Etiology characteristics and their time series prediction of hand, foot and mouth disease in Dali
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摘要:
目的 了解大理白族自治州(简称大理州)手足口病(hand, foot and mouth disease, HFMD)的病原学特征，并利用季节性自回归移动平均(seasonal autoregressive integrated moving average, SARIMA)模型探索病原体的感染趋势，为该地区HFMD的病原监测和防控提供依据。 方法 收集大理州2013—2021年HFMD的病原学监测结果，采用描述性方法和SARIMA模型分析HFMD的病原学特征和预测病原感染趋势。 结果 2013—2021年大理州共检出HFMD阳性病原2 793份(60.27%)，其中柯萨奇病毒A16型(coxsackievirus A16, CA16)1 157份(41.42%)、肠道病毒71型(enterovirus 71, EV71)669份(23.95%)、其他肠道病毒(enterovirus, EV)967份(34.62%)；男女阳性比1.44∶1；1~3岁阳性占比最高(71.07%)；秋季阳性率最高(66.87%)，且CA16构成比最高(52.89%)；2013-2014年及2017年EV71为优势流行株，2015-2016年及2019年CA16为优势流行株，2018年和2021年其他EV为优势流行株；不同县市区的阳性率差异有统计学意义($\chi$2=220.63, P < 0.001)，以洱源县最高(75.92%)，南涧县最低(40.87%)。HFMD病原的流行存在季节性，利用SARIMA (1, 1, 0) (0, 1, 1)12能预测各病原体的感染趋势。 结论 大理州HFMD的病原多种共存，以CA16和其他EV为优势病株；重点人群为学龄前儿童；好发于夏秋季；洱源县、宾川县和鹤庆县为高发地区。SARIMA(1, 1, 0)(0, 1, 1)12模型能较为准确地预测HFMD病原体的变化趋势。 -
关键词:
- 手足口病 /
- 病原学特征 /
- 季节性自回归移动平均模型 /
- 感染趋势
Abstract:Objective To understand the etiological characteristics of hand, foot and mouth disease (HFMD) in Dali, to use the seasonal autoregressive integrated moving average (SARIMA) models to explore the infection trend of pathogens and to provide a basis for the pathogen monitoring and prevention and control of HFMD in this region. Methods The etiological test results of HFMD in Dali from 2013 to 2021 were collected, which descriptive methods were used to predict the etiological characteristics of HFMD and SARIMA models. Results A total of 2 793 positive pathogens (60.27%) were detected in Dali, including 1 157 coxsackievirus A16(CA16) (41.42%), 669 enterovirus 71 (EV71) (23.95%), and 967 other enteroviruses (EV) (34.62%) between 2013 and 2021. Male-to-female positive ratio was 1.44∶1. The highest ratio was 1-3 years old (71.07%). Autumn had the highest positive rate (66.87%). CA16 composition ratio was the highest (52.89%). EV71 were the dominant epidemic strains in 2013-2014 and 2017, CA16 were the dominant epidemic strains in 2015-2016 and 2019, and other EV strains were the dominant epidemic strains in 2018 and 2021. The positive rates of different counties were significantly ($\chi$2=220.63, P < 0.001), which the highest rate was in Eryuan county (75.92%) and the lowest rate was in Nanjian county (40.87%). The prevalence of HFMD pathogens is obviously seasonal, which using SARIMA (1, 1, 0) (0, 1, 1)12 can well predict the infection trend of each pathogen. Conclusions The pathogens of HFMD coexist in Dali, with CA16 and other EV as the dominant strains, the key population is preschool children, originated in summer and autumn, Eryuan, Binchuan and Heqing Counties are at high incidence. The SARIMA(1, 1, 0)(0, 1, 1)12 model can more accurately predict the changing trend of HFMD pathogens. -
表 1 大理州HFMD病原检测结果[n(%)]
Table 1. Detection results of HFMD pathogens in Dali [n(%)]
年份(年) 样本数 阳性数 CA16 EV71 其他EV 2013 758 145(19.13) 37(25.52) 91(67.76) 17(11.72) 2014 446 275(61.66) 58(21.09) 180(65.45) 37(13.45) 2015 541 352(65.06) 162(46.02) 30(8.52) 160(45.45) 2016 547 381(69.65) 219(57.48) 106(27.82) 56(14.70) 2017 581 381(65.58) 106(27.82) 155(40.68) 120(31.50) 2018 654 422(64.53) 90(21.33) 72(17.06) 260(61.61) 2019 741 544(73.41) 420(77.21) 2(0.37) 122(22.43) 2021 366 293(80.05) 65(22.18) 33(11.26) 195(66.55) 合计 4 634 2 793(60.27) 1 157(41.42) 669(23.95) 967(34.62) $\chi$2值 686.54 536.56 690.62 478.26 P值 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 大理州HFMD病原体的季节分布[n(%)]
Table 2. Seasonal distribution of HFMD pathogens in Dali [n(%)]
季节 例数 阳性数 CA16 EV71 其他EV 春季(3-5月) 1 567 860(54.88) 319(37.09) 284(33.02) 257(29.88) >夏季(6-8月) 1 776 1 109(62.44) 488(44.00) 235(21.19) 386(34.81) >秋季(9-11月) 803 537(66.87) 284(52.89) 88(16.39) 165(30.73) >冬季(12-次年2月) 488 287(58.81) 66(23.00) 62(21.60) 159(55.40) >合计 4 634 2 793(60.27) 1 157(41.42) 669(23.95) 967(34.62) >$\chi$2值 13.59 38.67 11.33 82.49 >P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 大理州各县市区HFMD病原体分布[n(%)]
Table 3. Seasonal distribution of HFMD pathogens in Dali [n(%)]
县市区 例数 阳性数 CA16 EV71 其他EV 宾川县 484 361(74.59) 130(36.01) 91(25.21) 140(38.78) 大理市 257 131(50.97) 36(27.48) 55(41.98) 40(30.53) 洱源县 353 268(75.92) 91(33.96) 103(38.43) 74(27.61) 鹤庆县 493 355(72.01) 142(40.00) 95(26.76) 118(33.24) 剑川县 291 180(61.86) 65(36.11) 45(25.00) 70(38.89) 弥渡县 551 307(55.72) 176(57.33) 31(10.10) 100(32.57) 南涧县 482 197(40.87) 71(36.04) 86(43.65) 40(20.30) 巍山县 266 165(62.03) 66(40.00) 45(27.27) 54(32.73) 祥云县 623 366(58.75) 187(51.09) 51(13.93) 128(34.97) 漾濞县 218 136(62.39) 62(45.59) 31(22.79) 43(31.61) 永平县 380 183(48.16) 71(38.80) 22(12.02) 90(49.18) 云龙县 234 142(60.68) 58(40.85) 14(9.86) 70(49.3) 合计 4 632 2 791(60.25) 1 155(41.38) 669(23.97) 967(34.65) $\chi$2值 220.63 73.54 181.46 61.15 P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 4 模型检验统计
Table 4. Model test statistics
模型 拟合度统计平稳R2 Ljung-Box Q (18) 离群值数 统计 P值 模型1(其他EV) 0.711 20.198 0.140 3 模型2(CA16) 0.565 19.562 0.428 2 模型3(EV71) 0.762 24.007 0.608 3
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