EV71疫苗预防重症手足口病的临床观察

Clinical Observation of EV71 Vaccine in Prevention of Severe Case in Children with Hand Foot and Mouth Disease

摘要: 目的：本研究主要是研究分析在手足口病患儿中EV71疫苗接种后对重症手足口病的影响。方法：收集2018年收治的手足口病患儿1434人，其中接种EV71疫苗169人，根据患儿有无并发脑炎分为轻型组及重症组。对患儿进行血EV71IgM、CoxA16IgM检测，咽拭子PCR检测肠道病毒核酸。结果：2018年我们收治的手足口病病人与2016年、2017年相比有所减少，疱疹性咽峡炎发病率有所升高，脑炎发病率下降。在2018年收治的1434病人中接种疫苗169人，占11.8%，未接种疫苗者1265人，占88.2%，脑炎患者221人，占15.4%。在接种疫苗与未接种疫苗患儿中性别、手足口病与疱疹性咽峡炎发病率无明显差异，但接种疫苗患儿的脑炎发病率低于未接种疫苗患儿(P = 0.039)。疫苗接种率在轻型组与重症组之间无差异，而EV71IgM与CoxA16PCR阳性率有明显的差异，脑炎发病中EV71感染为主。在169例接种患儿中，男性占62.1%，发病以手足口病为主，但接种疫苗后仍有10.7%的患儿并发脑炎。结论：本研究显示在我们收治的手足口病患儿中，疫苗接种后疱疹性咽峡炎发病率有所上升，脑炎的发生率下降，提示EV71疫苗接种对手足口病重症的发生有保护作用，但有些患儿接种后未产生保护作用或者保护作用较弱，尚需进一步观察研究。

Abstract: Objective: The purpose of this study was to investigate the effect of EV71 vaccination on severe case in children with HFMD. Methods: We collected a total of 1434 patients with HFMD admitted for treatment in 2018, among them 169 were vaccinated with EV71 vaccine. They were divided into the mild group and the severe group according to the presence or absence of complicated encephalitis. Blood EV71IgM and CoxA16IgM were detected, and enterovirus nucleic acid was detected by PCR with pharyngeal swab. Results: In 2018, the number of patients with HFMD admitted for treatment decreased compared with that of 2016 and 2017, and the incidence of herpangina increased and the incidence of encephalitis decreased. Among the 1434 patients admitted in 2018, 169 (11.8%) were vaccinated, 1265 (88.2%) were unvaccinated, and 221 (15.4%) were diagnosed with encephalitis. There were no significant differences in gender, incidence rate of HFMD and herpangina between vaccinated and unvaccinated children, but the incidence rate of encephalitis in vaccinated patients was lower than that in unvaccinated patients (P = 0.039). There was no difference in vaccination rates between the mild group and the severe group, while the positive rate of EV71IgM and CoxA16PCR was significantly different, and EV71 infection was the main infection in the incidence of encephalitis. Among the 169 patients vaccinated, 62.1% were males, the incidence HFMD was the main disease, but 10.7% of the vaccinated patients still developed encephalitis. Conclusion: This study showed that herpangina incidence has increased after vaccination in patients in our department, and the incidence of encephalitis has decreased. It shows that EV71 vaccine in the occurrence of severe HFMD has a protective effect, but some patients vaccinated did not produce protection or protection was weak, which still needs further study.