Objective:To investigate the characteristics of enterovirus (EV) VP1 gene from cases with hand, foot and mouth disease (HFMD) in Songjiang district of Shanghai in 2019.Methods:Samples from suspected HFMD cases were detected using real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR). Human rhabdomyosarcoma (RD) cells were used for EV culture. VP1 genes of the isolated EV A species were sequenced. The sequences of nucleotide and amino acid of EV A species were used in phylogenetic and homology analysis by MEGA X software.Results:Totally 207 HFMD specimens were detected in 2019, of which 188 specimens were screened positive for EV. The positive rates of Coxsackievirus (CV)-A6, CV-A16, CV-A10 and CV-A4 were 47.34% (89/188), 41.49% (78/188), 3.72% (7/188) and 2.66% (5/188), respectively. Other EV species were 4.79% (9/188) positive and EV-A71 was not detected. During the summer epidemic peak of HFMD (May to July), B1 gene subtype of CV-A16 was detected more frequently, of which B1a and B1b evolutionary branches were prevalent together. The CV-A6 virus of D3a branch dominated in secondary peak of autumn and winter (September to December). CV-A10 and CV-A4 were sporadic and both respective strains belonged to subtypes of C2 gene. Compared with the prototype strains, the nucleotide (amino acid) sequence homologies of CV-A6, CV-A16, CV-A10 and CV-A4 VP1 genes were 79.22%-81.78% (95.97%~-97.19%), 62.70%-65.54% (90.10%-91.30%), 81.76%-82.65% (91.63% -92.03%) and 81.09%-81.79% (97.27%-97.67%), respectively.Conclusions:The diversity and complexity of HFMD pathogen epidemic increase the difficulty of HFMD prevention and control. The expansion of EV surveillance programs and the studies on the molecular epidemiology of EV are helpful for the prevention and control of HFMD.

目的 分析上海市松江区手足口病聚集性疫情流行病学和病原学特征,为做好手足口病防控工作提供科学依据.方法 选取松江区2016年1月1日～2020年12月31日手足口病聚集性疫情资料进行流行病学分析,并采集手足口病聚集性疫情中病例标本,进行病原学检测,分析病原学特征.结果 上海市松江区2016年～2020年共报告手足口病聚集性疫情678起,呈逐年下降趋势,占同期总报告病例的16.05％;除2020年外,其余4年疫情报告高峰为5月～7月和10月～12月;手足口聚集性疫情主要发生在托幼机构(69.17％),其次在家庭(18.44％)和学校(12.39％);托幼儿童是高发人群;方松、九亭和泗泾属于聚集性疫情高发地区;病原呈多种肠道病毒基因型并存,且CV-A6和CV-A16交替作为优势毒株;首发病例发病-疫情报告时间间隔与疫情持续时间、发病人数呈正相关(r=0.514、0.153,P<0.05).结论 托幼机构是松江区手足口病聚集性疫情主要场所,卫生相关部门应在高峰期来临前强化私立幼儿园督导,针对重点区域和托幼儿童做好手足口病监控,及时发现、报告与正确处置是防控手足口病聚集性疫情的关键.

目的 调查松江区家长手足口病认知及获取媒介,为相关部门进一步开展手足口病预防及健康教育提供科学参考基础.方法 采用方便抽样的方法,自行设计问卷,于2020年9月10日-20日对居住在松江区的儿童家长通过网络平台开展问卷调查,调查家长对手足口病临床表现、传播途径、预防控制措施等知识的认知情况,分析家长手足口病认知的影响因素.结果 回收问卷6422份,有效问卷6408份,有效率为99.78％;调查家长以女性为主(75.51％),年龄主要在30～39岁,家庭身份为儿童主要照料人居多,受教育程度以大专及以上居多,居住在城镇比例高;12.44％调查对象家中有儿童曾患手足口病;松江区家长对手足口病防控知识知晓率在83.10％～97.58％;单因素分析显示,获取知识媒介受年龄、文化水平、居住区域及儿童手足口病既往史的影响;多因素回归分析显示,文化程度高、居住在农村且孩子有手足口病既往史的家长通过知识讲座获取知识的可能性大;低年龄、文化程度高且孩子有手足口病既往史的家长通过新媒体获取知识的可能性大;文化程度低、居住于农村且孩子有手足口病既往史的家长通过传统媒体获取知识的可能性大;高年龄且低文化水平的家长通过其他途径获取知识的可能性大.结论 松江区家长对手足口病预防与控制措施认知度较高,但仍存在防控误区,家长获取手足口病知识的媒介受到年龄、文化水平、居住区域及儿童手足口病既往史的影响.