手足口病流行病學(xué)及病原學(xué)研究
發(fā)布時(shí)間：2018-07-16 21:06
【摘要】： 目的 本研究的主要目的是通過分析2008年山東省手足口病疫情資料、住院病例個(gè)案調(diào)查信息和重癥病例主動(dòng)調(diào)查資料,描述手足口病流行病學(xué)特征,探索病因及其主要危險(xiǎn)因素。同時(shí),運(yùn)用腸道病毒分離鑒定和逆轉(zhuǎn)錄-多聚酶鏈反應(yīng)(RT—PCR)快速診斷等方法,了解該地區(qū)手足口病的分子流行病學(xué)特征,并對(duì)不同流行區(qū)分離到的腸道病毒主要流行毒株進(jìn)行比較研究,探索病原變遷規(guī)律。 材料與方法 所有病例信息來源于來自國家疾病監(jiān)測(cè)信息管理系統(tǒng)。人口資料來自山東省統(tǒng)計(jì)局2008山東統(tǒng)計(jì)年鑒。個(gè)案調(diào)查資料來自縣級(jí)疾控機(jī)構(gòu)上報(bào)的住院病例個(gè)案調(diào)查表。各類臨床標(biāo)本取自各級(jí)醫(yī)療機(jī)構(gòu)住院病例,共對(duì)采集的1837份糞便標(biāo)本、咽拭子、皰疹液、腦脊液、急性期血和恢復(fù)期血標(biāo)本進(jìn)行了實(shí)驗(yàn)室檢測(cè)。標(biāo)本檢測(cè)方法參照衛(wèi)生部《手足口病預(yù)防控制指南(2008年版)》規(guī)定的方法進(jìn)行;以病毒分離和RT-PCR方法對(duì)2008年山東省手足口病臨床標(biāo)本進(jìn)行了病原學(xué)的初步篩查。以上所得結(jié)果用Epi info 3.4.3軟件進(jìn)行統(tǒng)計(jì)學(xué)分析處理。 結(jié)果 2008年全省報(bào)告手足口病病例32974例,發(fā)病率為35.2023/10萬。1-12月均有手足口病疫情報(bào)告,發(fā)病高峰集中在5-7月份。男女性別比為1.80:1,男性發(fā)病率顯著高于女性;發(fā)病年齡集中在5歲以下,尤以2歲組發(fā)病率最高,各年齡別發(fā)病率之間存在差異性。全省病例分布廣泛,全部17個(gè)市、140個(gè)縣(市、區(qū))及90.42%的鄉(xiāng)(鎮(zhèn)、街辦)有病例報(bào)告,各市發(fā)病率之間存在顯著性差異,人口密度高的市轄區(qū)手足口病發(fā)病率高于人口密度較低的縣(市)地區(qū)。多數(shù)地區(qū)疫情以散發(fā)為主,局部地區(qū)出現(xiàn)聚集性發(fā)病。絕大多數(shù)病例表現(xiàn)為典型的的手、足、口等部位皮疹,除EV71和Cox A16合并感染所致出現(xiàn)手部皮疹病例數(shù)略高于其他型別外,其他不同型別腸道病毒所致病例出現(xiàn)發(fā)熱、足部皮疹、臀部皮疹、口腔黏膜疹和并發(fā)癥等癥狀無顯著差異,病例臨床癥狀普遍較輕微,出現(xiàn)并發(fā)癥者少見,預(yù)后良好,無致死病例出現(xiàn)。病原學(xué)和分子生物學(xué)結(jié)果顯示2008年引起全省手足口病流行的病原體主要為EV 71和Cox A16,二者所致病例占到了實(shí)驗(yàn)室確診病例的66.00%,其他腸病毒型別占34.00%,其中流行優(yōu)勢(shì)毒株為EV 71,而且存在EV 71和Cox A16交叉感染的病例,交叉陽性者占到了實(shí)驗(yàn)室確診病例的24.4%。引起山東省重癥病例的腸道病毒型別為EV 71。大多數(shù)手足口病病例沒有明確的流行學(xué)接觸史。 結(jié)論 2008年山東省手足口病地區(qū)分布廣泛,多以散發(fā)為主,引起手足口病流行的病原體主要為EV 71和Cox A16,流行優(yōu)勢(shì)毒株為EV 71,存在EV 71和Cox A16交叉感染的病例。加強(qiáng)監(jiān)測(cè),做好兒童個(gè)人、家庭和托幼機(jī)構(gòu)的防控措施落實(shí)是預(yù)防手足口病的關(guān)鍵。
[Abstract]:Objective the main purpose of this study was to describe the epidemiological characteristics of hand-foot-mouth disease by analyzing the epidemic data of hand-foot-mouth disease in Shandong Province in 2008, the information of in-patient case investigation and the active investigation of severe cases. To explore the etiology and its main risk factors. At the same time, the molecular epidemiological characteristics of hand, foot and mouth disease in this area were studied by means of isolation and identification of enterovirus and rapid diagnosis by reverse transcription-polymerase chain reaction (RT-PCR). The main enterovirus strains isolated in different epidemic areas were compared and studied to explore the rules of pathogen change. Materials and methods all case information comes from the National Disease Surveillance Information Management system. Population data from Shandong Statistical Bureau 2008 Shandong Statistical Yearbook. Case investigation data from county-level disease control institutions reported inpatient cases questionnaire. 1837 stool specimens, pharynx swabs, herpes fluid, cerebrospinal fluid, acute blood samples and convalescent blood samples were collected from all kinds of medical institutions. The method of specimen detection was carried out according to the method stipulated by the Ministry of Health "guidelines for the Prevention and Control of Hand-foot-mouth Disease (2008)", and the clinical specimens of hand-foot-mouth disease in Shandong Province in 2008 were screened by virus isolation and RT-PCR. The above results were analyzed with Epi info 3.4.3 software. Results 32974 cases of hand-foot-mouth disease were reported in the province in 2008. The incidence of HFMD was 35.2023 / 100,000.JanuaryDecember, the epidemic situation of hand-foot-mouth disease was reported, the peak of which was in May-July. The male / female sex ratio was 1.80: 1, the incidence rate of male was significantly higher than that of female, and the incidence age was mainly under 5 years old, especially in the group of 2 years old. Cases were widely distributed in all 17 cities, 140 counties (cities, districts) and 90.42% of townships (towns, street offices) reported cases. The incidence of HFMD in high population density areas is higher than that in counties (cities) with low population density. In most areas, the epidemic was mainly sporadic, and the local area was characterized by aggregation. Most of the cases showed typical rash of hand, foot, mouth, etc. Except for EV71 and Cox A16 co-infection, the number of cases of hand rash was slightly higher than that of other types, other types of enterovirus caused fever and foot rash. There was no significant difference in the symptoms of rashes oral mucosa rash and complications. The clinical symptoms of the cases were generally mild the complications were rare and the prognosis was good. There were no fatal cases. Etiology and molecular biology showed that EV71 and Cox A16 were the main pathogens causing HFMD epidemic in the province in 2008. The two cases accounted for 66.00% of laboratory confirmed cases, while other enterovirus types accounted for 34.00%. EV71and EV71 and Cox A16 cross infection cases, Cross-positive patients accounted for 24. 4% of laboratory confirmed cases. The type of enterovirus causing severe cases in Shandong Province is EV 71. Most HFMD cases do not have a clear history of epidemiological contact. Conclusion Hand-foot-mouth disease was widely distributed in Shandong Province in 2008 and was mainly sporadic. The main pathogens causing HFMD were EV71 and Cox A16, and the predominant strains were EV71.There were cases of EV71 and Cox A16 cross infection. The key to the prevention of HFMD is to strengthen surveillance and implement the prevention and control measures for individual children, families and child-care institutions.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R725.1;R181.3
本文編號(hào)：2127669
[Abstract]:Objective the main purpose of this study was to describe the epidemiological characteristics of hand-foot-mouth disease by analyzing the epidemic data of hand-foot-mouth disease in Shandong Province in 2008, the information of in-patient case investigation and the active investigation of severe cases. To explore the etiology and its main risk factors. At the same time, the molecular epidemiological characteristics of hand, foot and mouth disease in this area were studied by means of isolation and identification of enterovirus and rapid diagnosis by reverse transcription-polymerase chain reaction (RT-PCR). The main enterovirus strains isolated in different epidemic areas were compared and studied to explore the rules of pathogen change. Materials and methods all case information comes from the National Disease Surveillance Information Management system. Population data from Shandong Statistical Bureau 2008 Shandong Statistical Yearbook. Case investigation data from county-level disease control institutions reported inpatient cases questionnaire. 1837 stool specimens, pharynx swabs, herpes fluid, cerebrospinal fluid, acute blood samples and convalescent blood samples were collected from all kinds of medical institutions. The method of specimen detection was carried out according to the method stipulated by the Ministry of Health "guidelines for the Prevention and Control of Hand-foot-mouth Disease (2008)", and the clinical specimens of hand-foot-mouth disease in Shandong Province in 2008 were screened by virus isolation and RT-PCR. The above results were analyzed with Epi info 3.4.3 software. Results 32974 cases of hand-foot-mouth disease were reported in the province in 2008. The incidence of HFMD was 35.2023 / 100,000.JanuaryDecember, the epidemic situation of hand-foot-mouth disease was reported, the peak of which was in May-July. The male / female sex ratio was 1.80: 1, the incidence rate of male was significantly higher than that of female, and the incidence age was mainly under 5 years old, especially in the group of 2 years old. Cases were widely distributed in all 17 cities, 140 counties (cities, districts) and 90.42% of townships (towns, street offices) reported cases. The incidence of HFMD in high population density areas is higher than that in counties (cities) with low population density. In most areas, the epidemic was mainly sporadic, and the local area was characterized by aggregation. Most of the cases showed typical rash of hand, foot, mouth, etc. Except for EV71 and Cox A16 co-infection, the number of cases of hand rash was slightly higher than that of other types, other types of enterovirus caused fever and foot rash. There was no significant difference in the symptoms of rashes oral mucosa rash and complications. The clinical symptoms of the cases were generally mild the complications were rare and the prognosis was good. There were no fatal cases. Etiology and molecular biology showed that EV71 and Cox A16 were the main pathogens causing HFMD epidemic in the province in 2008. The two cases accounted for 66.00% of laboratory confirmed cases, while other enterovirus types accounted for 34.00%. EV71and EV71 and Cox A16 cross infection cases, Cross-positive patients accounted for 24. 4% of laboratory confirmed cases. The type of enterovirus causing severe cases in Shandong Province is EV 71. Most HFMD cases do not have a clear history of epidemiological contact. Conclusion Hand-foot-mouth disease was widely distributed in Shandong Province in 2008 and was mainly sporadic. The main pathogens causing HFMD were EV71 and Cox A16, and the predominant strains were EV71.There were cases of EV71 and Cox A16 cross infection. The key to the prevention of HFMD is to strengthen surveillance and implement the prevention and control measures for individual children, families and child-care institutions.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R725.1;R181.3
【引證文獻(xiàn)】
相關(guān)期刊論文 前2條
1 胡斌;王明席;;我國兒童中樞神經(jīng)系統(tǒng)感染的病原學(xué)現(xiàn)況[J];廣東化工;2013年17期
2 裴耀文;李忠;張華寧;呂慧;孫娜;張巖;王爽;王宇路;王顯軍;;2009年山東省手足口病病例的病原學(xué)檢測(cè)分析[J];中華疾病控制雜志;2010年08期
相關(guān)會(huì)議論文 前1條
1 裴耀文;李忠;張華寧;呂慧;孫娜;張巖;王爽;王宇路;王顯軍;;2009年山東省手足口病病例的病原學(xué)檢測(cè)分析[A];華東地區(qū)第十次流行病學(xué)學(xué)術(shù)會(huì)議暨華東地區(qū)流行病學(xué)學(xué)術(shù)會(huì)議20周年慶典論文集[C];2010年
相關(guān)碩士學(xué)位論文 前2條
1 尹穎;健康管理理念在手足口病防控中的應(yīng)用研究[D];南京醫(yī)科大學(xué);2011年
2 陰珊珊;泰安市腸道傳染病發(fā)病趨勢(shì)與流行特征分析[D];泰山醫(yī)學(xué)院;2012年
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