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Article(id=1241522769020638008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202306376, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1687104000000, receivedDateStr=2023-06-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931694512, onlineDateStr=2026-03-19, pubDate=1704816000000, pubDateStr=2024-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931694512, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931694512, creator=13701087609, updateTime=1773931694512, updator=13701087609, issue=Issue{id=1241522764012647140, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931693318, creator=13701087609, updateTime=1773931808852, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523248643494379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523248643494380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=149, endPage=155, ext={EN=ArticleExt(id=1241522770929046394, articleId=1241522769020638008, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis on epidemic characteristics and trend of infectious diseases among kindergarten children in Shenzhen from 2013 to 2022, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the incidence trend and epidemic characteristics of infectious diseases among kindergarten children in Shenzhen, to provide reference for scientific prevention and control of infectious diseases.

Methods

Descriptive epidemiological methods and Joinpoint regression model were used to analyze the surveillance data of infectious diseases among children in Shenzhen from 2013 to 2022.

Results

A total of 249 614 cases of 31 infectious diseases were reported in Shenzhen from 2013 to 2022, with an average annual reported incidence of 4 981.47/100 000, showing a stable trend [annual percentage change (APC)=7.19%, P>0.05]. The main diseases were respiratory and intestinal infectious diseases, accounting for 53.93% and 46.00% of the total cases, respectively. The top five cumulative reported cases were hand-foot-mouth disease, influenza, chicken pox, other infectious diarrheal diseases, and mumps. Among them, the incidence of hand-foot-mouth disease and mumps decreased slowly, but the trend test was not statistically significant (APC was -9.70% and -3.98%, respectively, P > 0.05). Influenza and chickenpox showed a “rising-falling”trend, with the turning point in 2019. The rising trend of influenza from 2013 to 2019 was statistically significant (APC=166.11%, P=0.005), and the downward trend of chickenpox from 2019 to 2022 was statistically significant (APC=-52.42%, P=0.022). Other infectious diarrheal diseases showed an upward trend (APC=19.15%, P=0.002). The incidence of infectious diseases in kindergarten children showed a bimodal type, with a peak in summer and winter-spring. The proportion of intestinal infectious diseases in girls was lower than that in boys (P < 0.001). The proportion of intestinal infectious diseases in children aged 3 years and above was lower than that in children under 3 years old (P < 0.001).

Conclusion

The overall incidence of infectious diseases among kindergarten children in Shenzhen is relatively high. The vaccination rate of EV71, influenza, and varicella vaccine should be further improved. At the same time, comprehensive prevention and control measures such as monitoring and early warning, health education, and institutional health management should be taken to effectively control the occurrence and prevalence of common infectious diseases among kindergarten children.

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目的

分析深圳市托幼儿童传染病的发病趋势和流行特征，为科学开展托幼儿童传染病防控工作提供参考。

方法

采用描述性流行病学方法及Joinpoint回归模型，对2013—2022年深圳市托幼儿童传染病监测数据进行分析。

结果

2013—2022年深圳市累积报告托幼儿童传染病31种共249 614例，年均报告发病率为4 981.47/10万，趋势变化较平稳（APC=7.19%，P>0.05）。疾病发病以呼吸道及肠道传染病为主，分别占病例总数的53.93%和46.00%。累积报告发病数居前五位的依次为手足口病、流行性感冒、水痘、其他感染性腹泻病及流行性腮腺炎。其中，手足口病及流行性腮腺炎发病率呈缓慢下降趋势，但趋势检验无统计学意义（APC分别为-9.70%、-3.98%，P>0.05）；流行性感冒及水痘均呈“升-降”趋势，转折点在2019年，2013—2019年流行性感冒的上升趋势有统计学意义（APC=166.11%，P=0.005），2019—2022年水痘的下降趋势有统计学意义（APC=-52.42%，P=0.022）；其他感染性腹泻病呈上升趋势（APC=19.15%，P=0.002）。托幼儿童传染病发病呈双峰型，夏季及冬春季为发病高峰。女童中肠道传染病占发病总数的比例低于男童（P<0.001），三岁及以上儿童肠道传染病占发病总数的比例低于三岁以下儿童（P<0.001）。

结论

深圳市托幼儿童传染病总体发病水平较高，应进一步提高深圳市托幼儿童EV71、流感及水痘疫苗的接种率，同时采取监测预警、健康教育及机构卫生管理等综合防控措施，有效控制托幼儿童常见传染病的发生和流行。

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吕秋莹，E-mail:
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温莹（1989—），女，博士，副主任医师，研究方向：疾病控制

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Chinese Journal of Virology, 2023, 39(2): 453-459., articleTitle=Epidemiological characteristics and etiology of HFMD cases in Shandong province, China, from 2017 to 2021, refAbstract=null)], funds=[Fund(id=1241677617863127838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, awardId=SZXK064, language=CN, fundingSource=深圳市医学重点学科(SZXK064), fundOrder=null, country=null), Fund(id=1241677618043482918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, awardId=SZSM202011008, language=CN, fundingSource=深圳市医疗卫生三名工程(SZSM202011008), fundOrder=null, country=null), Fund(id=1241677618219643700, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, awardId=JCYJ202103241154 11030, language=CN, fundingSource=深圳市科技创新委员会重点项目(JCYJ202103241154 11030), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241677608623075791, tenantId=1146029695717560320, 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tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, companyId=1241677608753099225, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南方医科大学公共卫生学院，广东 广州 510515)])], figs=[ArticleFig(id=1241677614276997792, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Figure 1, caption=Incidence trends of infectious diseases among kindergarten children in Shenzhen, 2013—2022, figureFileSmall=d2k7bWBvy2d9EvKTEip6PA==, figureFileBig=2dqDuBHa5vRoA6iBAzn3ag==, tableContent=null), ArticleFig(id=1241677614444769960, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=图1, caption=2013—2022年深圳市托幼儿童传染病发病趋势, figureFileSmall=d2k7bWBvy2d9EvKTEip6PA==, figureFileBig=2dqDuBHa5vRoA6iBAzn3ag==, tableContent=null), ArticleFig(id=1241677614574793396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Figure 2, caption=Ranking of incidence of infectious diseases among kindergarten children in Shenzhen, 2013—2022, figureFileSmall=/XuYlV+yklQSCkM6B/FUBQ==, figureFileBig=1CZX2El94WDdHRGWhcEQow==, tableContent=null), ArticleFig(id=1241677614675456699, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=图2, caption=2013—2022年深圳市托幼儿童传染病发病顺位, figureFileSmall=/XuYlV+yklQSCkM6B/FUBQ==, figureFileBig=1CZX2El94WDdHRGWhcEQow==, tableContent=null), ArticleFig(id=1241677614788702914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Figure 3, caption=Incidence trends of major infectious diseases among kindergarten children in Shenzhen, 2013—2022, figureFileSmall=T+Q6sZGzqSoLuLi83Z/vrw==, figureFileBig=HHvR5rXjwI8p68ZAU1MN/Q==, tableContent=null), ArticleFig(id=1241677614893560521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=图3, caption=2013—2022年深圳市托幼儿童主要传染病病种发病趋势, figureFileSmall=T+Q6sZGzqSoLuLi83Z/vrw==, figureFileBig=HHvR5rXjwI8p68ZAU1MN/Q==, tableContent=null), ArticleFig(id=1241677616445453009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Figure 4, caption=Seasonal distribution of infectious diseases among kindergarten children in Shenzhen, 2013—2022, figureFileSmall=1VVbuLF5DmEXYjEOq/oPoA==, figureFileBig=+wGgPrNLR+GDD93In10ENA==, tableContent=null), ArticleFig(id=1241677616634196696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=图4, caption=2013—2022年深圳市托幼儿童传染病季节分布, figureFileSmall=1VVbuLF5DmEXYjEOq/oPoA==, figureFileBig=+wGgPrNLR+GDD93In10ENA==, tableContent=null), ArticleFig(id=1241677616810357478, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Table 1, caption=

Incidence rates of infectious diseases among kindergarten children in Shenzhen, 2013—2022 (1/100 000)

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）乙类传染病丙类传染病其他传染病总计
发病数发病率发病数发病率发病数发病率发病数发病率
2013442119.805 9301 607.321 411382.457 7832 109.57
2014710177.9412 9243 238.981 726432.5715 3603 849.49
2015774176.519 5682 181.992 197501.0312 5392 859.53
2016783169.0016 7593 617.162 183471.1719 7254 257.33
20172 008397.6616 1713 202.466 2711 241.8924 4504 842.02
20181 675319.5429 2895 587.454 995952.8935 9596 859.88
20191 269232.8356 29310 328.385 5431 017.0063 10511 578.22
202054497.2013 5162 414.981 931345.0215 9912 857.20
20211 510252.6921 5093 599.422 024338.7125 0434 190.81
2022656107.6028 2664 636.38737120.8929 6594 864.87
总计10 371206.97210 2254 195.4029 018579.10249 6144 981.47
), ArticleFig(id=1241677616931992302, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=表1, caption=

2013—2022年深圳市托幼儿童传染病报告发病率（1/10万）

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）乙类传染病丙类传染病其他传染病总计
发病数发病率发病数发病率发病数发病率发病数发病率
2013442119.805 9301 607.321 411382.457 7832 109.57
2014710177.9412 9243 238.981 726432.5715 3603 849.49
2015774176.519 5682 181.992 197501.0312 5392 859.53
2016783169.0016 7593 617.162 183471.1719 7254 257.33
20172 008397.6616 1713 202.466 2711 241.8924 4504 842.02
20181 675319.5429 2895 587.454 995952.8935 9596 859.88
20191 269232.8356 29310 328.385 5431 017.0063 10511 578.22
202054497.2013 5162 414.981 931345.0215 9912 857.20
20211 510252.6921 5093 599.422 024338.7125 0434 190.81
2022656107.6028 2664 636.38737120.8929 6594 864.87
总计10 371206.97210 2254 195.4029 018579.10249 6144 981.47
), ArticleFig(id=1241677617062015734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Table 2, caption=

Annual change trends in the incidence rates of infectious diseases among kindergarten children in Shenzhen, 2013—2022

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病时间段（年）APC (%)95%CI t值P值AAPC (%)95%CI
传染病分类
乙类2013—2022-0.45-12.16～12.81-0.080.935-0.45-12.16～12.81
丙类2013—20229.18-3.26～23.211.670.1339.18-3.26～23.21
其他2013—201918.99-1.54～43.802.360.065-11.33-25.33～5.29
2019—2022-50.76-71.88～-13.79-3.250.023
总计2013—20227.19-4.59～20.441.370.2067.19-4.59～20.44
主要病种
手足口病2013—2022-9.70-23.69～6.85-1.400.200-9.70-23.69～6.85
流行性感冒2013—2019166.1157.49～349.634.800.00565.863.04～166.98
2019—2022-35.56-86.34～204.07-0.730.499
水痘2013—201919.06-2.16～44.892.280.071-12.30-26.62～4.80
2019—2022-52.42-73.38～-14.96-3.290.022
其他感染性腹泻病2013—202219.159.08～30.154.570.00219.159.08～30.15
流行性腮腺炎2013—2022-3.98-10.46～2.97-1.340.217-3.98-10.46～2.97
猩红热2013—2022-1.79-15.60～14.28-0.280.790-1.79-15.60～14.28
), ArticleFig(id=1241677617229787900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=表2, caption=

2013—2022年深圳市托幼儿童传染病发病率年度变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病时间段（年）APC (%)95%CI t值P值AAPC (%)95%CI
传染病分类
乙类2013—2022-0.45-12.16～12.81-0.080.935-0.45-12.16～12.81
丙类2013—20229.18-3.26～23.211.670.1339.18-3.26～23.21
其他2013—201918.99-1.54～43.802.360.065-11.33-25.33～5.29
2019—2022-50.76-71.88～-13.79-3.250.023
总计2013—20227.19-4.59～20.441.370.2067.19-4.59～20.44
主要病种
手足口病2013—2022-9.70-23.69～6.85-1.400.200-9.70-23.69～6.85
流行性感冒2013—2019166.1157.49～349.634.800.00565.863.04～166.98
2019—2022-35.56-86.34～204.07-0.730.499
水痘2013—201919.06-2.16～44.892.280.071-12.30-26.62～4.80
2019—2022-52.42-73.38～-14.96-3.290.022
其他感染性腹泻病2013—202219.159.08～30.154.570.00219.159.08～30.15
流行性腮腺炎2013—2022-3.98-10.46～2.97-1.340.217-3.98-10.46～2.97
猩红热2013—2022-1.79-15.60～14.28-0.280.790-1.79-15.60～14.28
), ArticleFig(id=1241677617384977152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=EN, label=Table 3, caption=

Population distribution of infectious diseases among kindergarten children in Shenzhen, 2013—2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
传播途径性别年龄总计
男女χ2值P值<3岁≥3岁χ2值P值
呼吸道传染病78 015 (52.50)56 603 (56.03)301.64<0.00119 487 (32.93)115 131 (60.45)13 903.16<0.001134 618 (53.93)
肠道传染病70 476 (47.43)44 353 (43.90)39 655 (67.02)75 174 (39.47)114 829 (46.00)
经血与性传播传染病92 (0.06)59 (0.06)25 (0.04)126 (0.07)151 (0.06)
动物源性及虫媒传染病10 (0.01)6 (0.01)2 (0.00)14 (0.01)16 (0.01)
总计148 593 (100)101 021 (100)59 169 (100)190 445 (100)249 614 (100)
), ArticleFig(id=1241677617561137930, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522769020638008, language=CN, label=表3, caption=

2013—2022年深圳市托幼儿童传染病人群分布［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
传播途径性别年龄总计
男女χ2值P值<3岁≥3岁χ2值P值
呼吸道传染病78 015 (52.50)56 603 (56.03)301.64<0.00119 487 (32.93)115 131 (60.45)13 903.16<0.001134 618 (53.93)
肠道传染病70 476 (47.43)44 353 (43.90)39 655 (67.02)75 174 (39.47)114 829 (46.00)
经血与性传播传染病92 (0.06)59 (0.06)25 (0.04)126 (0.07)151 (0.06)
动物源性及虫媒传染病10 (0.01)6 (0.01)2 (0.00)14 (0.01)16 (0.01)
总计148 593 (100)101 021 (100)59 169 (100)190 445 (100)249 614 (100)
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2013—2022年深圳市托幼儿童传染病流行特征及趋势分析
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温莹 1, 2 , 罗日景 2 , 程雁鹏 1 , 杜昕蓉 1 , 陈志高 1 , 张振 1 , 吕秋莹 1, 2
现代预防医学 | 疾病预防控制 2024,51(1): 149-155
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现代预防医学 | 疾病预防控制 2024, 51(1): 149-155
2013—2022年深圳市托幼儿童传染病流行特征及趋势分析
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温莹1, 2, 罗日景2, 程雁鹏1, 杜昕蓉1, 陈志高1, 张振1, 吕秋莹1, 2
作者信息
  • 1.深圳市疾病预防控制中心传染病预防控制所，广东 深圳 518055
  • 2.南方医科大学公共卫生学院，广东 广州 510515

    • 温莹（1989—），女，博士，副主任医师，研究方向：疾病控制

通讯作者:

吕秋莹，E-mail:
Analysis on epidemic characteristics and trend of infectious diseases among kindergarten children in Shenzhen from 2013 to 2022
Ying WEN1, 2, Ri-jing LUO2, Yan-peng CHENG1, Xin-rong DU1, Zhi-gao CHEN1, Zhen ZHANG1, Qiu-ying LV1, 2
Affiliations
  • Institute of Infectious Disease Prevention and Control, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong 518055, China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202306376
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摘要
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目的

分析深圳市托幼儿童传染病的发病趋势和流行特征，为科学开展托幼儿童传染病防控工作提供参考。

方法

采用描述性流行病学方法及Joinpoint回归模型，对2013—2022年深圳市托幼儿童传染病监测数据进行分析。

结果

2013—2022年深圳市累积报告托幼儿童传染病31种共249 614例，年均报告发病率为4 981.47/10万，趋势变化较平稳（APC=7.19%，P>0.05）。疾病发病以呼吸道及肠道传染病为主，分别占病例总数的53.93%和46.00%。累积报告发病数居前五位的依次为手足口病、流行性感冒、水痘、其他感染性腹泻病及流行性腮腺炎。其中，手足口病及流行性腮腺炎发病率呈缓慢下降趋势，但趋势检验无统计学意义（APC分别为-9.70%、-3.98%，P>0.05）；流行性感冒及水痘均呈“升-降”趋势，转折点在2019年，2013—2019年流行性感冒的上升趋势有统计学意义（APC=166.11%，P=0.005），2019—2022年水痘的下降趋势有统计学意义（APC=-52.42%，P=0.022）；其他感染性腹泻病呈上升趋势（APC=19.15%，P=0.002）。托幼儿童传染病发病呈双峰型，夏季及冬春季为发病高峰。女童中肠道传染病占发病总数的比例低于男童（P<0.001），三岁及以上儿童肠道传染病占发病总数的比例低于三岁以下儿童（P<0.001）。

结论

深圳市托幼儿童传染病总体发病水平较高，应进一步提高深圳市托幼儿童EV71、流感及水痘疫苗的接种率，同时采取监测预警、健康教育及机构卫生管理等综合防控措施，有效控制托幼儿童常见传染病的发生和流行。

传染病  /  监测  /  Joinpoint回归模型  /  发病率  /  儿童
Objective

To analyze the incidence trend and epidemic characteristics of infectious diseases among kindergarten children in Shenzhen, to provide reference for scientific prevention and control of infectious diseases.

Methods

Descriptive epidemiological methods and Joinpoint regression model were used to analyze the surveillance data of infectious diseases among children in Shenzhen from 2013 to 2022.

Results

A total of 249 614 cases of 31 infectious diseases were reported in Shenzhen from 2013 to 2022, with an average annual reported incidence of 4 981.47/100 000, showing a stable trend [annual percentage change (APC)=7.19%, P>0.05]. The main diseases were respiratory and intestinal infectious diseases, accounting for 53.93% and 46.00% of the total cases, respectively. The top five cumulative reported cases were hand-foot-mouth disease, influenza, chicken pox, other infectious diarrheal diseases, and mumps. Among them, the incidence of hand-foot-mouth disease and mumps decreased slowly, but the trend test was not statistically significant (APC was -9.70% and -3.98%, respectively, P > 0.05). Influenza and chickenpox showed a “rising-falling”trend, with the turning point in 2019. The rising trend of influenza from 2013 to 2019 was statistically significant (APC=166.11%, P=0.005), and the downward trend of chickenpox from 2019 to 2022 was statistically significant (APC=-52.42%, P=0.022). Other infectious diarrheal diseases showed an upward trend (APC=19.15%, P=0.002). The incidence of infectious diseases in kindergarten children showed a bimodal type, with a peak in summer and winter-spring. The proportion of intestinal infectious diseases in girls was lower than that in boys (P < 0.001). The proportion of intestinal infectious diseases in children aged 3 years and above was lower than that in children under 3 years old (P < 0.001).

Conclusion

The overall incidence of infectious diseases among kindergarten children in Shenzhen is relatively high. The vaccination rate of EV71, influenza, and varicella vaccine should be further improved. At the same time, comprehensive prevention and control measures such as monitoring and early warning, health education, and institutional health management should be taken to effectively control the occurrence and prevalence of common infectious diseases among kindergarten children.

Infectious diseases  /  Surveillance  /  Joinpoint regression model  /  Incidence  /  Children
温莹, 罗日景, 程雁鹏, 杜昕蓉, 陈志高, 张振, 吕秋莹. 2013—2022年深圳市托幼儿童传染病流行特征及趋势分析. 现代预防医学, 2024 , 51 (1) : 149 -155 . DOI: 10.20043/j.cnki.MPM.202306376
Ying WEN, Ri-jing LUO, Yan-peng CHENG, Xin-rong DU, Zhi-gao CHEN, Zhen ZHANG, Qiu-ying LV. Analysis on epidemic characteristics and trend of infectious diseases among kindergarten children in Shenzhen from 2013 to 2022[J]. Modern Preventive Medicine, 2024 , 51 (1) : 149 -155 . DOI: 10.20043/j.cnki.MPM.202306376
正文
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托幼机构是学龄前儿童高度聚集的重要场所。托幼儿童免疫系统尚未发育完全，也尚未养成良好的卫生习惯，加上托幼机构相对密闭、人员接触密切且接触时间长等特点，使托幼儿童成为传染病的高发人群。深圳作为中国最大的移民城市，托幼机构数量众多，同时气候温暖湿润，更容易造成传染病的大规模传播和流行，严重影响儿童健康和教学秩序，增加家庭和社会的经济负担。本研究基于Joinpoint回归模型，通过分析2013—2022年深圳市托幼儿童传染病的发病趋势和流行特征，为制定针对性的防控措施、降低托幼儿童的发病水平提供参考依据。
1　资料与方法
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1.1　资料来源
传染病数据来自“中国疾病预防控制信息系统”中的“监测报告管理”模块，选择“发病日期”在2013—2022年、“审核状态”为“已终审”、“现住地址”在深圳市、“病例分类”为“临床诊断病例”或“实验室确诊病例”、“人群分类”为“幼托儿童”的传染病个案信息，采用Excel 2019建立数据库。2013—2021年托幼机构在校学生数来自《深圳统计年鉴2022》[1]，2022年在校学生数来自深圳市教育局。
1.2　统计学分析
对疾病流行强度及季节性采用描述性流行病学分析，指标主要包括发病率、发病顺位和季节指数。某年平均发病率（/10万）=某年平均发病数/某年托幼机构在校学生数×100 000。采用2013—2022年各月病例数占全年病例总数的比例做图，分析疾病的季节性，同时计算季节指数：季节指数=各年指定月份的平均病例数/2013—2022年所有月份的平均病例数；如果数值接近1，表明无明显季节性[2]。此外，对不同性别及年龄的人群进行疾病分布特征比较，计数资料采用频数（构成比）表示，组间比较采用χ2检验。
采用对数线性Joinpoint回归模型对疾病发病率随时间变化的趋势进行多阶段回归分析。转折点确定、参数估计和模型选择基于网格搜索法（grid search method, GSM）和修正贝叶斯信息准则（modified Bayesian information criterion, MBIC），选择MBIC值最小的模型为最优模型[3]。以年为单位，通过年度变化百分比（annual percent change, APC）分析各分段函数对应的时间区间内疾病的发病趋势，通过平均年度变化百分比（average annual percent change, AAPC）分析全局发病趋势；若APC或AAPC >0,表明疾病发病率随时间变化呈上升趋势，反之则呈下降趋势；若APC=AAPC，表明分析时间段内无连接点，疾病发病呈单调趋势[4]。
统计分析采用Excel 2019、R 4.2.1及Joinpoint 4.9.0.0软件进行。检验水准为双侧α=0.05。
2　结果
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2.1　传染病发病概况
2013—2022年深圳市累积报告托幼儿童传染病31种共249 614例，年均报告发病率为4 981.47/10万。其中无甲类传染病报告；乙类传染病16种，累积病例10 371例，年均发病率为206.97/10万；丙类传染病7种，累积病例210 225例，年均发病率为4 195.40 /10万；另报告重点监测管理的其他传染病8种，累积病例29 018例，年均发病率为579.10/10万。2013—2022年托幼儿童各类传染病报告发病率见表1。Joinpoint回归分析结果显示，2013—2022年乙类、丙类传染病及总传染病发病率趋势较平稳（APC分别为-0.45%、9.18%、7.19%，P>0.05）；其他传染病发病率在2013—2019年缓慢上升（APC=18.99%，P>0.05），2019—2022年逐渐下降（APC=-50.76%，P=0.023）。见表2，图1。
2.2　病种分布特征
2013—2022年深圳市托幼儿童传染病发病以呼吸道和肠道传染病为主，分别为134 618和114 829例，占病例总数的53.93%和46.00%；经血与性传播传染病151例，占0.06%；动物源性及虫媒传染病16例，占0.01%。累积报告发病数最高的病种为手足口病，为92 491例（占37.05%），其余依次为流行性感冒84 709例（占33.94%）、水痘28 725例（占11.51%）、其他感染性腹泻病20 143例（占8.07%）、流行性腮腺炎11 401例（占4.57%）及猩红热8 792例（占3.52%）。其中，流行性感冒的占比逐年上升，并于2019、2020及2022年超过手足口病成为发病第一顺位；水痘的占比在2017年之后逐渐下降。托幼儿童主要传染病的发病顺位见图2。此外，Joinpoint回归分析结果显示，手足口病、流行性腮腺炎及猩红热的发病率呈缓慢下降趋势，但趋势检验无统计学意义（APC分别为-9.70%、-3.98%、-1.79%，P>0.05）；流行性感冒及水痘均呈“升-降”趋势，各有1个转折点，均在2019年，其中2013—2019年流行性感冒的上升趋势有统计学意义（APC=166.11%，P=0.005），2019—2022年水痘的下降趋势有统计学意义（APC=-52.42%，P=0.022）；其他感染性腹泻病发病率呈上升趋势（APC=19.15%，P=0.002）。见表2、图3。
2013—2022年深圳市累积报告托幼儿童免疫规划类传染病12 106例，占报告总数的4.85%。其中，累积发病数居前三位的病种分别为：流行性腮腺炎11 401例（占94.18%）、百日咳491例（占4.06%）和乙肝100例（占0.83%）。无脊髓灰质炎、流行性脑脊髓膜炎及白喉报告。
2.3　季节分布特征
季节性分析结果显示，托幼儿童传染病发病呈双峰分布，每年5—6月及12月—次年1月为发病高峰，累积报告134 748例，占全年的53.98%，2月及8月托幼儿童寒暑假期间发病数锐减。其中，呼吸道传染病4—6月及12月—次年1月高发，季节性指数6月最高为2.55；肠道传染病5—6月及9—10月高发，季节性指数5月最高为2.33，见图4。经血与性传播传染病和动物源性及虫媒传染病呈散发状态，无明显季节性。
2.4　人群分布特征
托幼儿童传染病发病数男童高于女童，男女性别比为1.47：1。从传播途径上看，女童呼吸道传染病占发病总数的比例高于男童（56.03% vs. 52.50%），肠道传染病占发病总数的比例低于男童（43.90% vs. 47.43%），差异有统计学意义（P<0.001）。此外，三岁及以上儿童呼吸道传染病占发病总数的比例高于三岁以下儿童（60.45% vs.32.93%），肠道传染病占发病总数的比例低于三岁以下儿童（39.47% vs. 67.02%），差异有统计学意义（P<0.001）。见表3。
3　讨论
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本研究发现，2013—2022年深圳市托幼儿童传染病发病率在2 109.57/10万～11 578.22 /10万之间，年均发病率为4 981.47/10万，略低于北京朝阳区[5]，但高于贵阳市[6]、海口市[7]和上海金山区[8]，可能与深圳市流动人员较多、人口密集，同时气候温暖湿润，传染病整体发病水平较高有关。此外，深圳市托幼儿童传染病年均发病率也显著高于本市全人群年均发病率（1 368.11/10万），提示托幼儿童是传染病防控的重点人群。
深圳市托幼儿童传染病发病主要以呼吸道和肠道传染病为主，占总病例数的99.93%。与常熟市[9]、烟台市[10]及贵阳市[6]等地区的研究一致，手足口病是深圳市托幼儿童发病的最主要病种之一。2013—2019年深圳市手足口病发病呈波动下降的趋势，这可能与EV71疫苗的上市应用有关，但EV71疫苗仅针对EV71病毒引起的手足口病具有保护作用，对其他病毒无交叉免疫[11]，且深圳市托幼儿童EV71疫苗接种率仅20%左右[12]，无法形成有效的免疫屏障，因此深圳市托幼儿童手足口病的发病水平仍处于高位。建议一方面将托幼儿童EV71疫苗纳入免费接种规划，提高深圳市托幼儿童EV71疫苗的接种率，另一方面继续加强手足口病的监测预警及校园防控工作。
本研究发现深圳市托幼儿童流行性感冒发病率在2013—2019年间呈上升趋势，其中2016—2019年上升明显并在2019年达到高峰；与本研究一致，多项研究发现我国流行性感冒发病率在2016年后快速上升[13-14]，除了疾病自然波动的原因外，还可能与流感快检技术的广泛应用、主动就医人数增多及疫情监测报告质量不断提升有关[5,15]。自2020年开始，受新冠非药物干预措施（non-pharmaceutical interventions,NPIs）如检疫隔离、停课停学、社区管理、个人防护及环境措施等的影响，广东省呼吸道传染病发病率与2015—2019年相比呈下降趋势[16]。然而，美国CDC的研究发现2023年全球流感活跃水平升高，流感疫情已恢复至2020年前的水平[17]。接种流感疫苗是预防流行性感冒的最重要手段之一，但目前深圳市流感疫苗的免费接种对象仅包括中小学生和年龄超过60岁的老年人，建议将托幼儿童纳入免费接种规划，切实降低托幼儿童流行性感冒发病率。
2019年后深圳市托幼儿童水痘发病率呈显著性下降趋势，除了新冠非药物干预措施在减少呼吸道传染病方面发挥的重要作用外[16,18-19]，自2019年起，深圳对全市适龄儿童实行水痘疫苗免费接种政策，水痘疫苗预防接种效果明显。此外，本研究结果显示2013—2022年托幼儿童其他感染性腹泻病的发病率呈上升趋势。其他感染性腹泻病主要指各种病原体肠道感染引起的腹泻，病因复杂，与环境卫生状况高度相关。深圳市托幼机构数量众多，卫生状况参差不齐，因此防控重点主要为加强深圳市托幼机构食品、饮用水及环境的管理。
从季节分布上看，深圳市托幼儿童传染病发病呈双峰型，且不同类型的传染病发病高峰不同。从人群分布上看，男童的发病数显著高于女童，这可能与男童较女童更加活跃、卫生习惯较差，更容易接触污染物有关[20]；此外，三岁以下儿童肠道传染病占总传染病的比例更高，这可能与低龄儿童免疫系统尚未发育完善、也尚未建立良好的手卫生习惯有关。因此应根据不同传染病发病的季节特点和人群特点，采取针对性的监测预警、宣传教育及卫生管理等措施，避免出现聚集性疫情[6]。
本研究表明，2013—2022年深圳市托幼儿童传染病发病趋势较平稳，总体发病水平较高；呼吸道及肠道传染病是托幼儿童传染病防控的重点，尤其要重视手足口病、流行性感冒、水痘及其他感染性腹泻病的防控工作，建议将托幼儿童EV71及流感疫苗纳入免费接种规划，进一步提高深圳市托幼儿童EV71、流感及水痘疫苗的接种率，同时采取监测预警、健康教育及机构卫生管理等综合防控措施，有效控制托幼儿童常见传染病的发生和流行。
基金
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  • 深圳市医学重点学科(SZXK064)
  • 深圳市医疗卫生三名工程(SZSM202011008)
  • 深圳市科技创新委员会重点项目(JCYJ202103241154 11030)
文献
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2024年第51卷第1期
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doi: 10.20043/j.cnki.MPM.202306376
  • 接收时间：2023-06-19
  • 首发时间：2026-03-19
  • 出版时间：2024-01-10
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  • 收稿日期：2023-06-19
基金
深圳市医学重点学科(SZXK064)
深圳市医疗卫生三名工程(SZSM202011008)
深圳市科技创新委员会重点项目(JCYJ202103241154 11030)
作者信息
    1.深圳市疾病预防控制中心传染病预防控制所，广东 深圳 518055
    2.南方医科大学公共卫生学院，广东 广州 510515

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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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