南京市2011—2016年儿童手足口病流行特征及与气温关联

赵慧; 洪镭; 陈佳萍; 周轶敏; 闵吉; 徐斐; 邵方; 刘思浚

doi:10.16835/j.cnki.1000-9817.2021.04.033

南京市2011—2016年儿童手足口病流行特征及与气温关联

doi: 10.16835/j.cnki.1000-9817.2021.04.033

赵慧¹,
洪镭²,
陈佳萍¹,
周轶敏¹,
闵吉³,
徐斐²,
邵方¹,
刘思浚^1, ,

1.
南京医科大学公共卫生学院，江苏 211166
2.
南京市疾病预防控制中心计划免疫科
3.
太仓市妇幼保健所儿童保健科

基金项目:

“十三五”南京市医学科技发展资金重大项目 ZDX16020

太仓市科技局重点研发计划(社会发展)项目 TC2017SFYL14

详细信息

作者简介:
赵慧(1995-)，女，江苏徐州人，在读硕士，主要研究方向为传染病流行病学

通讯作者:
刘思浚，E-mail：sjliu@njmu.edu.cn

中图分类号: R 122 R 181.3 R 725.1
计量
- 文章访问数: 479
- HTML全文浏览量: 298
- PDF下载量: 49
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-04
- 修回日期: 2020-12-20
- 网络出版日期: 2021-04-16
- 刊出日期: 2021-04-25

Epidemiological characteristics of children's Hand, Foot and Mouth Disease and its association with temperature in Nanjing from 2011-2016

1.
College of Public Health, Nanjing Medical University, Nanjing (211166), China

摘要

摘要: 目的了解南京市0~5岁儿童手足口病(hand, foot and mouth disease, HFMD)的流行病学分布，并探讨气温与儿童手足口病发病的关系，为制定手足口病有针对性的防控措施提供参考依据。方法收集南京市2011—2016年5岁及以下儿童HFMD的日发病数和日气象变量资料。对HFMD流行病学特征进行描述性分析，利用分布滞后非线性模型(distributed lag non-linear model, DLNM)分析HFMD日发病数与日平均气温的关系。结果 2011—2016年南京市共报告0~5岁儿童手足口病104 977例，男女性别比为1.49∶1，手足口病年均报告发病率为213.5/10万，呈季节性双峰分布，南京市溧水区和浦口区为HFMD高发地区；EV-A71阳性、CV-A16阳性和其他肠道病毒感染阳性分别占HFMD阳性标本的32.5%，29.1%和38.4%；5岁及以下儿童HFMD发病数与日平均气温呈非线性关系，存在明显的滞后效应。当滞后14 d时，气温对手足口病的累积效应呈倒“U”型，气温为25.7 ℃时效应值最大，累积相对危险度为2.71(95%CI=1.93~3.81)；不同人群分析显示，男童和 < 1岁组儿童更易受气温的影响。结论南京市≤5岁儿童HFMD流行具有季节性、地区性分布特征，气温对HFMD发病存在显著影响。
- 手足口病 /
- 发病率 /
- 流行病学研究 /
- 温度 /
- 儿童
Abstract: Objective This study aims to investigate the epidemiological distribution of HFMD and quantify the association of temperature with the incidence of children's HFMD in Nanjing, China. Methods Daily counts of HFMD in children under 5 years and daily meteorological variables during 2011-2016 were obtained. Descriptive statistics were used to describe the epidemiological characteristics and distributed lag non-linear model (DLNM) was used to assess the associations of temperature on HFMD cases. Results A total of 104 977 HFMD cases aged 0-5 years were reported in Nanjing during the study period and the male-to-female sex ratio was 1.49∶1. The average annual incidence was 213.5 per 100 000. A bimodal seasonal pattern was observed and the south and west were found to be the high-incidence areas in the city. Of these laboratory-confirmed enteroviruses positive cases, 32.5% cases were positive for EV-A71 infections, 29.1% cases were positive for CV-A16 infections and 38.4% cases were positive of other enteroviruses infections. The temperature-HFMD relationships were non-linear and showed obvious lag effects. The cumulative relative risk presented as an approximately inverted U-shape over 14 days and peaked at 25.7 ℃ with value of 2.71(95%CI=1.93-3.81). Subgroup analyses revealed that males and children aged < 1 year were more vulnerable to temperature variations. Conclusion Epidemiological characteristics of HFMD among children aged 0-5 years old in Nanjing presented temporal and regional distribution. The temperature has significant impact on children's HFMD occurrence.
- Hand, foot and nouth disease /
- Incidence /
- Epidemiologic studies /
- Temperature /
- Child

HTML全文

图 1 南京市2011—2016年0~5岁儿童手足口病病原学特征分析

Figure 1. Enterovirus serotypes of HFMD cases of children aged 0-5 years old in Nanjing City, 2011-2016

下载: 全尺寸图片幻灯片

表 1 南京市2011—2016年各区0~5岁儿童手足口病报告发病率/10^-5

Table 1. Spatial trend of HFMD annual incidence rate among children aged 0-5 years old in Nanjing City, 2011-2016/10^-5

年份	六合	栖霞	浦口	鼓楼	玄武	建邺	秦淮	雨花台	江宁	溧水	高淳
2011	131.9	182.5	259.5	134.7	131.5	216.5	132.9	186.6	192.6	320.8	229.4
2012	147.6	227.1	358.4	140.8	112.1	208.2	111.6	249.4	219.9	232.9	213.3
2013	194.5	200.6	327.8	105.9	113.1	140.8	126.6	205.6	249.1	226.7	243.1
2014	247.9	268.1	507.9	132.2	150.3	230.4	152.2	294.9	439.5	335.8	340.3
2015	143.3	174.5	384.8	108.7	100.6	148.7	102.1	179.9	270.1	99.0	318.8
2016	182.4	292.8	439.9	125.0	124.2	216.0	147.5	317.4	429.8	534.3	309.9

下载: 导出CSV

表 2 南京市2011—2016年不同气温和滞后天数时0~5岁儿童手足口病发病风险[RR值(RR值95%CI)，n=104 977]

Table 2. Relative risks of different average temperature for HFMD cases of children aged 0-5 years old in Nanjing City, 2011-2016[RR(RR95%CI), n=104 977]

气温/℃	0 d	2 d	4 d	6 d	8 d	12 d	14 d
8.2	1.01(0.96~1.06)	0.96(0.93~0.98)^**	1.00(0.98~1.01)	1.04(1.02~1.06)^**	1.05(1.03~1.07)^**	1.01(0.98~1.03)	1.14(1.08~1.20)^**
17.8	1.15(1.03~1.28)^**	0.92(0.88~0.97)^**	0.98(0.94~1.02)	1.09(1.05~1.13)^**	1.12(1.07~1.17)^**	0.99(0.94~1.05)	1.18(1.06~1.32)^**
24.0	1.20(1.06~1.35)^**	0.91(0.86~0.96)^**	0.98(0.94~1.03)	1.13(1.08~1.18)^**	1.17(1.12~1.22)^**	1.00(0.95~1.06)	1.24(1.10~1.40)^**
27.9	1.22(1.07~1.39)^**	0.91(0.86~0.97)^**	0.98(0.94~1.03)	1.13(1.08~1.18)^**	1.17(1.12~1.22)^**	1.00(0.94~1.06)	1.21(1.06~1.37)^**
注：**P < 0.01。

下载: 导出CSV

参考文献(20)

[1]	WANG Y, FENG Z, YANG Y, et al. Hand, foot, and mouth disease in China: patterns of spread and transmissibility[J]. Epidemiology, 2011, 22(6): 781-792. doi: 10.1097/EDE.0b013e318231d67a
[2]	OOI M H, WONG S C, LEWTHWAITE P, et al. Clinical features, diagnosis, and management of enterovirus 71[J]. Lancet Neurol, 2010, 9(11): 1097-1105. doi: 10.1016/S1474-4422(10)70209-X
[3]	段亮亮, 商晋, 张维敏, 等. 2010—2017年中国大陆法定传染病疫情分析[J]. 现代预防医学, 2019, 46(14): 2501-2506. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201914002.htm DUAN L L, SHANG J, ZHANG W M, et al. Analysis of epidemic situation of legal infectious diseases in mainland China in 2010-2017[J]. Modern Prev Med, 2019, 46(14): 2501-2506. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201914002.htm
[4]	牛涛, 乌兰, 滕跃, 等. 2016—2017年呼和浩特市影响手足口病发病的气象因素分析[J]. 中国病毒病杂志, 2019, 9(1): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-ZRYX201901006.htm NIU T, WU L, TENG Y, et al. Association of meteorological factors and the incidence of hand, foot and mouth disease during 2016 to 2017 in Hohhot city of China[J]. Chin J Viral Dis, 2019, 9(1): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-ZRYX201901006.htm
[5]	郑大山, 郭玉清, 陈喆, 等. 基于分布滞后非线性模型分析气温对潍坊市手足口病影响[J]. 中国公共卫生, 2019: 1-5. DOI: 10.11847/zgggws1124536. ZHENG D S, GUO Y Q, CHEN Z, et al. Effect of ambient temperature on hand, foot and mouth disease incidence in Weifang City: a distributed lag non-linear model analysis[J]. Chin J Public Health, 2019: 1-5. DOI: 10.11847/zgggws1124536.
[6]	中华人民共和国卫生部. 手足口病诊疗指南(2010年版)节选[J]. 中国社区医师, 2010, 26(21): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201021004.htm Ministry of Health of the People's Repblblic of China. Excerpt from the Guidelines for the Diagnosis and Treatment of Hand foot and mouth Disease(2010 edition)[J]. Chin Commun Doctors, 2010, 26(21): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201021004.htm
[7]	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. doi: 10.3760/cma.j.issn.0254-6450.2019.02.005 ZHANG J. Trend of epidemics and variation of pathogens of hand, foot and mouth disease in China: a dynamic series analysis, 2008-2017[J]. Chin J Epidemiol, 2019, 40(2): 147-154. doi: 10.3760/cma.j.issn.0254-6450.2019.02.005
[8]	LIU W, JI H, SHAN J, et al. Spatiotemporal dynamics of hand-foot-mouth disease and its relationship with meteorological factors in Jiangsu Province, China[J]. PLoS One, 2015, 10(6): e0131311. doi: 10.1371/journal.pone.0131311
[9]	陈琦, 邢学森, 吴杨, 等. 湖北省2009—2015年手足口病流行病学和病原学分析[J]. 中华流行病学杂志, 2017, 38(4): 441-445. doi: 10.3760/cma.j.issn.0254-6450.2017.04.006 CHEN Q, XING X S, WU Y, et al. Hand, foot and mouth disease in Hubei province, 2009-2015: an epidemiological and etiological study[J]. Chin J Epidemiol, 2017, 38(4): 441-445. doi: 10.3760/cma.j.issn.0254-6450.2017.04.006
[10]	林春燕, 王明昌, 曾小平, 等. 海口市2008—2015年手足口病流行病学特征分析[J]. 中华流行病学杂志, 2016, 37(12): 1615-1618. doi: 10.3760/cma.j.issn.0254-6450.2016.12.012 LIN C Y, WANG M C, ZENG X P, et al. Epidemiologic features of hand-foot-mouth disease in Haikou city from 2008 to 2015[J]. Chin J Epidemiol, 2016, 37(12): 1615-1618. doi: 10.3760/cma.j.issn.0254-6450.2016.12.012
[11]	BLOMQVIST S, KLEMOLA P, KAIJALAINEN S, et al. Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland[J]. J Clin Virol, 2010, 48(1): 49-54. doi: 10.1016/j.jcv.2010.02.002
[12]	ZHU F, XU W, XIA J, et al. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China[J]. N Engl J Med, 2014, 370(9): 818-828. doi: 10.1056/NEJMoa1304923
[13]	LI R, LIU L, MO Z, et al. An inactivated enterovirus 71 vaccine in healthy children[J]. N Engl J Med, 2014, 370(9): 829-837. doi: 10.1056/NEJMoa1303224
[14]	LI T, WANG H, LU Y, et al. Willingness and influential factors of parents to vaccinate their children with novel inactivated enterovirus 71 vaccines in Guangzhou, China[J]. Vaccine, 2018, 36(26): 3772-3778. doi: 10.1016/j.vaccine.2018.05.054
[15]	QI L, SU K, XIA Y, et al. Enterovirus 71 vaccine acceptance among parents of children < 5 years old and their knowledge of hand, foot and mouth disease, Chongqing, China, 2017[J]. PLoS One, 2019, 14(11): e0225569. doi: 10.1371/journal.pone.0225569
[16]	刘鸽群, 谭徽, 李成华, 等. 2013-2018年郴州市手足口病流行病学特征及EV71疫苗接种效果分析[J]. 中国公共卫生, 2020, 36(3): 385-388. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202003031.htm LIU G Q, TAN H, LI C H, et al. Incidence of hand, foot and mouth disease and effect of EV71 vaccine vaccination in Chenzhou city of Hunan province, 2013-2018[J]. Chin J Public Health, 2020, 36(3): 385-388. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202003031.htm
[17]	杨军, 欧春泉, 丁研, 等. 分布滞后非线性模型[J]. 中国卫生统计, 2012, 29(5): 772-773, 777. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201205054.htm YANG J, OU C Q, DING Y, et al. Distributed Lag Non-linear Model[J]. Chin J Health Statist, 2012, 29(5): 772-773, 777. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201205054.htm
[18]	BERTRAND I, SCHIJVEN J F, SáNCHEZ G, et al. The impact of temperature on the inactivation of enteric viruses in food and water: a review[J]. J Appl Microbiol, 2012, 112(6): 1059-1074. doi: 10.1111/j.1365-2672.2012.05267.x
[19]	DU Z, LIN S, MARKS T, et al. Weather effects on hand, foot, and mouth disease at individual level: a case-crossover study[J]. BMC Infect Dis, 2019, 19(1): 1029. doi: 10.1186/s12879-019-4645-4
[20]	CHEN K T, CHANG H L, WANG S T, et al. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005[J]. Pediatrics, 2007, 120(2): e244-252. doi: 10.1542/peds.2006-3331