0进行系统发育分析。结果共报告重症手足口病7994例，其中住院7224例，PICU住院611例，死亡68例。平均重症发病率、死亡率、重症病死率、重症重症监护病房入院率和重症住院率分别为14.54、0.12、8506、76430和9037 / 100万。12 ~ 23月龄重症发生率最高，6 ~ 11月龄死亡率最高。重症发病率和死亡率存在地域差异。感染EV-A71的患者在不同中枢神经系统受累甚至死亡的比例更高。EV-A71、CV-A16和其他肠道病毒分别占79.14%、6.49%和14.47%。共鉴定出CV-A2、CV-A4、cv - a6、CV-A9、CV-A10、CV-B1、CV-B2、CV-B3、CV-B4、CV-B5、E-6、E-7、E-18和EV-C96等14种非ev - a71 / CV-A16基因型。系统发育分析表明，EV-A71株属于C4a亚基因型，而CV-A16株属于B1基因型的B1a和B1b亚基因型。CV-A6株属于F基因组，CV-A10株属于d基因组。结论未来的缓解政策应考虑年龄、地区异质性、中枢神经系统状况和疾病的血清型。此外，还需要对轻度和重度手足口病进行更严格的研究，以阐明其流行病学、病原体谱和免疫模式的差异，并优化后续研究中的干预措施。
BackgroundSevere hand, foot, and mouth disease (HFMD) is a common childhood illness caused by various enteroviruses. The disease has imposed increased burden on children younger than 5years old. We aimed to determine the epidemiology, CNS complication, and etiology among severe HFMD patients, in Jiangsu, China.MethodsEpidemiological, clinical, and laboratory data of severe HFMD cases were extracted from 2009 to 2015. The CNS complication, annually severe illness rates, mortality rates, severity-PICU admission rates, severity-hospitalization rates, and so on were analyzed to assess the disease burden of severe HFMD. All analyses were stratified by time, region, population, CNS involvement and serotypes. The VP1 gene from EV-A71, CV-A16, CV-A6, CV-A10 and other enteroviruses isolates was amplified. Phylogenetic analysis was performed using MEGA5.0.ResultsSeven thousand nine hundred ninety-four severe HFMD cases were reported, of them, 7224 cases were inpatients, 611 were PICU inpatients, and 68 were fatal. The average severe illness rate, mortality rate, severity-fatality rate, severity-PICU admission rate, and severity-hospitalization rate were 14.54, 0.12,8506, 76,430, and 903,700 per 1 million, respectively. The severe illness rate was the highest in the 12-23months age group, and the greatest mortality rate was in the 6-11months age group. Geographical difference in severe illness rate and mortality were found. Patients infected with EV-A71 were at a higher proportion in different CNS involvement even death. EV-A71, CV-A16 and other enteroviruses accounted for 79.14, 6.49, and 14.47%, respectively. A total of 14 non-EV-A71/ CV-A16 genotypes including CV-A2, CV-A4, CV-A 6, CV-A9, CV-A10, CV-B1, CV-B2, CV-B3, CV-B4, CV-B5, E-6, E-7, E-18, and EV-C96 were identified. Phylogentic analyses demonstrated that EV-A71 strains belonged to subgenotype C4a, while CV-A16 strains belonged to sub-genotype B1a and sub-genotype B1b of genotype B1. CV-A6 strains were assigned to genogroup F, and CV-A10 strains belonged to genogroup D.ConclusionsFuture mitigation policies should take into account the age, region heterogeneities, CNS conditions and serotype of disease. Additional a more rigorous study between the mild and severe HFMD should be warranted to elucidate the difference epidemiology, pathogen spectrum and immunity patterns and to optimize interventions in the following study.