新型冠状病毒感染“乙类乙管”后我国手足口病流行特征与趋势分析

doi:10.3969/j.issn.1672-2302.2023.04.002

摘要/Abstract

摘要：

目的了解新型冠状病毒感染“乙类乙管”后我国手足口病的流行特征和变化趋势，为科学应对和防控手足口病提供参考。方法采用描述流行病学方法对全国2023年1—6月手足口病病例报告情况、肠道病毒血清型构成情况等进行分析，并与2017—2019年和2020—2022年的同期平均水平进行对比；采用移动流行区间法（moving epidemic method, MEM）评估2023年1—6月我国手足口病的流行强度。结果 2023年1—6月，全国报告手足口病病例557 940例，报告发病率为39.68/10万，低于2017—2019年同期平均报告发病率（64.97/10万），高于2020—2022年同期平均报告发病率（26.37/10万）。从发病趋势来看，2023年手足口病发病高峰期较往年推迟，第20周报告病例数快速上升，第26周达到极高流行水平。从病原构成来看，2023年1—6月全国报告的实验室确诊病例中，肠道病毒A组71型（enterovirus A71, EV-A71）、柯萨奇病毒A组16型（coxasckievirus A16, CV-A16）和其他肠道病毒感染病例构成比分别为14.31%（4 694/32 804）、12.18%（3 995/32 804）和73.51%（24 115/32 804）；与2017—2019年和2020—2022年同期平均水平相比，EV-A71和CV-A16构成比均下降，而其他肠道病毒构成比均上升。MEM评估结果显示，2023年上半年南方手足口病总体流行强度高于北方，其中广东处于极高流行水平，江西和湖南处于中流行水平，贵州、四川、湖北、重庆和浙江处于低流行水平。结论 2023年，我国手足口病春夏季发病高峰后移，峰值明显高于新型冠状病毒感染疫情前同期平均水平，南方省份流行高峰早于北方省份。建议各省密切关注本省手足口病流行状况动态变化，做好疫情分析和风险评估工作。

关键词: 手足口病, 流行趋势, 新型冠状病毒感染, 监测预警

Abstract:

Objective To understand the epidemiological characteristics and changes of hand, foot and mouth disease (HFMD) in China after COVID-19 ranked as category B disease for evidence in scientific prevention and control of HFMD. Methods Descriptive epidemiological analysis was conducted to address the incidence and the composition of each enterovirus serotype of HFMD in China from January to June, 2023, and the results were compared with the corresponding findings in 2017-2019 and 2020-2022. Moving epidemic method (MEM) was used to estimate the epidemic intensity of HFMD reported from January to June, 2023 in China. Results From January to June, 2023, a total of 557 940 cases of HFMD were reported. The reported incidence was 39.68 /100 000, which was lower than the average incidence reported in the corresponding period of 2017-2019 (64.97/100 000), yet higher than the average incidence reported in the same period of 2020-2022 (26.37/100 000). The peak of the HFMD incidence in 2023 was delayed compared to the trends in previous years. The number of cases was rapidly increased after the 20^th week, and reached a very high epidemic level by the 26^th week. From January to June, 2023, the proportion of enterovirus A71 (EV-A71), coxasckievirus A16 (CV-A16) and other enterovirus in laboratory-diagnosed cases was 14.31% (4 694/32 804), 12.18% (3 995/32 804) and 73.51% (24 115/32 804), respectively. Compared with the average level of the same period in 2017-2019 and 2020-2022, the proportion of EV-A71 and CV-A16 decreased, while the proportion of other enterovirus increased. MEM evaluation results showed that the prevalence intensity of HFMD was higher in the south China than in the north, among which Guangdong remained at a very high epidemic level, whereas Jiangxi and Hunan were at medium epidemic level. Guizhou, Sichuan, Hubei, Chongqing and Zhejiang were at lower epidemic level. Conclusion In 2023, the incidence peak of HFMD in spring and summer in China moved backward, and the peak of this disease in the country exceeds the pre-pandemic level, and the epidemic peak in southern provinces was earlier than that in northern provinces, for which we suggest that all provinces should closely monitor the dynamic changes of the local epidemic by conducting epidemic analysis and risk assessment.

Key words: Hand, foot and mouth disease, Epidemic trend, COVID-19, Monitoring and warning

中图分类号:

R512.5

张雨桐, 宋杨, 刘凤凤, 丁凡, 刘言哲, 常昭瑞. 新型冠状病毒感染“乙类乙管”后我国手足口病流行特征与趋势分析[J]. 热带病与寄生虫学, 2023, 21(4): 186-190,227.

ZHANG Yutong, SONG Yang, LIU Fengfeng, DING Fan, LIU Yanzhe, CHANG Zhaorui. Analysis of the epidemic trend of hand, foot and mouth disease in China after COVID-19 as a category B disease[J]. Journal of Tropical Diseases and Parasitology, 2023, 21(4): 186-190,227.

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参考文献 33

[1]	Ju Y, Tan ZL, Huang H, et al. Clinical and epidemiological characteristics of Coxsackievirus A6- and Enterovirus 71-associated clinical stage 2 and 3 severe hand,foot,and mouth disease in Guangxi,Southern China,2017[J]. J Infect, 2020, 80(1):121-142.
[2]	聂陶然, 崔金朝, 任敏睿, 等. 应用移动流行区间法确定我国南方地区手足口病流行强度阈值[J]. 中华流行病学杂志, 2020, 41(7):1047-1053.
[3]	刘瑞, 闫敏敏, 魏嵘, 等. 儿童法定传染病流行特征及发病趋势预测分析[J]. 中国医院管理, 2023, 43(2):46-48,52.
[4]	Liu W, Guan WJ, Zhong NS. Strategies and advances in combating COVID-19 in China[J]. Engineering, 2020, 6(10):1076-1084. doi: 10.1016/j.eng.2020.10.003 URL
[5]	Zhang WY, Wu Y, Wen B, et al. Non-pharmaceutical interventions for COVID-19 reduced the incidence of infectious diseases: a controlled interrupted time-series study[J]. Infect Dis Poverty, 2023, 12(1):15. doi: 10.1186/s40249-023-01066-3 pmid: 36895021
[6]	张静. 2008—2017年中国手足口病流行趋势和病原变化动态数列分析[J]. 中华流行病学杂志, 2019, 40(2):147-154.
[7]	国家卫生健康委员会. 2020年全国法定传染病疫情概况[EB/OL]. (2021-03-12)[2023-07-07]. http://www.nhc.gov.cn/jkj/s3578/202103/f1a448b7df7d4760976fea6d55834966.shtml.
[8]	Adegbija O, Walker J, Smoll N, et al. Notifiable diseases after implementation of COVID-19 public health prevention measures in Central Queensland,Australia[J]. Commun Dis Intell, 2021, 45:11.
[9]	Rosińska M, Czarkowski MP, Sadkowska-Todys M. Infectious diseases in Poland in 2020[J]. Przegl Epidemiol, 2022, 76(4):514-527. doi: 10.32394/pe.76.47 pmid: 37017226
[10]	Hibiya K, Iwata H, Kinjo T, et al. Incidence of common infectious diseases in Japan during the COVID-19 pandemic[J]. PLoS One, 2022, 17(1):e0261332.
[11]	冯倩, 张媛媛, 崔朋伟, 等. 新冠大流行后的免疫负债[J]. 江苏预防医学, 2023, 34(2):126-128,222.
[12]	周海健, 崔志刚, 阚飙. 实验室监测在传染病预警中的应用及思考[J]. 中华预防医学杂志, 2022, 56(4):401-404.
[13]	Vega T, Lozano JE, Meerhoff T, et al. Influenza surveillance in Europe:establishing epidemic thresholds by the moving epidemic method[J]. Influenza Other Respir Viruses, 2013, 7(4):546-558. doi: 10.1111/irv.2013.7.issue-4 URL
[14]	Teeluck M, Samura A. Assessing the appropriateness of the Moving Epidemic Method and WHO Average Curve Method for the syndromic surveillance of acute respiratory infection in Mauritius[J]. PLoS One, 2021, 16(6):e0252703.
[15]	Bouguerra H, Boutouria E, Zorraga M, et al. Applying the moving epidemic method to determine influenza epidemic and intensity thresholds using influenza-like illness surveillance data 2009-2018 in Tunisia[J]. Influenza Other Respir Viruses, 2020, 14(5):507-514. doi: 10.1111/irv.v14.5 URL
[16]	Murray JLK, Marques DFP, Cameron RL, et al. Moving epidemic method (MEM) applied to virology data as a novel real time tool to predict peak in seasonal influenza healthcare utilisation. The Scottish experience of the 2017/18 season to date[J]. Eur Commun Dis Bull, 2018, 23(11):18-00079.
[17]	Xing WJ, Liao QH, Viboud C, et al. Epidemiological characteristics of hand-foot-and-mouth disease in China, 2008-2012[J]. Lancet Infect Dis, 2014, 14(4):308-318. doi: 10.1016/S1473-3099(13)70342-6 URL
[18]	国务院应对新型冠状病毒感染疫情联防联控机制综合组. 关于印发对新型冠状病毒感染实施“乙类乙管”总体方案的通知[A/OL]. (2022-12-26)[2023-07-09].http://www.nhc.gov.cn/xcs/zhengcwj/202212/e97e4c449d7a475794624b8ea12123c6.shtml.
[19]	Billard MN, Bont LJ. Quantifying the RSV immunity debt following COVID-19:a public health matter[J]. Lancet Infect Dis, 2023, 23(1):3-5. doi: 10.1016/S1473-3099(22)00544-8 URL
[20]	Cohen R, Pettoello-Mantovani M, Somekh E, et al. European pediatric societies call for an implementation of regular vaccination programs to contrast the immunity debt associated to coronavirus disease-2019 pandemic in children[J]. J Pediatr, 2022, 242:260-261. doi: 10.1016/j.jpeds.2021.11.061 URL
[21]	Cohen R, Ashman M, Taha MK, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood,how can we fill the immunity gap?[J]. Infect Dis Now, 2021, 51(5):418-423.
[22]	Chen BZ, Wang ML, Huang X, et al. Changes in incidence of notifiable infectious diseases in China under the prevention and control measures of COVID-19[J]. Front Public Health, 2021, 9:728768. doi: 10.3389/fpubh.2021.728768 URL
[23]	Zhang JF, Cao JJ, Ye Q. Nonpharmaceutical interventions against the COVID-19 pandemic significantly decreased the spread of enterovirus in children[J]. J Med Virol, 2022, 94(8):3581-3588. doi: 10.1002/jmv.v94.8 URL
[24]	Wang C, Li X, Zhang YJ, et al. Spatiotemporal cluster patterns of hand,foot,and mouth disease at the County level in mainland China,2008-2012[J]. PLoS One, 2016, 11(1):e0147532.
[25]	Li JF, Zhang CJ, Li YW, et al. Coxsackievirus A6 was the most common enterovirus serotype causing hand,foot,and mouth disease in Shiyan City,central China[J]. World J Clin Cases, 2022, 10(31):11358-11370. doi: 10.12998/wjcc.v10.i31.11358 URL
[26]	Peng D, Ma Y, Liu YQ, et al. Epidemiological and aetiological characteristics of hand,foot,and mouth disease in Sichuan Province,China,2011-2017[J]. Sci Rep, 2020, 10(1):6117. doi: 10.1038/s41598-020-63274-3 pmid: 32273569
[27]	Kou ZQ, Jia J, Liu XH, et al. Epidemiological characteristics and spatial-temporal clusters of hand,foot,and mouth disease in Qingdao City,China,2013-2018[J]. PLoS One, 2020, 15(6):e0233914.
[28]	Jiang HC, Zhang Z, Rao Q, et al. The epidemiological characteristics of enterovirus infection before and after the use of enterovirus 71 inactivated vaccine in Kunming,China[J]. Emerg Microbes Infect, 2021, 10(1):619-628. doi: 10.1080/22221751.2021.1899772 URL
[29]	He FL, Rui J, Deng ZQ, et al. Surveillance,epidemiology and impact of EV-A71 vaccination on hand,foot,and mouth disease in Nanchang,China,2010-2019[J]. Front Microbiol, 2021, 12:811553. doi: 10.3389/fmicb.2021.811553 URL
[30]	Liu FF, Ren MR, Chen SM, et al. Pathogen spectrum of hand,foot,and mouth disease based on laboratory surveillance - China,2018[J]. China CDC Wkly, 2020, 2(11):167-171.
[31]	Yoshida K, Fujimoto T, Muramatsu M, et al. Prediction of hand,foot,and mouth disease epidemics in Japan using a long short-term memory approach[J]. PLoS One, 2022, 17(7):e0271820. doi: 10.1371/journal.pone.0271820 URL
[32]	Borkakoty B, Das M, Jakharia A, et al. Hand,foot and mouth disease caused by Coxsackie viruses A6 and A16 in Assam,Northeast India:A need for surveillance[J]. Indian J Dermatol Venereol Leprol, 2020, 86(1):105.
[33]	Jiao MMA, Apostol LNG. Molecular detection of enteroviruses from hand-foot-and-mouth disease surveillance cases in the Philippines,2012 to 2017[J]. Int J Infect Dis, 2019, 79:89.

时间	病例数（例）	发病率（/10万）	重症数（例）	死亡数（例）
2023年1—6月	557 940	39.68	225	1
2020—2022年同期平均	370 832	26.37	345	3
2017—2019年同期平均	901 710	64.97	3 202	36

时间	实验室确诊病例数（例）	不同血清型病例数及构成比[n（%）]
时间	实验室确诊病例数（例）	EV-A71	CV-A16	其他肠道病毒
2023年1—6月	32 804	4 694（14.31）	3 995（12.18）	24 115（73.51）
2020—2022年同期平均	25 387	4 624（18.22）	7 223（28.45）	13 540（53.33）
2017—2019年同期平均	55 992	16 771（29.95）	14 606（26.09）	24 615（43.96）