摘要
目的分析杭州市2016-2018年猩红热流行病学特征及其影响因素,为制定猩红热有效防控措施提供数据支撑。方法应用描述性流行病学方法对从中国疾病预防控制信息系统中获取的杭州市2016-2018年猩红热病例资料进行流行病学特征分析。开展病例对照研究,选取2016年1月1日~2018年12月31日期间,在杭州市儿童医院就诊的猩红热病例作为病例组,选取杭州市托幼机构健康儿童作为对照组。采集病例和对照组咽拭子样本,培养分离GAS,应用PCR检测GAS的emm基因并进行分型;应用非条件logistic回归分析方法探索猩红热发病的影响因素。结果2016-2018年杭州市共报告猩红热病例1866例,年平均发病率为6.74/10万;4~6月和11月到次年1月呈两个发病高峰;年报告发病率居前五位的分别为桐庐县、江干区、下城区、余杭区和大江东产业集聚区。病例以幼托儿童、学生和散居儿童为主。共采集咽拭子样本226份,分离出11株GAS,PCR检测其中7株GAS的emm基因型,鉴定出三种基因型,分别为emm1型、emm12型和emm22型,分别占57.14%(4/7)、28.57%(2/7)、和14.29%(1/7)。单因素非条件logistic分析显示,年龄、发病前5 d与发热患者接触暴露史、个人卫生习惯等三因素为猩红热发病影响因素,差异有统计学意义(P<0.01);进一步多因素非条件logistic分析显示,发病前5 d与发热患者接触暴露史是猩红热发病的危险因素(OR=17.47,95%CI为4.27~71.51,P=0.018);年龄为猩红热发病的保护因素(OR=0.45,95%CI为0.23~0.87,P<0.01)。结论杭州市猩红热发病重点人群为幼托儿童和学生,呈周期性和季节性发病。emm1和emm12为杭州市GAS的主要流行株。发病前5d与发热患者接触暴露史为猩红热发病危险因素,年龄为猩红热的猩红热发病的保护因素。应加强托幼机构和学校疾病监测与防控,以有效预防疾病流行。
Objective To understand the epidemiological characteristics and influencing factors of scarlet fever in Hangzhou from 2016 to 2018,and to provide data support for the effective prevention and control of scarlet fever.Methods The epidemiological characteristics of scarlet fever in Hangzhou city were analyzed using descriptive epidemiological methods on clinical data of cases abtained from China′s disease prevention and control information system between 2016 and 2018.A case-control study was performed,Patients with scarlet fever treated in Hangzhou Children′s Hospital from January 1,2016 to December 31,2018 were enrolled in case group,while healthy children in kindergartens in Hangzhou were recruited in the control group.Samples of pharyngeal swabs were collected in both groups to isolate GAS.The emm gene of GAS was amplified by PCR and sequenced for genotyping.The influencing factors of scarlet fever were explored by using the non-conditional Logitic regression analysis.Results A total of 1866 cases of scarlet fever were reported in Hangzhou from 2016 to 2018 with the average annual incidence rate of 6.74/100000.The two seasonal peak activities were in April-June and November-January.The top five areas with the highest annual incidence rates were Tonglu county,Jianggan district,Xiacheng district,Yuhang district and dajiangdong industrial district.Majority of cases were young children,students and scattered children.A total of 226 pharyngeal swab samples were collected,11 GAS were isolated,and the emm genotypes of 7 of them were determined by PCR.A total of 3 genotypes were identified as emm1,emm12 and emm22,accounting for 57.14%(4/7),28.57%(2/7)and 14.29%(1/7),respectively.The single factor non-conditional logitic analysis showed that age,exposure to fever patients five days before disease onset,and personal hygiene habit were influencing facters of scarlet fever,and multivariate non-conditional logitic analysis showed that exposure to fever patients five days before disease onset was a risk factor for scarlet fever(OR=17.47,95%CI:4.27-71.51,P=0.018),while age was a protective factor(OR=0.45,95%CI:0.23-0.87,P<0.01).Conclusions Children in kindergartens and students are more vulnerable to scarlet fever in Hangzhou,which has obvious periodic and seasonal features.emm1 and emm12 are the predominant genotypes of GAS in Hangzhou.Exposure to fever cases five days before disease onset is a risk factor for scarlet fever,while age is a protective factor.Disease surveillance and control in kindergartens and schools should be strengthened to effectively prevent the spread of the disease.
作者
温圆圆
孙昼
陈珺芳
王兵
考庆君
朱一
黄银燕
刘伟
吴亦斐
程庆林
谢立
WEN Yuan-yuan;SUN Zhou;CHEN Jun-fang;WANG Bing;KAO Qing-jun;ZHU Yi;HUANG Yin-yan;LIU Wei;WU Yi-fei;CHENG Qing-lin;XIE Li(Hangzhou Center for Disease Control and Prevention,Hangzhou,Zhejiang 310021,China)
出处
《中国预防医学杂志》
CAS
CSCD
2020年第7期754-759,共6页
Chinese Preventive Medicine
基金
浙江省医药卫生科技计划基金资助项目(2016KYB242)
杭州市科技计划引导项目(20163501Y37)
关键词
猩红热
病例对照研究
流行病学特征
影响因素
Scarlet fever
Case-control study
Epidemiological characteristics
Influencing factors
