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Article(id=1324078368190243832, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509408, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758643200000, receivedDateStr=2025-09-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614483162, onlineDateStr=2026-11-02, pubDate=1769270400000, pubDateStr=2026-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614483162, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614483162, creator=13701087609, updateTime=1793614483162, updator=13701087609, issue=Issue{id=1324078175000605624, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='1769270400000', pubDateStr='2026-01-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614437103, creator='13701087609', updateTime=1793614526046, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078548130082942, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078548130082943, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=370, endPage=374, ext={EN=ArticleExt(id=1324078368907469817, articleId=1324078368190243832, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of a free varicella vaccination policy on the incidence rate among preschool children, Yangzhou City, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemiological characteristics of varicella in Yangzhou from 2018 to 2024 and to evaluate the impact of incorporating a two-dose varicella vaccination schedule into the immunization program on the reported incidence among preschool children.

Methods

Monthly incidence data of varicella among children aged 1-6 years and vaccination data were collected from China Disease Prevention and Control Information System and Jiangsu Provincial Comprehensive Service Management Information System for Vaccination, respectively. The study described the varicella vaccination coverage in Yangzhou from 2018 to 2024 and employed an interrupted time series analysis to evaluate the impact of immunization strategies on the reported incidence of varicella among preschool-aged children.

Results

During the 2018-2024 period, the average annual reported incidence of varicella among preschool children in Yangzhou was 867.87 per 100 000. Following the implementation of the varicella immunization strategy, vaccination coverage rose substantially in the target population, with the average annual incidence significantly declining from 1 148.33 per 100 000 to 166.75 per 100 000 (χ2=2 272.2, P<0.001). Interrupted time series analysis revealed that after the introduction of the free two-dose varicella vaccination policy, the level change in the monthly reported incidence was -94.41 per 100 000 (P<0.001), indicating a significant immediate reduction. Furthermore, the previous upward trend in incidence was reversed, with a slope change of -3.95 per 100 000 per month (P=0.023).

Conclusion

The implemented varicella immunization strategy significantly increased vaccination coverage and effectively reduced the incidence and disease burden of varicella among preschool children.

, authors=Shi-jing TANG, Jie LIANG, Yan-lin ZHANG, Xiao-yan ZHENG, Shan-shan XU, Jin-lei MA, Ya-jing XU, authorsList=Shi-jing TANG, Jie LIANG, Yan-lin ZHANG, Xiao-yan ZHENG, Shan-shan XU, Jin-lei MA, Ya-jing XU, authorCompany=null, correspAuthors=Jie LIANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078372212580353, articleId=1324078368190243832, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=扬州市免费水痘疫苗接种政策对学龄前儿童发病率的影响, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析2018—2024年扬州市水痘发病的流行特征，评价将2剂次水痘疫苗纳入免疫规划对学龄前儿童水痘报告发病率的影响。

方法

通过中国疾病预防控制信息系统和江苏省预防接种综合服务管理信息系统分别收集研究期间1~6岁儿童水痘月发病率数据和疫苗接种数据，描述2018—2024年扬州市水痘疫苗接种率情况，采用中断时间序列分析方法，评估免疫策略实施对学龄前儿童水痘报告发病率的影响。

结果

2018—2024年期间，扬州市学龄前儿童水痘年均报告发病率为867.87/10万，实施水痘免疫策略后，目标人群接种率大幅提升，年均发病率从自费阶段的1 148.33/10万显著下降至166.75/10万（χ2=2 272.2，P<0.001）。中断时间序列分析结果，实施免费2剂次水痘疫苗免疫政策后，水痘月报告发病率的水平变化量为-94.41/10万（P<0.001），发病率的上升趋势被扭转，发病率斜率变化量为-3.95/10万（P=0.023）。

结论

水痘疫苗免疫策略的实施极大幅度提升了疫苗接种覆盖率，有效降低了学龄前儿童的水痘发病率和疾病负担。

, authors=唐诗静, 梁杰, 章艳林, 郑晓艳, 徐闪闪, 马金蕾, 许雅静, authorsList=唐诗静, 梁杰, 章艳林, 郑晓艳, 徐闪闪, 马金蕾, 许雅静, authorCompany=null, correspAuthors=梁杰, authorNote=

唐诗静（1996—），女，硕士，主管医师，研究方向：疾病控制

, correspAuthorsNote=
梁杰，E-mail:
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唐诗静（1996—），女，硕士，主管医师，研究方向：疾病控制

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Parameter estimates of the interrupted time series regression model for varicella incidence among children aged 1-6 in Yangzhou City, 2018-2024

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误t值95%置信区间P值
截距项53.229.265.7435.07~71.37<0.001
X11.410.285.000.86~1.96<0.001
X2-94.4125.04-3.77-143.49~-45.33<0.001
X3-3.951.70-2.32-7.28~-0.620.023
), ArticleFig(id=1324078377438683193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078368190243832, language=CN, label=表1, caption=

2018—2024年扬州市1~6岁儿童水痘发病率中断时间序列回归模型参数值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误t值95%置信区间P值
截距项53.229.265.7435.07~71.37<0.001
X11.410.285.000.86~1.96<0.001
X2-94.4125.04-3.77-143.49~-45.33<0.001
X3-3.951.70-2.32-7.28~-0.620.023
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扬州市免费水痘疫苗接种政策对学龄前儿童发病率的影响
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唐诗静 , 梁杰 , 章艳林 , 郑晓艳 , 徐闪闪 , 马金蕾 , 许雅静
现代预防医学 | 疾病预防控制 2026,53(2): 370-374
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现代预防医学 |疾病预防控制 2026 , 53 (2) : 370 -374
扬州市免费水痘疫苗接种政策对学龄前儿童发病率的影响
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唐诗静, 梁杰 , 章艳林, 郑晓艳, 徐闪闪, 马金蕾, 许雅静
作者信息
  • 扬州市疾病预防控制中心，江苏 扬州 225000
通讯作者:
梁杰，E-mail:
作者简介:

唐诗静（1996—），女，硕士，主管医师，研究方向：疾病控制

The impact of a free varicella vaccination policy on the incidence rate among preschool children, Yangzhou City
Shi-jing TANG, Jie LIANG , Yan-lin ZHANG, Xiao-yan ZHENG, Shan-shan XU, Jin-lei MA, Ya-jing XU
Affiliations
  • Yangzhou Center for Disease Control and Prevention, Yangzhou, Jiangsu 225000, China
出版时间: 2026-01-25 doi: 10.20043/j.cnki.MPM.202509408
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摘要
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目的

分析2018—2024年扬州市水痘发病的流行特征，评价将2剂次水痘疫苗纳入免疫规划对学龄前儿童水痘报告发病率的影响。

方法

通过中国疾病预防控制信息系统和江苏省预防接种综合服务管理信息系统分别收集研究期间1~6岁儿童水痘月发病率数据和疫苗接种数据，描述2018—2024年扬州市水痘疫苗接种率情况，采用中断时间序列分析方法，评估免疫策略实施对学龄前儿童水痘报告发病率的影响。

结果

2018—2024年期间，扬州市学龄前儿童水痘年均报告发病率为867.87/10万，实施水痘免疫策略后，目标人群接种率大幅提升，年均发病率从自费阶段的1 148.33/10万显著下降至166.75/10万（χ2=2 272.2，P<0.001）。中断时间序列分析结果，实施免费2剂次水痘疫苗免疫政策后，水痘月报告发病率的水平变化量为-94.41/10万（P<0.001），发病率的上升趋势被扭转，发病率斜率变化量为-3.95/10万（P=0.023）。

结论

水痘疫苗免疫策略的实施极大幅度提升了疫苗接种覆盖率，有效降低了学龄前儿童的水痘发病率和疾病负担。

水痘  /  水痘减毒活疫苗  /  中断时间序列  /  流行特征  /  免疫策略
Objective

To analyze the epidemiological characteristics of varicella in Yangzhou from 2018 to 2024 and to evaluate the impact of incorporating a two-dose varicella vaccination schedule into the immunization program on the reported incidence among preschool children.

Methods

Monthly incidence data of varicella among children aged 1-6 years and vaccination data were collected from China Disease Prevention and Control Information System and Jiangsu Provincial Comprehensive Service Management Information System for Vaccination, respectively. The study described the varicella vaccination coverage in Yangzhou from 2018 to 2024 and employed an interrupted time series analysis to evaluate the impact of immunization strategies on the reported incidence of varicella among preschool-aged children.

Results

During the 2018-2024 period, the average annual reported incidence of varicella among preschool children in Yangzhou was 867.87 per 100 000. Following the implementation of the varicella immunization strategy, vaccination coverage rose substantially in the target population, with the average annual incidence significantly declining from 1 148.33 per 100 000 to 166.75 per 100 000 (χ2=2 272.2, P<0.001). Interrupted time series analysis revealed that after the introduction of the free two-dose varicella vaccination policy, the level change in the monthly reported incidence was -94.41 per 100 000 (P<0.001), indicating a significant immediate reduction. Furthermore, the previous upward trend in incidence was reversed, with a slope change of -3.95 per 100 000 per month (P=0.023).

Conclusion

The implemented varicella immunization strategy significantly increased vaccination coverage and effectively reduced the incidence and disease burden of varicella among preschool children.

Varicella  /  Varicella vaccine  /  Interrupted time series  /  Epidemiological characteristics  /  Immunization strategy
唐诗静, 梁杰, 章艳林, 郑晓艳, 徐闪闪, 马金蕾, 许雅静. 扬州市免费水痘疫苗接种政策对学龄前儿童发病率的影响. 现代预防医学, 2026 , 53 (2) : 370 -374 . DOI: 10.20043/j.cnki.MPM.202509408
Shi-jing TANG, Jie LIANG, Yan-lin ZHANG, Xiao-yan ZHENG, Shan-shan XU, Jin-lei MA, Ya-jing XU. The impact of a free varicella vaccination policy on the incidence rate among preschool children, Yangzhou City[J]. Modern Preventive Medicine, 2026 , 53 (2) : 370 -374 . DOI: 10.20043/j.cnki.MPM.202509408
正文
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水痘（varicella）是由水痘-带状疱疹病毒（varicella-zoster virus, VZV）初次感染引起的一种具有高度传染性的急性呼吸道传染病，以全身性斑疹、丘疹和疱疹为主要临床特征，常见于儿童和青少年，极易在幼托机构和学校引起暴发[1]。近年来，水痘报告发病率居于我国儿童疫苗可预防传染病的前列，水痘基本是造成学校突发公共卫生事件的主要原因[2]。在中国，水痘并非法定报告传染病，真实的发病水平可能被严重低估[3]。自2017年7月江苏将其纳入丙类传染病管理后，扬州市的水痘发病率在2018年出现显著增长，全人群报告病例数较2017年增长171.06%。接种水痘减毒活疫苗（Varicella Vaccine, VarV）是预防水痘最经济、有效的公共卫生策略。目前，VarV尚未被纳入国家免疫规划疫苗，2023年1月1日起，江苏省将2剂次VarV纳入免疫规划项目，扬州市依照省级政策实施VarV免疫策略，对满12月龄和4周岁的儿童提供免费接种和补种服务。本研究通过收集政策实施前后水痘发病的纵向监测数据，对扬州市学龄前儿童水痘发病率趋势改变进行分析，评估这项重大公共卫生干预措施在人群中的真实效果。
1　材料和方法
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1.1　数据来源
扬州市2018年1月1日至2024年12月31日的水痘报告病例情况的信息来源于中国疾病预防控制信息系统，包括报告病例数、发病率、发病日期等数据。水痘疫苗接种数据来源于江苏省预防接种综合服务管理信息系统，主要包括目标人群的接种率、特定年龄人口数据。
1.2　VarV免疫策略
在2022年12月之前，VarV在扬州市属于非免疫规划疫苗，受种者按需选择自费接种。自2023年1月1日起，江苏省将VarV纳入地方免疫规划，对满12月龄和4周岁的6周岁以下儿童实行免费VarV免疫接种策略，为适龄儿童提供免费接种服务。该政策包括常规接种和常规补种策略：对未满接种月龄的儿童需在满12月龄和48月龄时分别接种1剂次VarV；同时，对超期未种的儿童实施了积极的补种策略，即年满12~48月龄的的儿童应尽快接种第一剂VarV接种，48月龄~6周岁的儿童应尽快完成两剂次VarV接种，须在6周岁前完成两剂次接种，2剂次接种间隔应不小于3个月。
1.3　研究方法
本研究采用单组中断时间序列设计，以2023年1月1日作为干预变化节点，2018年1月1日至2022年12月31日为VarV自费接种阶段，2023年1月1日至2024年12月31日为推行2剂次VarV免费接种阶段，共84个月度观测值。运用分段线性回归模型对疫苗政策实施前后扬州市学龄前儿童的水痘报告发病率的变化进行对比和分析，分段回归模型回归模型如下：
其中，Yt为在时间点t的水痘月都报告发病率的观测结果；β0为截距项，表示研究起始时刻的预测值；β1估计政策实施前的的长期趋势，X1为连续时间变量，从研究年份起点开始取值：1、2、3……84，对应2018年1月至2024年12月的每个月份；β2估计政策干预带来的即时水平变化，反映政策实施后的即时效应，X2表示干预状态变量，将VarV纳入免疫规划项目前取值为0，干预后取值为1；β3反映政策干预的持续或长期效应的长期效应，X3干预前取0，干预后取值从1~24；ε为误差项。
考虑到水痘发病率存在明确的以年为周期的季节性波动模式，在模型中加入了傅里叶项（k=2）以控制季节性波动[4]。通过残差自相关函数图发现模型残差存在自相关，违背普通最小二乘法的残差独立性假设，因此采用广义最小二乘法（Generalized Least Squares, GLS）进行参数估计，通过自回归滑动平均（Auto Regressive Moving Average, ARMA）建模来校正自相关，并采用Ljung-Box检验进行自相关检验。
使用R 4.5.1软件完成数据的统计分析，所有统计检验均采用双侧检验，显著性水平设定为α=0.05。
2　结果
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2.1　水痘流行概况
在2018年1月1日至2024年12月31日期间，扬州市共报告11 796例1~6岁学龄前儿童水痘病例，无死亡病例，年均发病率为867.87/10万。水痘年均报告发病率从自费接种阶段（2018—2022年）的1 148.33/10万降至VarV政策推行阶段（2023—2024年）的166.75/10万，差异具有统计学意义（χ2=2 272.2，P<0.001）。研究期间扬州市水痘病例全年均有报告，发病呈双峰分布的季节性特征，每年度10月至次年1月为发病高峰期，4~7月为次高峰期。2018—2022年期间，扬州市共报告水痘突发公共卫生事件71起，其中28（39.44%）起发生在幼托机构，33（46.48%）起发生在小学，10（14.08%）起发生在中学；2023—2024年期间，突发公共卫生事件5起，其中2（40.00%）起发生在小学，3（60.00%）起发生在中学，幼托机构未报告突发公共卫生事件。
根据水痘月度报告数据，对扬州市2018年1月至2024年12月水痘报告发病率的时间序列趋势进行了可视化分析（图1）。为了辅助识别水痘发病率潜在的长期趋势和方向性变化，采用移动平均法，通过计算12个月移动平均线平滑了短期波动，展示了发病率的潜在趋势变化。2020年上半年的水痘流行季节发病率出现了急剧下降，这可能与COVID-19疫情暴发初期严格的防控措有关；而在2020年11月至次年1月，发病率出现明显反弹，12月水痘发病率达到研究期间的最高发病水平445.50/10万。2023年1月后发病率呈现出明显的下降趋势。
2.2　VarV接种情况
2018—2024年间扬州市1~6岁儿童的VarV的接种覆盖率总体呈现上升趋势，特别是2剂次接种率的增长幅度尤为显著。2018—2022年期间，1剂次VarV接种率低于50%，在VarV免疫策略实施后，至2024年底，1剂次接种率增长至97.36%，较政策实施前增加48.26个百分点。2018—2021年，2剂次接种率处于较低水平，免费政策实施后至2024年底，2剂次接种率达93.15%，与2022年相比增长82.49个百分点。
2.3　免费VarV免疫策略的效果分析
中断时间序列分析采用GLS+ARMA(p, q)模型，其中p是自回归的阶数，q是移动平均的阶数，通过一系列迭代过程确定滞后阶数：首先检查初始模型残差的自相关函数ACF和偏自相关函数PACF图以识别初步特征；随后，通过拟合一系列候选模型，选择了AIC值最小的模型ARMA(2, 2)。该模型具有更好的拟合优度，模型残差诊断无显著相关，Ljung-Box检验在滞后6期 (P=0.827) 和12期 (P=0.098) 均不显著。
分析结果显示，在VarV自费阶段，1~6岁人群的水痘报告发病率逐年显著上升，估计月发病率增加1.41/10万（P<0.001）。与自愿自费接种时期相比，VarV免疫策略实施后水痘发病率减少94.41/10万，差异具有统计学意义（P<0.001），发病率下降2.54/10万（β1+β3：1.41-3.95），发病率斜率在VarV免疫策略实施后亦下降3.95/10万（P=0.023）（表1）。
3　讨论
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本研究基于2018—2024年的水痘月报告发病率数据，采用GLS构建分段回归模型，分析VarV免费接种政策推行前后扬州市1~6岁儿童水痘报告发病率的变化，间接推断疫苗的实际保护效果，评估该政策对水痘防控的效果，为优化免疫策略提供实证依据[5]。
自免费接种政策实施后，目标人群VarV接种率迅速提升至较高水平，1剂次接种率由49.10%上升至97.36%，2剂次接种率由10.66%大幅提高至93.15%。与此同时，水痘报告发病率在短期内出现显著下降，年均发病率从自费阶段的1 148.33/10万降至166.75/10万。该结果反应了高水平的VarV接种覆盖率是控制疫情暴发、进一步降低水痘发病率的重要因素，且两剂次VarV的免疫策略能够更加有效的减少病例和疾病负担[6-8]。疫苗政策实施不仅在一定程度上消除了家庭经济障碍，还提升了儿童监护人对水痘疾病的认知水平和防控意识，从而显著增强接种意愿[9]。疫苗的快速覆盖从根本上减少了学龄前儿童中的易感者积累，有效阻断了水痘传播链，为区域性水痘防控提供了关键支持。VarV免费接种政策实施后，水痘突发公共卫生事件数量明显减少，有研究表明，水痘暴发疫情的初期，实施应急接种能够有效控制发病率，在有基础免疫史的人群中实施应急接种能够增强应急免疫的效果，且两剂次VarV能够显著降低突破病例的发病率[10-12]。但值得一提的是，VarV免费接种政策实施后的主要发病人群向青少年人群转变，对初高中教学秩序产生冲击影响。
时间序列结果显示，2020上半年水痘春季的发病高峰几乎完全消失，该现象可能与COVID-19初期采取的严格非药物干预措施(Non-PharmaceuticalInterventions, NPls)高度相关。水痘与COVID-19同属呼吸道传染病，传播途径相似，疫情防控初期采取的幼托机构停课、学校关闭、社交距离等严格措施实质上切断了水痘病毒的传播链，从而抹平了固有的季节性高峰[13-14]。但发病率在进入下半年的流行季节后出现了明显反弹，月发病率达到研究期间的最高水平，这可能与严格防控措施期间积累的易感人群在NPIs 放松后集中暴发有关，形成了观察到的补偿性流行。这一现象提示针对COVID-19采取的NPIs能有效抑制水痘等其他呼吸道传染病的传播，但NPIs条件下导致的易感人群堆积可能引发更加剧烈的疫情反弹[15]。
分段回归模型的结果提示，VarV免疫策略的实施产生了显著的即时效应和持续性的趋势改善，实现了发病率水平的下降和增长趋势的逆转。政策实施后，发病率下降，同时政策前原有的上升趋势被扭转，反映了疫苗政策对水痘发病水平的有效遏制，提示政策执行的及时性和覆盖面达到了预期效果。这一变化表明，将VarV纳入免疫规划并采取积极的补种政策，可显著降低学龄前儿童水痘发病风险。该结果与上海、无锡、青岛等地的研究结论一致，进一步印证了VarV免费策略在不同城市背景下的普遍适用性和有效性[10,16-17]。
本研究存在一些局限性。首先，研究期与COVID-19大流行期重叠。疫情防控期间暴露机会减少导致易感人群蓄积，政策实施前的发病率基线随防控政策的逐步放松可能被异常抬高，存在政策真实效果被高估的可能性。此外，政策后观察期较短，评估政策效果的数据有限。较短的观察点可能会影响对政策效果的长期持续性的判断，可能需要更长时间跨度的数据进来确认其趋势是否得以维持。
综上，扬州市将VarV纳入免疫规划并开展补种政策的干预措施取得了显著成效。该政策实施后，学龄前儿童中的VarV接种覆盖率大幅提高，水痘发病率的长期上升趋势被有效遏制，发病水平显著下降并呈现持续下降趋势。因此，持续推行免费的两剂次VarV接种，是巩固群体的免疫屏障并控制水痘的发病水平的关键举措。
基金
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  • 扬州市科技局软科学研究计划(YZ2023304)
文献
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2026年第53卷第2期
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doi: 10.20043/j.cnki.MPM.202509408
  • 接收时间：2025-09-24
  • 首发时间：2026-11-02
  • 出版时间：2026-01-25
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  • 收稿日期：2025-09-24
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扬州市科技局软科学研究计划(YZ2023304)
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    扬州市疾病预防控制中心，江苏 扬州 225000

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Number of
genus		 种数
Number of
species		 占总种数比例
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total species (%)		 属
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Number of
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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
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