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Article(id=1240633238083916604, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202402285, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1709136000000, receivedDateStr=2024-02-29, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773719613810, onlineDateStr=2026-03-17, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773719613810, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773719613810, creator=13701087609, updateTime=1773719613810, updator=13701087609, issue=Issue{id=1240633237542851387, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773719613680, creator=13701087609, updateTime=1773720039302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240635022806405370, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240635022806405371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1742, endPage=1747, ext={EN=ArticleExt(id=1240633238352352061, articleId=1240633238083916604, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiological and etiological characteristics of hand foot and mouth disease, Sichuan, 2017-2021, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemic characteristics of hand foot and mouth disease(HFMD) in Sichuan province from 2017 to 2021 and to provide evidence for prevention and control．

Methods

A descriptive analysis was conducted by downloading the case-data of HFMD in Sichuan province during 2017 to 2021 from the Chinese National Notifiable Infectious Disease Reporting System.

Results

A total of 442 079 cases of HFMD were reported from 2017 to 2021, including 627 severe cases and 4 deaths．The average annual incidence rate was 106.17/100 000. Cases in children aged 5 or younger accounted for 90.99％. Boys had higher incidence than girls (1.35:1). The scattered children accounted for 63.34％. Two peaks of incidence were observed other years, except for a few years, with the highest occurring between April to July and the second occurring in November to December．The incidence in Chengdu plain and its surrounding areas were significantly higher than other regions. Other enteroviruses (non-enterovirus 71 and Coxsackie virus A16) were the main pathogen, accounting for 71.45%; Coxsackie virus A16 accounted for 21.20% and enterovirus 71 accounted for 7.35%.

Conclusion

The incidence of HFMD in Sichuan Province is high from 2017 to 2021. The proportion of severe cases has significantly decreased（χ2=273.241，P<0.001）, and the main pathogen is the other enteroviruses (non-enterovirus 71 and Coxsackie virus A16).

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目的

分析2017—2021年四川省手足口病流行特征，为科学防控提供依据。

方法

从中国疾病预防控制中心“疾病监测信息报告管理系统”中下载2017—2021年四川省手足口病个案资料，采用描述性流行病学方法分析。

结果

2017—2021年四川省累计报告手足口病442 079例，发病率106.17／10万；重症病例627例，死亡病例4例。病例以5岁以下儿童为主，占病例总数的90.99%。男女性别比为1.35:1。散居儿童占病例总数的63.34％。除个别年份外，每年有两个发病高峰，春夏高峰为4—7月，秋冬高峰为11—12月。成都平原及周边地区发病水平较高。2017—2021年病原学构成以其他肠道病毒（非肠道病毒71型和柯萨奇病毒A16型）为主，比例为71.45%；柯萨奇病毒A16型和肠道病毒71型的比例分别为21.20%和7.35%。

结论

2017—2021年四川省手足口病发病水平高，重症病例比例大幅下降（χ2趋势=273.241，P<0.001）、主要流行毒株为非肠道病毒71型和柯萨奇病毒A16型的其他肠道病毒。

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袁珩，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=u8FrJcNE3k52o/rfu41yIw==, magXml=knke8dkXiOdtpZjF+i8ybw==, pdfUrl=null, pdf=OFrsKuNzHLfVN19/PT9SBg==, pdfFileSize=1500448, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=IeMlwKUV47wxyDYtRdSwzA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=SjGzqk2Yn9YbMWmz+hTIBg==, mapNumber=null, authorCompany=null, fund=null, authors=

刘雅琼（1986—），女，硕士，副主任医师，研究方向：传染病预防控制

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刘雅琼（1986—），女，硕士，副主任医师，研究方向：传染病预防控制

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刘雅琼（1986—），女，硕士，副主任医师，研究方向：传染病预防控制

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Archives of Public Health, 2022, 80(1): 220., articleTitle=Epidemiological and etiological characteristics of mild hand, foot and mouth disease in children under 7 years old, Nanjing, China, 2010-2019, refAbstract=null), Reference(id=1240633252277440993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=4, pageStart=422, pageEnd=426, url=null, language=null, rfNumber=[12], rfOrder=19, authorNames=潘锴, 周康平, 徐军强, journalName=中国疫苗和免疫, refType=null, unstructuredReference=潘锴，周康平，徐军强，等．湖北省2018—2022年儿童手足口病肠道病毒病原谱和柯萨奇病毒A6型基因特征[J]．中国疫苗和免疫，2023，29（4）：422-426．, articleTitle=湖北省2018—2022年儿童手足口病肠道病毒病原谱和柯萨奇病毒A6型基因特征, refAbstract=null), Reference(id=1240633252369715687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=4, pageStart=422, pageEnd=426, url=null, language=null, rfNumber=[12], rfOrder=20, authorNames=Pan K, Zhou KP, Xu JQ, journalName=Chinese Journal of Vaccines and Immunization, refType=null, unstructuredReference=Pan K, Zhou KP,Xu JQ, et al. 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Chinese Journal of Vaccines and Immunization, 2023, 29(4): 422-426., articleTitle=Pathogenic spectrum of enteroviruses and genetic characteristics of Coxsackievirus A6 in children with hand,foot,and mouth disease from 2018 to 2022 in Hubei province, refAbstract=null), Reference(id=1240633252491350511, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=8, pageStart=1069, pageEnd=1075, url=null, language=null, rfNumber=[13], rfOrder=21, authorNames=刘雅琼, 郑红茹, 包莹, journalName=预防医学情报杂志, refType=null, unstructuredReference=刘雅琼，郑红茹，包莹，等．四川省EV-A71疫苗接种现状与手足口病流行特征分析[J]．预防医学情报杂志，2022，38（8）：1069-1075．, articleTitle=四川省EV-A71疫苗接种现状与手足口病流行特征分析, refAbstract=null), Reference(id=1240633252575236601, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=8, pageStart=1069, pageEnd=1075, url=null, language=null, rfNumber=[13], rfOrder=22, authorNames=Liu YQ, Zheng HR, Bao Y, journalName=Journal of Preventive Medicine Information, refType=null, unstructuredReference=Liu YQ,Zheng HR, Bao Y, et al. 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distribution of HFMD cases in Sichuan Province, 2017-2021, figureFileSmall=7mgg++Kfk7dlzzi+m0JQlA==, figureFileBig=IeMlwKUV47wxyDYtRdSwzA==, tableContent=null), ArticleFig(id=1240633246598352984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=图1, caption=2017—2021年四川省手足口病例性别年龄分布, figureFileSmall=7mgg++Kfk7dlzzi+m0JQlA==, figureFileBig=IeMlwKUV47wxyDYtRdSwzA==, tableContent=null), ArticleFig(id=1240633246845816942, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Fig.2, caption=Occupational distribution of HFMD cases in Sichuan Province, 2017-2021, figureFileSmall=e+Y+AYsjEeZDlKHP1Ony9g==, figureFileBig=q1I6E/haL9BdfT/J+2Ks6Q==, tableContent=null), ArticleFig(id=1240633246925508729, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=图2, caption=2017—2021年四川省手足口病例职业分布, figureFileSmall=e+Y+AYsjEeZDlKHP1Ony9g==, figureFileBig=q1I6E/haL9BdfT/J+2Ks6Q==, tableContent=null), ArticleFig(id=1240633247114252421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Fig.3, caption=Time distribution of HFMD cases in Sichuan Province, 2017—2021, figureFileSmall=l8Mbql/mO2yGoSOS7vBuNA==, figureFileBig=tY8ZgEXdbO2fPSLN/NempQ==, tableContent=null), ArticleFig(id=1240633247240081548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=图3, caption=2017—2021年四川省手足口病报告病例时间分布, figureFileSmall=l8Mbql/mO2yGoSOS7vBuNA==, figureFileBig=tY8ZgEXdbO2fPSLN/NempQ==, tableContent=null), ArticleFig(id=1240633247336550548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Fig.4, caption=Time distribution of pathogen types of HFMD laboratory-confirmed cases in Sichuan Province, 2017-2021, figureFileSmall=5uxrzl9LX15K11EVsKb9dQ==, figureFileBig=Tc/PCZ3B/aPpAGfeGwPUDw==, tableContent=null), ArticleFig(id=1240633247529488547, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=图4, caption=2017—2021年四川省手足口病确诊病例病原构成时间分布, figureFileSmall=5uxrzl9LX15K11EVsKb9dQ==, figureFileBig=Tc/PCZ3B/aPpAGfeGwPUDw==, tableContent=null), ArticleFig(id=1240633247642734769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Table 1, caption=

The incidence and number of HFMD cases reported in Sichuan Province, 2017—2021

, figureFileSmall=null, figureFileBig=null, tableContent=
年份病例数发病率（/10万）死亡病例重症病例重症构成比(%)确诊病例确诊比例(%)
201762 39575.5212980.486 1029.78
2018136 975164.9911450.119 6737.06
201997 579116.991930.108 6688.88
202063 92976.330380.065 6948.91
202181 20197.041530.077 3529.05
合计442 079106.1746270.1437 4898.48
), ArticleFig(id=1240633247772758204, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=表1, caption=

2017—2021年四川省手足口病发病概况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份病例数发病率（/10万）死亡病例重症病例重症构成比(%)确诊病例确诊比例(%)
201762 39575.5212980.486 1029.78
2018136 975164.9911450.119 6737.06
201997 579116.991930.108 6688.88
202063 92976.330380.065 6948.91
202181 20197.041530.077 3529.05
合计442 079106.1746270.1437 4898.48
), ArticleFig(id=1240633247902781640, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Table 2, caption=

Regional distribution of HFMD incidence rate（per 100 000）in Sichuan Province, 2017-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2017年2018年2019年2020年2021年年均发病率
成都市159.08385.21214.07133.28145.42207.41
自贡市28.84100.4390.6931.8361.5062.66
攀枝花市48.88117.95150.8928.84245.09118.33
泸州市26.5460.6667.3984.1271.4162.03
德阳市119.84168.32136.1487.4875.43117.44
绵阳市69.40112.35141.3453.3995.3294.36
广元市56.7799.10162.1383.8132.5786.88
遂宁市80.50142.50154.2268.4998.11108.76
内江市46.0485.6860.3966.7886.4169.06
乐山市39.60177.8776.0083.95102.7596.03
南充市48.14116.0771.1096.6661.9078.77
眉山市135.16225.63124.5077.00164.49145.35
宜宾市21.7759.8548.1172.6948.4050.16
广安市41.23115.42106.2662.7557.3376.60
达州市54.9066.8448.3221.8839.0346.19
雅安市73.07150.15144.35104.67108.25116.10
巴中市79.09125.5296.2751.3155.0781.45
资阳市45.90164.3689.1347.1457.1380.73
阿坝藏族羌族自治州23.5273.4083.6929.2883.9258.76
甘孜藏族自治州16.7731.9527.8413.8426.3723.35
凉山彝族自治州40.1990.0382.4829.65138.2476.12
), ArticleFig(id=1240633248024416472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=表2, caption=

2017—2021年四川省手足口病发病率（/10万）地区分布

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2017年2018年2019年2020年2021年年均发病率
成都市159.08385.21214.07133.28145.42207.41
自贡市28.84100.4390.6931.8361.5062.66
攀枝花市48.88117.95150.8928.84245.09118.33
泸州市26.5460.6667.3984.1271.4162.03
德阳市119.84168.32136.1487.4875.43117.44
绵阳市69.40112.35141.3453.3995.3294.36
广元市56.7799.10162.1383.8132.5786.88
遂宁市80.50142.50154.2268.4998.11108.76
内江市46.0485.6860.3966.7886.4169.06
乐山市39.60177.8776.0083.95102.7596.03
南充市48.14116.0771.1096.6661.9078.77
眉山市135.16225.63124.5077.00164.49145.35
宜宾市21.7759.8548.1172.6948.4050.16
广安市41.23115.42106.2662.7557.3376.60
达州市54.9066.8448.3221.8839.0346.19
雅安市73.07150.15144.35104.67108.25116.10
巴中市79.09125.5296.2751.3155.0781.45
资阳市45.90164.3689.1347.1457.1380.73
阿坝藏族羌族自治州23.5273.4083.6929.2883.9258.76
甘孜藏族自治州16.7731.9527.8413.8426.3723.35
凉山彝族自治州40.1990.0382.4829.65138.2476.12
), ArticleFig(id=1240633248129274083, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Table 3, caption=

Pathogen types of HFMD laboratory-confirmed cases in Sichuan Province, 2017-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
年份实验室确诊数EV-A71CVA16其他肠道病毒
例数比例（%）例数比例（%）例数比例（%）
20176 1021 33821.931 42723.393 33754.69
20189 6732702.791 65717.137 74680.08
20198 6683804.383 16836.555 12059.07
20205 6943846.741923.375 11889.88
20217 3523845.221 50420.465 46474.32
合计37 4892 7567.357 94821.2026 78571.45
), ArticleFig(id=1240633248238326000, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=表3, caption=

2017—2021年四川省手足口病病例病原构成概况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份实验室确诊数EV-A71CVA16其他肠道病毒
例数比例（%）例数比例（%）例数比例（%）
20176 1021 33821.931 42723.393 33754.69
20189 6732702.791 65717.137 74680.08
20198 6683804.383 16836.555 12059.07
20205 6943846.741923.375 11889.88
20217 3523845.221 50420.465 46474.32
合计37 4892 7567.357 94821.2026 78571.45
), ArticleFig(id=1240633248372543742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=EN, label=Table 4, caption=

Pathogen types of HFMD sentinel surveillance cases in Sichuan Province, 2018

, figureFileSmall=null, figureFileBig=null, tableContent=
地区病例数EV-A71CVA16CVA6CVA10未分型肠道病毒合计
成都市8230.492.4382.756.687.6569.86
自贡市3550.8516.6247.3214.0821.1330.14
合计1 1780.596.7172.078.9111.71100.00
), ArticleFig(id=1240633249857327371, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238083916604, language=CN, label=表4, caption=

2018年四川省手足口病哨点监测病例病原构成（%）概况

, figureFileSmall=null, figureFileBig=null, tableContent=
地区病例数EV-A71CVA16CVA6CVA10未分型肠道病毒合计
成都市8230.492.4382.756.687.6569.86
自贡市3550.8516.6247.3214.0821.1330.14
合计1 1780.596.7172.078.9111.71100.00
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2017—2021年四川省手足口病流行病学和病原学特征分析
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刘雅琼 1 , 童文彬 1 , 马小珍 1 , 速丽媛 2 , 张朝勇 3 , 张洁 4 , 包莹 1 , 漆琪 1 , 刘伦光 1 , 袁珩 1
现代预防医学 | 流行病与统计方法 2024,51(10): 1742-1747
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现代预防医学 | 流行病与统计方法 2024, 51(10): 1742-1747
2017—2021年四川省手足口病流行病学和病原学特征分析
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刘雅琼1, 童文彬1, 马小珍1, 速丽媛2, 张朝勇3, 张洁4, 包莹1, 漆琪1, 刘伦光1, 袁珩1
作者信息
  • 1.四川省疾病预防控制中心，四川 成都 610041
  • 2.成都市疾病预防控制中心
  • 3.成都市公共卫生临床医疗中心
  • 4.自贡市疾病预防控制中心

    • 刘雅琼（1986—），女，硕士，副主任医师，研究方向：传染病预防控制

通讯作者:

袁珩，E-mail:
Epidemiological and etiological characteristics of hand foot and mouth disease, Sichuan, 2017-2021
Ya-qiong LIU1, Wen-bin TONG1, Xiao-zhen MA1, Li-yuan SU2, Chao-yong ZHANG3, Jie ZHANG4, Yin BAO1, Qi QI1, Lun-guang LIU1, Heng YUAN1
Affiliations
  • Institute for Acute Infectious diseases Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
出版时间: 2024-05-25 doi: 10.20043/j.cnki.MPM.202402285
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摘要
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目的

分析2017—2021年四川省手足口病流行特征，为科学防控提供依据。

方法

从中国疾病预防控制中心“疾病监测信息报告管理系统”中下载2017—2021年四川省手足口病个案资料，采用描述性流行病学方法分析。

结果

2017—2021年四川省累计报告手足口病442 079例，发病率106.17／10万；重症病例627例，死亡病例4例。病例以5岁以下儿童为主，占病例总数的90.99%。男女性别比为1.35:1。散居儿童占病例总数的63.34％。除个别年份外，每年有两个发病高峰，春夏高峰为4—7月，秋冬高峰为11—12月。成都平原及周边地区发病水平较高。2017—2021年病原学构成以其他肠道病毒（非肠道病毒71型和柯萨奇病毒A16型）为主，比例为71.45%；柯萨奇病毒A16型和肠道病毒71型的比例分别为21.20%和7.35%。

结论

2017—2021年四川省手足口病发病水平高，重症病例比例大幅下降（χ2趋势=273.241，P<0.001）、主要流行毒株为非肠道病毒71型和柯萨奇病毒A16型的其他肠道病毒。

手足口病  /  流行病学  /  肠道病毒
Objective

To analyze the epidemic characteristics of hand foot and mouth disease(HFMD) in Sichuan province from 2017 to 2021 and to provide evidence for prevention and control．

Methods

A descriptive analysis was conducted by downloading the case-data of HFMD in Sichuan province during 2017 to 2021 from the Chinese National Notifiable Infectious Disease Reporting System.

Results

A total of 442 079 cases of HFMD were reported from 2017 to 2021, including 627 severe cases and 4 deaths．The average annual incidence rate was 106.17/100 000. Cases in children aged 5 or younger accounted for 90.99％. Boys had higher incidence than girls (1.35:1). The scattered children accounted for 63.34％. Two peaks of incidence were observed other years, except for a few years, with the highest occurring between April to July and the second occurring in November to December．The incidence in Chengdu plain and its surrounding areas were significantly higher than other regions. Other enteroviruses (non-enterovirus 71 and Coxsackie virus A16) were the main pathogen, accounting for 71.45%; Coxsackie virus A16 accounted for 21.20% and enterovirus 71 accounted for 7.35%.

Conclusion

The incidence of HFMD in Sichuan Province is high from 2017 to 2021. The proportion of severe cases has significantly decreased（χ2=273.241，P<0.001）, and the main pathogen is the other enteroviruses (non-enterovirus 71 and Coxsackie virus A16).

Hand foot and mouth disease  /  Epidemiology  /  Enteroviruses
刘雅琼, 童文彬, 马小珍, 速丽媛, 张朝勇, 张洁, 包莹, 漆琪, 刘伦光, 袁珩. 2017—2021年四川省手足口病流行病学和病原学特征分析. 现代预防医学, 2024 , 51 (10) : 1742 -1747 . DOI: 10.20043/j.cnki.MPM.202402285
Ya-qiong LIU, Wen-bin TONG, Xiao-zhen MA, Li-yuan SU, Chao-yong ZHANG, Jie ZHANG, Yin BAO, Qi QI, Lun-guang LIU, Heng YUAN. Epidemiological and etiological characteristics of hand foot and mouth disease, Sichuan, 2017-2021[J]. Modern Preventive Medicine, 2024 , 51 (10) : 1742 -1747 . DOI: 10.20043/j.cnki.MPM.202402285
正文
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手足口病是由肠道病毒感染引起的儿童常见传染病，临床表现以手足口和臀部斑丘疹、疱疹为主要特点，多伴有发热。该病隐性感染比例大、传染性强、传播速度快，高发季节易引起暴发流行。少数重症病例可并发心肌炎、神经源性肺水肿、无菌性脑膜炎等，病情进展快，如不及时救治可导致死亡[1-3]。四川省作为西部人口大省，是承接华南华中、连接西南西北的重要交汇点和交通走廊，人口基数大且流动人口众多，利于各种肠道传染病的流行和传播，手足口病亦不例外。四川省手足口病报告病例数长期居全省法定传染病报告数前列，防控形势不容乐观。本文对2017—2021年四川省手足口病流行特征进行分析，以期为科学防控手足口病提供新的线索。
1　资料与方法
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1.1　资料来源
根据发病日期和报告地区在《中国疾病预防控制信息系统》中导出2017—2021年四川省所有手足口病个案。2018年哨点监测病例病原学信息来源于成都市公共卫生临床医疗中心和自贡市疾病预防控制中心。
1.2　病例定义
手足口病的诊断依据中华人民共和国卫生行业标准WS 588-2018《手足口病诊断》判定[3]。病原学监测标本的采集和检测按照《手足口病预防控制指南（2009版）》执行[2]。
1.3　方法
利用Excel 2007整理所有病例个案数据，采用Excel 2007软件和R 4.1.3软件进行统计分析和统计图绘制。用χ2检验对构成比和率进行比较，检验水准取α=0.05。
2　结果
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2.1　发病概况
2017—2021年四川省累计报告手足口病例442 079例，发病率106.17／10万；其中重症病例627例，占病例总数的0.14％；死亡病例4例，详见表1。不同年份间重症病例数差异有统计学意义（χ2=588.365，P<0.001），且总体呈下降趋势（，P<0.001）。
2.2　人群分布
2017—2021年报告病例中男性254 021例，女性188 058例，男女性别比为1.35：1。病例以5岁以下儿童为主，占总数的90.99%，其中1~3岁婴幼儿占5岁以下病例数的80.75%，详见图1；病例中散居儿童285 355例、幼托儿童139 428例、学生14 645例，分别占病例总数的64.55％、31.54％和3.31%，详见图2。
2.3　时间分布
2017年、2019年和2021年发病呈典型的季节性双峰分布特征：病例数自3月下旬开始上升，4—7月为春夏高峰；自7月下旬开始下降，整个8—9月间发病水平低且波动不大；9月下旬开始病例数再次上升，10—12月为秋冬高峰，详见图3（A）。春夏高峰发病强度高于秋冬高峰：三年春夏高峰病例数占全年病例总数的比例分别为43.58%、53.56%和49.15%；秋冬高峰比例分别为23.86%、24.27%和32.19%。
2018年报告病例数为历年来最多，1—4月病例数为五年同期中最低，自 6月开始病例数逐渐上升，进入7月后病例数呈井喷式增加；7、8两个月病例数均超过两万，8月报告病例24 499例，为历年来最高；8—10月间发病强度波动较大，但病例总数仍处于历年同期最高水平；11月之后病例数开始下降，但仍远高于既往同期。2020年受新型冠状病毒感染疫情影响，2—7月病例数极少，10—12月秋冬高峰累计报告病例48 018例，为历年来秋冬季最高。详见图3（A）。
2017—2018年重症发病高峰为4—7月；自2019年开始，重症病例数大幅度下降且无明显时间分布特征。详见图3（B）。
2.4　地区分布
2017—2021年四川省发病率在75/10万~164/10万之间，全省各地发病率在13/10万~ 385/10万之间；四川省五年平均发病率为106/10万，省内各市州五年平均发病率在23/10万~207/10万之间。年均发病率居前5位的地区依次为成都市、眉山市、攀枝花市、德阳市和雅安市，其中成都市年均发病率超过200/10万，详见表2。以上地区病例数占全省总数的64.05%。
2.5　病原学特征
2017—2021年全省共报告实验室确诊病例37 489例，肠道病毒71型(enterovirus 71，EV-A71)占7.35%，柯萨奇病毒A16型(Coxsackie virus A16，CVA16)占21.20%，其他肠道病毒占71.45%。五年中确诊病例病原分型均以其他肠道病毒为主，构成比均高于50%以上，见表3和图4。
2018年报告病例数为历年来最多，确诊病例中80%为其他肠道病毒阳性。8—10月间对成都市和自贡市监测的1 178例肠道病毒阳性病例标本增加了柯萨奇病毒A6型(Coxsackie virus A6，CVA6)和柯萨奇病毒A10型(Coxsackie virus A10，CVA10)检测，在1 178份标本中，CVA6阳性849例（72.07%），CVA10阳性105例（8.91%），CVA16阳性79例（6.71%），EV-A71阳性7例（0.59%），未分型肠道病毒 138例（11.71%），详见表4。
3　讨论
收起
自2008年5月手足口病被纳入法定传染病管理以来，手足口病报告病例数在四川省法定传染病中一直占据较大比例，整体发病水平呈现出流行强度大、地理分布范围广、流行持续时间长等特征[4]。2015年12月起，我国 3种 EV-A71灭活疫苗陆续获批上市。2017—2021年是EV-A71疫苗上市后的第一个五年，与2009—2016年相比，全国各地手足口病流行特征和病原构成发生明显变化，主要表现在重症病例比例大幅度下降，除EV-A71和CVA16外的其他肠道病毒成为优势病原[1,5-12]。与2012—2015年相比，2017—2020年四川省手足口病重症病例数下降78.6%，确诊病例中EV-A71型病例下降61.24%[13]。EV-A71疫苗降低重症、减少死亡的效果明显。现阶段四川省适龄婴幼儿的EV-A71疫苗接种率较疫苗刚上市时已有大幅上升，但要在适龄儿童中建立长期稳定有效的EV-A71免疫屏障，还需进一步提高苗接种率，建议各地加强EV-A71疫苗科学宣教，争取EV-A71疫苗接种惠民政策，提高适龄儿童接种率。
2017—2021年，四川省累计报告手足口病442 079例，其中实验室确诊病例37 489例，确诊比例为8.48%；每年的确诊比例均低于10%，绝大多数报告病例为临床诊断病例；与2009—2016年确诊比例6.65%（31 116/467 714）相比[4]，略有提高。本课题组在川内手足口病高发地区调研发现，医疗机构在《中国疾病预防控制信息系统》中上报的手足口病例中，实际做了病原学检测的病例数高于当前系统显示的“确诊病例”数，其差异主要原因是：《中国疾病预防控制信息系统》的手足口病病例个案报告卡中，涉及病例病原学检测结果的“实验室诊断结果”一栏中，仅有“EV-A71”、“CVA16”和“其他肠道病毒”三个选项可供选择，且只能录入阳性结果，无法录入阴性结果。一部分做了病原学检测的病例，由于检测结果为“阴性”，无法录入系统，这些病例在信息系统中的“病例类型”仍然是“临床诊断病例”。建议优化疾病预防控制信息系统中“实验室诊断结果”选项，增加“阴性”结果录入，以便提高肠道病毒阳性检出率的准确性，为科学调整防控策略提供依据。
2018年报告手足口病例136 975例，为手足口病纳入法定传染病管理以来历史最高，结合全省各地病原学监测结果和实地调研情况，可以推断2018年夏季的手足口病例数持续激增，是由优势毒株转变引起，与各地CVA6型手足口病高发相关。自2014年起，四川省内陆续有以大疱样皮疹、脱甲为特征的CVA6型手足口病[14-15]病例报告，2016年开始，CVA6型手足口病例逐渐增多，但在全省各地均未形成优势毒株。2018年成都市和自贡市病原学监测结果显示CVA6比例超过70%。建议除EV-A71和CVA16外，加强对CVA6和CVA10等常见肠道病毒的动态监测，及时掌握婴幼儿人群中肠道病毒优势毒株变化趋势，制定科学防控措施，将防控关口前移，有效减少托幼机构和学校等重点场所发生聚集性疫情的风险。
基金
收起
  • 四川省疾病预防控制中心自立课题(ZX201802)
  • 中央补助重大疾病与健康危害因素监测项目(川财社[2020]208号)
文献
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参考文献 引证文献
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[8]
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2024年第51卷第10期
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doi: 10.20043/j.cnki.MPM.202402285
  • 接收时间：2024-02-29
  • 首发时间：2026-03-17
  • 出版时间：2024-05-25
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  • 收稿日期：2024-02-29
基金
四川省疾病预防控制中心自立课题(ZX201802)
中央补助重大疾病与健康危害因素监测项目(川财社[2020]208号)
作者信息
    1.四川省疾病预防控制中心，四川 成都 610041
    2.成都市疾病预防控制中心
    3.成都市公共卫生临床医疗中心
    4.自贡市疾病预防控制中心

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袁珩，E-mail:
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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