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目的调查一起杭州市某幼儿园脱甲症暴发疫情的原因,分析脱甲症与手足口病/肠道病毒感染的关系。方法调查脱甲症流行病学特征和临床表现,开展室内环境空气质量、肠道寄生虫和微量元素检测,采用荧光PCR检测柯萨奇病毒A组6型(Cox A6)核酸,采用ELISA法检测Cox A Ig G抗体。选取该起脱甲症暴发疫情的病例和实验室确诊感染Cox A6的手足口病散发病例,进行病例对照研究。结果 33例病例中,男童21例,女童12例,平均年龄为(3.00±0.72)岁,发病时间主要集中在10月底至12月中旬。主要临床表现为指甲白斑、空洞、断裂及脱落等,平均受损指/趾(5.1±3.05)个。脱甲症发生时间距离手足口病发病期平均间隔(45±15)d。该幼儿园室内空气甲醛、苯、甲苯和二甲苯检测均在正常范围内;肠道寄生虫检测均为阴性;微量元素检测均在正常值范围内。病例Cox A Ig G抗体阳性率为63.64%;幼儿园脱甲症暴发疫情病例组和对照组发热、咳嗽、流涕、皮疹和脱屑等症状发生率差异有统计学意义(P<0.05)。Cox A6感染散发手足口病患儿的脱甲症罹患率为31.43%(11/35);脱甲表现与幼儿园暴发疫情类似,并有36.36%患儿伴皮疹和脱屑。患儿基础指标、生活习惯指标以及家庭影响指标等因素均非产生脱甲的危险因素(P>0.05)。结论杭州市某幼儿园脱甲症疫情可能是Cox A6病毒感染手足口病愈后发生的。脱甲症可能为肠道病毒感染引起的继发症状。
Objective To investigate the causes of an outbreak of demethylation in a nursery in Hangzhou and to analyze the relationship between demethylation and hand, foot and mouth disease / enterovirus infection. Methods The epidemiological characteristics and clinical manifestations of demethylation were investigated. Indoor ambient air quality, intestinal parasites and trace elements were detected. Coxsackie A6 type 6 (Cox A6) nucleic acid was detected by fluorescence PCR and detected by ELISA Cox A Ig G antibody. Select the cases of outbreaks of dementia and laboratory confirmed Cox A6 cases of hand, foot and mouth disease sporadic cases, case-control study. Results Among the 33 cases, 21 were boys and 12 were girls. The mean age was (3.00 ± 0.72) years old. The onset time was mainly concentrated in the end of October to mid December. The main clinical manifestations of nails, voids, rupture and fall off, the average damaged finger / toe (5.1 ± 3.05) months. The incidence of demethylation occurred at an average interval of 45 ± 15 days from the onset of HFMD. The kindergarten indoor air formaldehyde, benzene, toluene and xylene were detected within the normal range; intestinal parasites were negative; trace elements were detected in the normal range. The positive rate of Cox A Ig G antibody was 63.64%. The incidence of fever, cough, runny nose, rash and desquamation in case and control group were statistically significant (P <0.05). The prevalence of demethylation in Cox A6 infected children with HFMD was 31.43% (11/35). The performance of detoxification was similar to that of kindergarten outbreaks, with 36.36% of children with rash and scaling. The basic indicators of children, lifestyle indicators and family impact indicators and other factors are not risk factors for dementia (P> 0.05). Conclusion The incidence of demethylation in a nursery in Hangzhou may be the result of Cox A6 virus infected foot and mouth disease. Demethylation may be a secondary symptom of enterovirus infection.