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Article(id=1228016567779263295, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411241, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1731340800000, receivedDateStr=2024-11-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1770711565202, onlineDateStr=2026-02-10, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1770711565202, onlineIssueDateStr=2026-02-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1770711565202, creator=13701087609, updateTime=1770711565202, updator=13701087609, issue=Issue{id=1228016566646801206, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1770711564932, creator=13701087609, updateTime=1770711815039, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1228017615784833769, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1228017615784833770, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3271, endPage=3275, ext={EN=ArticleExt(id=1228016567988978498, articleId=1228016567779263295, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiological characteristics analysis and trend prediction of hand, foot, and mouth disease, Hebei, 2014-2024, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in Hebei Province from 2014 to August 2024, and to provide a scientific basis for the formulation of effective prevention and control measures.

Methods

The case report data of HFMD in Hebei Province from 2014 to August 2024 were extracted from the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used for analysis, and the incidence trend of HFMD was predicted by the ARIMA model.

Results

A total of 371 393 cases of HFMD were reported with 26 deaths from 2014 to August 2024. The average annual incidence and mortality rates were 45.279 1 per 100 000 and 0.003 2 per 100 000, respectively. The incidence rate of HFMD decreased year by year, as did the number of severe cases and deaths. The disease showed a clear seasonal pattern, with a high incidence period from May to July every year. The incidence rates in Langfang, Baoding, and Chengde were high. Children aged 1-4 were the most susceptible group, with more male cases than female. Enterovirus 71, Coxsackievirus A16, and other enteroviruses accounted for 20.62%, 26.87%, and 52.51%, respectively. Using the SARIMAX model to predict the number of HFMD cases from September 2024 to August 2025, which would decrease first and then increase. And the seasonal peak of incidence in 2025 would be higher than that in 2024.

Conclusion

The incidence rate of HFMD in Hebei Province has shown a downward trend, but the peak in 2025 is predicted to be higher than that in 2024. It is necessary to strengthen the monitoring of the epidemic and etiology, scientifically formulate prevention and control plans, and prepare for the response.

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目的

分析河北省2014年至2024年8月手足口病的流行特征，为制定有效防控措施提供科学依据。

方法

从中国疾病预防控制信息系统传染病报告信息管理系统中导出2014年至2024年8月河北省手足口病的病例报告数据，采用描述性流行病学方法进行分析，用ARIMA模型对手足口病发病趋势进行预测。

结果

在2014年至2024年8月，全省报告手足口病病例371 393例和死亡26例。年均发病率和死亡率分别为45.279 1/10万和0.003 2/10万。不同年份手足口病发病率逐年呈波动下降趋势，重症病例数和死亡数逐年减少。发病有明显季节性，每年5-7月为高发期。廊坊、保定、承德发病率高。1~4岁儿童为高发人群，男性病例多于女性。EV71、Cox A16和其他肠道病毒分别占20.62%、26.87%和52.51%。用SARIMAX预测2024年9月至2025年8月的手足口病发病数，为先降后升，2025年发病季节性峰值将高于2024年。

结论

河北省手足口病发病率呈下降趋势，但预测2025年将出现高于2024年的峰值，应加强疫情和病原学监测，科学制定防控预案，做好应对准备。

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董辉,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Phly/JWAQQLfdrfKR0K3VQ==, magXml=ZelAmiHTGemwsH9NGPVglQ==, pdfUrl=null, pdf=lYpW8BBQpStdXOZ19F0YrA==, pdfFileSize=1083348, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=f1UzyC36w4b8cQs2PpKn+Q==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=OhFUGdHv/nHtF5rD4YoMog==, mapNumber=null, authorCompany=null, fund=null, authors=

曾娟（1979—），女，本科，副主任技师，研究方向：传染病监测

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曾娟（1979—），女，本科，副主任技师，研究方向：传染病监测

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曾娟（1979—），女，本科，副主任技师，研究方向：传染病监测

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Chinese Journal of Virology, 2023, 39(2): 453-459.(In Chinese), articleTitle=Epidemiological characteristics and etiology of HFMD cases in Shandong province, China, from 2017 to 2021, refAbstract=null), Reference(id=1228016580236345919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, doi=null, pmid=null, pmcid=null, year=2023, volume=33, issue=16, pageStart=2040, pageEnd=2042,2049, url=null, language=null, rfNumber=[16], rfOrder=28, authorNames=李绍飞, 周海珍, 郑国鑫, journalName=中国卫生检验杂志, refType=null, unstructuredReference=李绍飞，周海珍，郑国鑫．2019年—2022年文成县手足口病患儿病原谱及临床特征分析[J].中国卫生检验杂志，2023, 33(16): 2040-2042,2049., articleTitle=2019年—2022年文成县手足口病患儿病原谱及临床特征分析, refAbstract=null), Reference(id=1228016580357980737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, doi=null, pmid=null, pmcid=null, year=2023, volume=33, issue=16, pageStart=2040, pageEnd=2042,2049, url=null, language=null, rfNumber=[16], rfOrder=29, authorNames=Li SF, Zhou HZ, Zheng GX, journalName=Chinese Journal of Health Inspection, refType=null, unstructuredReference=Li SF, Zhou HZ, Zheng GX. Pathogenic spectrum and clinical characteristics of hand-foot-mouth disease in Wencheng County from 2019 to 2022[J]. 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注：基于自然资源部标准地图服务网站审图号为 GS(2024)0650号的标准地图制作，底图边无修改。

, figureFileSmall=I2Babd0eJ+0VbyX8G/U9dA==, figureFileBig=f1UzyC36w4b8cQs2PpKn+Q==, tableContent=null), ArticleFig(id=1228016574720835732, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Fig.2, caption=Seasonal distribution of HFMD cases reported in HeBei Province from 2014 to 2023, figureFileSmall=ljat+C3qGkvMrKnghE0AQg==, figureFileBig=uwVPKTPYAYSdOBbWqojDwQ==, tableContent=null), ArticleFig(id=1228016574905385121, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=图2, caption=2014—2023年河北省报告HFMD例季节分布, figureFileSmall=ljat+C3qGkvMrKnghE0AQg==, figureFileBig=uwVPKTPYAYSdOBbWqojDwQ==, tableContent=null), ArticleFig(id=1228016575043797165, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Fig.3, caption=Age and gender distribution of HFMD cases in HeBei Province from 2014 to August 2024, figureFileSmall=2TpAAnQCwrqRGp/850bJXA==, figureFileBig=UEBUTs/OUh4VWur3mCF2AA==, tableContent=null), ArticleFig(id=1228016575173820597, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=图3, caption=2014—2024年8月河北省HFMD年龄、性别分布, figureFileSmall=2TpAAnQCwrqRGp/850bJXA==, figureFileBig=UEBUTs/OUh4VWur3mCF2AA==, tableContent=null), ArticleFig(id=1228016575333204162, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Fig.4, caption=Age-specific composition of HFMD cases from 2014 to August 2024, figureFileSmall=7kUWUCxSYY0AFWk7kniAzA==, figureFileBig=/5lsUWeNp2V8HVibKHYdQw==, tableContent=null), ArticleFig(id=1228016575471616206, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=图4, caption=2014—2024年8月HFMD年龄别构成, figureFileSmall=7kUWUCxSYY0AFWk7kniAzA==, figureFileBig=/5lsUWeNp2V8HVibKHYdQw==, tableContent=null), ArticleFig(id=1228016575605833950, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Fig.5, caption=Time series forecasting chart of Hand, Foot, and Mouth Disease incidence in HeBei Province, figureFileSmall=1VP/tLidDV5YB3CnS5pwrg==, figureFileBig=enuWMsQymJpUcXGNljfLEw==, tableContent=null), ArticleFig(id=1228016575727468777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=图5, caption=河北省手足口发病数时间序列预测图, figureFileSmall=1VP/tLidDV5YB3CnS5pwrg==, figureFileBig=enuWMsQymJpUcXGNljfLEw==, tableContent=null), ArticleFig(id=1228016575878463735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Table 1, caption=

Reported cases of HFMD in HeBei Province, January 2014 to August 2024

, figureFileSmall=null, figureFileBig=null, tableContent=
年份报告病例数发病率(/10万)死亡例数死亡率(/10万)重症病例数
201485 276116.296 9150.020 5332
201552 42470.999 200.000 058
201660 76881.843 350.006 7160
201745 12360.398 740.005 470
201835 61347.360 720.002 748
201938 23050.593 600.000 015
20205 0156.605 700.000 02
202117 27023.147 000.000 02
20224 5336.086 200.000 04
202321 92229.544 900.000 08
2024.1-2024.85 2197.039 200.000 03
), ArticleFig(id=1228016575995904258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=表1, caption=

2014—2024年8月河北省HFMD病例报告

, figureFileSmall=null, figureFileBig=null, tableContent=
年份报告病例数发病率(/10万)死亡例数死亡率(/10万)重症病例数
201485 276116.296 9150.020 5332
201552 42470.999 200.000 058
201660 76881.843 350.006 7160
201745 12360.398 740.005 470
201835 61347.360 720.002 748
201938 23050.593 600.000 015
20205 0156.605 700.000 02
202117 27023.147 000.000 02
20224 5336.086 200.000 04
202321 92229.544 900.000 08
2024.1-2024.85 2197.039 200.000 03
), ArticleFig(id=1228016576142704913, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Table 2, caption=

Etiological composition of laboratory-confirmed HFMD cases from January 2014 to August 2024

, figureFileSmall=null, figureFileBig=null, tableContent=
年份实验室确诊病例数EV71Cox A16其他肠道病毒
病例数构成（%）病例数构成（%）病例数构成（%）
20145 4742 87252.471 55828.461 04419.07
20153 3753079.1092227.322 14663.59
20164 0341 23430.591 65240.951 14828.46
20173 6211 33736.9237010.221 91452.86
20183 2621805.5273022.382 35272.10
20194 3502666.112 17650.021 90843.86
2020494346.887615.3838477.73
20212 5251616.3846418.381 90075.24
2022580183.1014124.3142172.59
20233 5291494.222136.043 16789.74
2024795486.0430638.4944155.47
合计32 0396 60620.628 60826.8716 82552.51
), ArticleFig(id=1228016576264339741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=表2, caption=

2014—2024年8月HFMD实验室确诊病例病原构成

, figureFileSmall=null, figureFileBig=null, tableContent=
年份实验室确诊病例数EV71Cox A16其他肠道病毒
病例数构成（%）病例数构成（%）病例数构成（%）
20145 4742 87252.471 55828.461 04419.07
20153 3753079.1092227.322 14663.59
20164 0341 23430.591 65240.951 14828.46
20173 6211 33736.9237010.221 91452.86
20183 2621805.5273022.382 35272.10
20194 3502666.112 17650.021 90843.86
2020494346.887615.3838477.73
20212 5251616.3846418.381 90075.24
2022580183.1014124.3142172.59
20233 5291494.222136.043 16789.74
2024795486.0430638.4944155.47
合计32 0396 60620.628 60826.8716 82552.51
), ArticleFig(id=1228016576390168879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=EN, label=Table 3, caption=

Predicted HFMD incidence numbers by month in HeBei province from September 2024 to August 2025

, figureFileSmall=null, figureFileBig=null, tableContent=
时间（年-月）发病数预测值LCLUCL
2024-091 0363302 504
2024-101 3292054 642
2024-111 0881094 495
2024-12520392 363
2025-011369657
2025-02694346
2025-03864443
2025-04235111 225
2025-05882394 657
2025-062 1169011 264
2025-073 68015319 706
2025-083 71115119 955
), ArticleFig(id=1228016576503415100, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016567779263295, language=CN, label=表3, caption=

河北省2024年9月—2025年8月各月份HFMD发病数预测

, figureFileSmall=null, figureFileBig=null, tableContent=
时间（年-月）发病数预测值LCLUCL
2024-091 0363302 504
2024-101 3292054 642
2024-111 0881094 495
2024-12520392 363
2025-011369657
2025-02694346
2025-03864443
2025-04235111 225
2025-05882394 657
2025-062 1169011 264
2025-073 68015319 706
2025-083 71115119 955
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河北省2014—2024年手足口病流行特征分析及趋势预测
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曾娟 1 , 董辉 1 , 黄鑫 2 , 宋杏 1 , 祝佳慧 1 , 李艳菊 2 , 艾瑾 3
现代预防医学 | 流行病与统计方法 2025,52(18): 3271-3275
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现代预防医学 | 流行病与统计方法 2025, 52(18): 3271-3275
河北省2014—2024年手足口病流行特征分析及趋势预测
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曾娟1, 董辉1 , 黄鑫2, 宋杏1, 祝佳慧1, 李艳菊2, 艾瑾3
作者信息
  • 1．河北省疾病预防控制中心，河北　石家庄　050000
  • 2．邯郸市疾病预防控制中心
  • 3．唐山市疾病预防控制中心

    • 曾娟（1979—），女，本科，副主任技师，研究方向：传染病监测

通讯作者:

Epidemiological characteristics analysis and trend prediction of hand, foot, and mouth disease, Hebei, 2014-2024
Juan ZENG1, Hui DONG1 , Xing HUANG2, Xing SONG1, Jia-hui ZHU1, Yan-ju LI2, Jin AI3
Affiliations
  • Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050000, China
出版时间: 2025-09-25 doi: 10.20043/j.cnki.MPM.202411241
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摘要
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目的

分析河北省2014年至2024年8月手足口病的流行特征，为制定有效防控措施提供科学依据。

方法

从中国疾病预防控制信息系统传染病报告信息管理系统中导出2014年至2024年8月河北省手足口病的病例报告数据，采用描述性流行病学方法进行分析，用ARIMA模型对手足口病发病趋势进行预测。

结果

在2014年至2024年8月，全省报告手足口病病例371 393例和死亡26例。年均发病率和死亡率分别为45.279 1/10万和0.003 2/10万。不同年份手足口病发病率逐年呈波动下降趋势，重症病例数和死亡数逐年减少。发病有明显季节性，每年5-7月为高发期。廊坊、保定、承德发病率高。1~4岁儿童为高发人群，男性病例多于女性。EV71、Cox A16和其他肠道病毒分别占20.62%、26.87%和52.51%。用SARIMAX预测2024年9月至2025年8月的手足口病发病数，为先降后升，2025年发病季节性峰值将高于2024年。

结论

河北省手足口病发病率呈下降趋势，但预测2025年将出现高于2024年的峰值，应加强疫情和病原学监测，科学制定防控预案，做好应对准备。

手足口病  /  病原学监测  /  流行特征  /  趋势预测  /  ARIMA
Objective

To analyze the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in Hebei Province from 2014 to August 2024, and to provide a scientific basis for the formulation of effective prevention and control measures.

Methods

The case report data of HFMD in Hebei Province from 2014 to August 2024 were extracted from the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used for analysis, and the incidence trend of HFMD was predicted by the ARIMA model.

Results

A total of 371 393 cases of HFMD were reported with 26 deaths from 2014 to August 2024. The average annual incidence and mortality rates were 45.279 1 per 100 000 and 0.003 2 per 100 000, respectively. The incidence rate of HFMD decreased year by year, as did the number of severe cases and deaths. The disease showed a clear seasonal pattern, with a high incidence period from May to July every year. The incidence rates in Langfang, Baoding, and Chengde were high. Children aged 1-4 were the most susceptible group, with more male cases than female. Enterovirus 71, Coxsackievirus A16, and other enteroviruses accounted for 20.62%, 26.87%, and 52.51%, respectively. Using the SARIMAX model to predict the number of HFMD cases from September 2024 to August 2025, which would decrease first and then increase. And the seasonal peak of incidence in 2025 would be higher than that in 2024.

Conclusion

The incidence rate of HFMD in Hebei Province has shown a downward trend, but the peak in 2025 is predicted to be higher than that in 2024. It is necessary to strengthen the monitoring of the epidemic and etiology, scientifically formulate prevention and control plans, and prepare for the response.

Hand, foot and mouth disease(HFMD)  /  Etiological surveillance  /  Epidemic characteristics  /  Trend forecasting  /  ARIMA
曾娟, 董辉, 黄鑫, 宋杏, 祝佳慧, 李艳菊, 艾瑾. 河北省2014—2024年手足口病流行特征分析及趋势预测. 现代预防医学, 2025 , 52 (18) : 3271 -3275 . DOI: 10.20043/j.cnki.MPM.202411241
Juan ZENG, Hui DONG, Xing HUANG, Xing SONG, Jia-hui ZHU, Yan-ju LI, Jin AI. Epidemiological characteristics analysis and trend prediction of hand, foot, and mouth disease, Hebei, 2014-2024[J]. Modern Preventive Medicine, 2025 , 52 (18) : 3271 -3275 . DOI: 10.20043/j.cnki.MPM.202411241
正文
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手足口病（hand, foot and mouth disease, HFMD）是一种由肠道病毒引起的儿童常见传染病, 表现为发热和手、足、口腔等部位出现皮疹或疱疹，部分患儿出现重症或死亡[1]。HFMD位居我国报告的丙类传染病首位，是我国重点关注的公共卫生问题之一[2-3] 。河北省作为华北地区人口大省，HFMD流行形势严峻，据国家卫生健康委员会报告河北省年均报告病例数约占全国总数的5%~8%，发病率长期高于全国平均水平[4]。然而近年来尚未有针对河北省全域的手足口病流行特征分析及趋势预测。因此本研究旨在通过国家网络直报系统对河北省2014年至2024年8月的病例报告，对近10年来HFMD流行特征进行分析，并预测疫情变化趋势，为预防控制提供科学依据。
1　资料与方法
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1.1　资料来源
全部病例来源于覆盖全省的传染病疫情报告单位的医生，当责任医生诊断为HFMD后，在规定时间内通过国家网络直报系统报告病例，本研究的病例资料源于中国疾病预防控制信息系统监测报告管理模块。以患者“发病日期”筛选，对已审核的HFMD报告卡按病例现住址，对临床和确诊病例查重后进行统计。HFMD疑似病例、病原携带者、港澳台人员、外籍人员、已删除报告卡者不参与统计。本研究已通过河北省疾病预防控制中心伦理委员会审批，伦理编号：HeBIRB(S)2024028。
1.2　病例定义
病例定义执行WS 588-2018《手足口病诊断》标准。具有HFMD临床表现，并排除其他相关疾病者判为临床诊断病例。临床诊断病例的血液或脑脊液检测到抗 EV-A71 或 CV-A16 等肠道病毒 IgM 抗体；或恢复期比急性期血清抗体升高 4 倍以上或急性期抗体阴性而恢复期转为阳性；或相关标本特异性RNA 检测呈阳性，或相关标本病毒分离阳性者判为确诊病例；有HFMD临床表现同时伴有精神差、嗜睡、易惊、谵妄；头痛、呕吐；肢体抖动、肌阵挛、眼球震颤、共济失调、眼球运动障碍；无力或急性弛缓性麻痹；惊厥等症状者判为重症病例[5-6]。
1.3　统计分析与趋势预测
使用SPSS 27.0软件进行统计学分析。采用描述性统计方法分析HFMD的流行特征及变化趋势,计数资料以占比或发病率表示，率的比较采用χ2检验，P<0.05为差异有统计学意义。采用ARIMA建模器对2014年1月至2024年8月收集的HFMD资料建立模型并分析,第一步是先建立平稳时间序列；第二步进行平稳性检验; 第三步推算并设置模型参数，再根据自相关函数（autocorrelation function, ACF）和偏自相关函数（partial autocorrelation, PACF）推断模型最佳参数; 第四步进行模型检验判断模型的有效性和精确性。
2　结果
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2.1　发病概况
2014年1月至2024年8月，全省共报告HFMD病例371 393例，年均发病率45.279 1/10万；死亡26例，年均死亡率0.003 2/10万，病死率0.01%。报告临床诊断病例339 354例，占91.37%；实验室确诊病例32 039例，占8.63%。报告重症病例702例，占0.19%。
2.2　地区分布
2014—2023年8月全省11个设区市均有病例报告，不同地区发病率有统计学差异（χ2=1 403.232，P<0.01）。年均发病率廊坊为77.762 1/10万、保定67.187 4/10万、承德60.539 2/10万、沧州54.052 3/10万、石家庄47.108 1/10万、秦皇岛45.360 4/10万、唐山39.780 6/10万、邢台28.442 3/10万、衡水28.071 2/10万、张家口23.170 2/10万、邯郸19.197 5/10万，见图1。
2.3　时间分布
对2014—2023年全省HFMD疫情分析，发病率和死亡率均呈逐年下降趋势（χ2=219.9,P<0.01），2019年及之后重症数明显降低，无死亡病例报告，见表1。
图1显示，各地市不同年份发病率呈现逐年下降趋势。2020年北部和中部地区的承德、秦皇岛、唐山和保定的HFMD发病呈明显下降趋势，南部地区的石家庄、邯郸、邢台和衡水呈缓慢下降趋势，地处京津腹地的廊坊疫情一直处于中高水平。2020—2021年各地HFMD发病率均处在较低水平。
图2显示，HFMD具有明显季节性高峰，呈单峰型。每年4月份左右开始上升，7月左右达到高峰，随后下降。不同年份的发病高峰月份略有差异，2014—2019、2021、2023年季节性疫情峰值较高，峰值在6月份的有2014年和2015年，在7月份的有2016—2019和2021年，在9月份的仅为2023年。2020年和2022年季节性峰值不明显。
2.4　人群分布
全省报告的371 393例患者中，男性223 087例，男女性比为1.5∶1。病例以1~4岁为主，占病例总数的76.5%。近年来病例年龄构成显著变化（χ2=153.4，P<0.01），4岁以上病例构成比逐年增加。见图3、4。
病例主要分布在散居和托幼儿童，占93.1%。其中托幼儿童病例数为86 001例（23.16%），散居儿童259 995例（70.01%），学生22 249例（5.99%），其他人群3 028例（0.82%）。
2.5　病原学监测
由表2可见，2014-2024年8月报告的32 039例实验室确诊病例中，EV71感染6 606例（20.62%）,CoxA16感染8 608例（26.87%）,其他肠道病毒感染16 825例（52.51%）。不同年份实验室确诊病例的病原构成有所不同（χ2=5 371.2, P<0.01）。EV71感染占比逐年下降，其他肠道病毒逐渐成为优势毒株。
2.6　发病预测
由于HFMD发病率具有明显季节, 为非平稳序列, 需对该序列进行季节差分。将季节周期设定s=12, 建立ARIMA预测模型, 最终确定模型最优参数为SARIMAX（1, 0, 1）×（0, 1, 1），得出最佳差分序列图。同时该模型不能拒绝模型的残差为白噪声序列的假设, 模型基本满足要求; 模型的拟合优度R2=0.866, 模型表现较为良好。
图5显示，用ARIMA预测模型获得2015—2024年HFMD发病预测值曲线，与实际报告的病例数曲线高度拟合。对2024年9月至2025年8月份的HFMD发病数预测，显示2024年9月至2025年8月HFMD发病数呈先下降后上升的趋势，下一年度全省HFMD的发病高峰将高于2024年，见图5和表3。
3　讨论
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2014年至 2024年8月，河北省共报告HFMD 371 393例，年均发病率呈下降趋势，发病率低于江苏[7]、四川[8]等地区，与全国发病特征一致[9]。河北位于华北地区，地处北纬36°05′至42°40′，东经113°27′至119°50′之间，属于暖温带季风气候，四季分明，HFMD的发病受季节因素影响，呈现明显的单峰型，但既往报道除有夏秋季明显峰值外，还有不明显的冬季次高峰[10]，后者与北京和内蒙古的季节性吻合[11-12]。河北省HFMD稳定的季节性特征和多年积累的疫情数据，为其流行趋势预测奠定了基础。用ARIMA预测模型预测河北2024年9月至2025年8月HFMD的发病趋势,获得了全省HFMD发病率将呈现先下降后上升的趋势，2025年季节峰值将高于2024年，该预测结果为河北省做好2025年手足口病疫情防控提供了科学数据，赢得了宝贵的疫情控制准备时间。
在2020—2022年新冠流行期间，人群的聚集和流动、社交活动受到限制，学校、幼儿园放假，停止集会、娱乐场所、居民小区封闭，实施了人群静默策略，加之全民佩戴口罩和洗手习惯的形成，在减少新冠传播的同时，也减少了HFMD的传播机会，2020—2021年全省各地HFMD发病率均处在较低水平,与既往报道结果一致[13]。然而，客观对待新冠期间全省HFMD疫情下降的问题，还必须要有更确凿的询证医学数据加以论证，不能忽视新冠疫情期间存在的HFMD漏报问题。
手足口病纳入法定传染病报告管理，加之医疗技术的进步，临床医生实践经验的增多，EV71疫苗的推广应用，是全省重症HFMD病例减少，2019 年后无死亡病例报告的重要原因。
河北省不同地区HFMD的发病率存在差异，廊坊、保定、承德、沧州、石家庄和秦皇岛的发病率高于全省平均水平，当地疫情报告质量，医疗服务水平和患者及时就诊是重要影响因素。廊坊地处京津腹地，交通便利，半小时内能得到京津的良好医疗资源，很多病例享受了高水平的诊疗服务的同时，病例报告工作的质量也得到提升。
病例的76.5%为1~4岁儿童，且发现4岁以上病例数构成有逐年增多现象，可能与人口年龄结构变化有关，但低龄儿童作为高发人群特征没有改变。造成该人群高发与其活动范围越来越大、幼儿园及小学内聚集、接触危险因素增加有关[14]。男童病例多于女童的成因值得深入研究。
引起HFMD的病毒有20多种，包括EV71，Cox A2-10，Cox A12，Cox A16，Cox B1-5，ECHO1，ECHO 4-7、9、11、13、18、19、25和30型等[15]，感染后彼此之间不能产生交叉保护,优势毒株的变化可能引起HFMD的流行[16]。本研究发现，病例中EV71感染占20.62%，Cox A16感染占26.87%，其他肠道病毒感染占52.51%，应对其他肠道病毒做更细的分类。此外，EV71 感染占比逐年下降，其他肠道病毒逐渐成为优势毒株，是否影响病例的临床类型和死亡概率，值得关注。监测病例感染的病毒型别，及时发现变异，对于预测预警具有重要指导意义。
本研究未对EV71疫苗人群接种覆盖情况进行调查，疫苗对全省HFMD疫情的逐年下降的贡献有待进一步研究。
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2025年第52卷第18期
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doi: 10.20043/j.cnki.MPM.202411241
  • 接收时间：2024-11-12
  • 首发时间：2026-02-10
  • 出版时间：2025-09-25
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  • 收稿日期：2024-11-12
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河北省医学科学研究课题(20260860)
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    1．河北省疾病预防控制中心，河北　石家庄　050000
    2．邯郸市疾病预防控制中心
    3．唐山市疾病预防控制中心

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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