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2014 — 2020年河南省EV71疫苗上市前后对重症手足口病流行特征及病原谱影响

Impact of the launch of EV71 vaccination on prevalence characteristics and pathogen spectrum of severe hand, foot and mouth disease in Henan province, 2014 – 2020: a register data analysis

    摘要
  • 摘要:
    目的  探索肠道病毒71型（EV71）疫苗上市前后河南省重症手足口病流行特征和病原谱的变化情况，为制定重症手足口病防控策略提供相关依据。
    方法 通过中国疾病预防控制中心传染病报告信息管理系统选取河南省2014 — 2020年所有手足口病报告信息，分析EV71疫苗上市后河南省重症手足口病流行特征及病原谱变化。
    结果 2014 — 2020年，河南省共报告重症手足口病病例13535例。EV71疫苗于2017年广泛使用，与上市前（2014 — 2016年）比较，上市后（2017 — 2020年）手足口病重症病例所占比率从3.19%（10948/343585）降为0.93%（2587/278075），差异有统计学意义（χ 2 = 3672.874，P < 0.001）。全年重症发病呈现单峰分布，高发季节主要集中在4 — 7月，4 — 7月报告病例数占75.53%（10223/13535），重症病例中男女比例为1.58 : 1；发病年龄仍然以 < 5岁婴幼儿为主，占97.34%（13175/13535），1岁年龄组重症病例构成比从47.23%下降到42.83%，2岁年龄组重症病例构成比从25.57%下降到22.84%（χ21岁组 = 16.311，P1岁组 < 0.001；χ22岁组 = 8.255，P2岁组 = 0.004）；托幼机构重症病例构成比由9.13%上升为16.24% （χ2 = 112.359，P < 0.001）；疫苗上市后，EV71构成比从65.14%下降到29.63%，其他肠道病毒构成比从27.49%上升到56.13%，其他肠道病毒代替EV71成为优势血清型（56.13%，737/1313）。
    结论  EV71疫苗上市后河南省手足口病重症比率明显下降，优势病原由EV71转为其他肠道病毒，应进一步加强重点人群、高发季节、重点场所的EV71疫苗推广应用工作，开展综合防控工作预防重症手足口病的发生。

     

    Abstract:
    Objective  To explore changes in prevalence characteristics and pathogen spectrum of severe hand, foot and mouth disease (HFMD) in Henan province before and after launching vaccination of enterovirus 71 (EV71) vaccine for developing strategies on HFMD prevention and control.
    Methods The data on all HFMD cases registered in Henan province from 2014 through 2020 were extracted from the Infectious Disease Report Information Management System of the Chinese Center for Disease Control and Prevention. Descriptive statistics was performed on the data to assess changes in constituent ratio of and distribution of pathogens detected in the severe HFMD cases before and after of the launch of EV71 vaccination from 2017 in the province.
    Results During 2014 to 2020, totally 13 535 severe HFMD cases were reported in the province, with a male-to-female ratio of 1.58:1 and the most (97.34%, 13 175) of the cases were children under the age of 5 years. A unimodal pattern throughout the year was observed in the incidence of severe HFMD, with the peak season mainly occurring from April to July and 75.53% (10 223) of the registered severe cases occurred during the season. The ratio of severe cases decreased significantly from 3.19% (10 948/343 585) for the period of 2014 – 2016 to 0.93% (2 587/278 075) for the period of 2017 – 2020 with the launch of EV71 vaccination (χ2 = 3672.874, P < 0.001). For the severe HFMD cases reported during 2017 – 2020, the proportion of the cases of one- and two-year-old decreased significantly from 47.23% to 42.83% (χ2 = 16.311, P1 < 0.001) and from 25.57% to 22.84% (χ2 = 8.255, P2 = 0.004); but the proportion of the cases occurred in preschool care facilities increased significantly from 9.13% to 16.24% (χ2 = 112.359, P < 0.001). Following the promotion of EV71 vaccination among the public, the detection rate of EV71 among the severe HFMD cases decreased from 65.14% to 29.63%, while that of other enteroviruses increased from 27.49% to 56.13%, indicating that other enteroviruses became dominant serotypes for pathogens of HFMD epidemic.
    Conclusion The ratio of severe cases among registered HFMD cases had significantly decreased after the launch of the EV71 vaccination in Henan province and the dominant pathogen of HFMD changed from EV71 to other enteroviruses. The results suggest that EV71 vaccination ought to be promoted among key populations and in peak season to prevent severe HFMD epidemic.

     

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