CAJ | 학술논문

目的调查广州市1例柯萨奇A6型(CA6)手足口病合并脊髓灰质炎病毒(PV)Ⅱ型疫苗衍生株(VD PVⅡ)感染病例,明确其感染病原及特征.方法通过现场调查获取病例相关流行病学资料,收集病例标本及其密切接触者粪便标本共16份进行肠道病毒(EV)分离鉴定.对病例就诊医院当月收集手足口病病例标本共21份,采用实时荧光RT-PCR检测手足口病相关病原,并用RT-PCR方法检测PV,CA6及PV阳性标本用RT-PCR方法扩增其VP1区基因片段进一步测序分析.结果该病例临床仅表现为手足口病症状,无急性弛缓性麻痹(AFP).16份病例及其密切接触者粪便标本均未检出EV,入户主动搜索调查未发现类似病例.在该病例当月就诊医院收集的手足口病病例标本中,EV71阳性4例,CA16阳性2例,包括该病例在内的其余15例均为CA6阳性,但仅该病例同时检出VDPVⅡ.对包括该病例在内的9例CA6阳性标本的VPI区扩增测序并进行同源性分析,9株病毒核苷酸同源性为98.9％～100.0％,推导的氨基酸同源性为96.0％～100.0％.遗传进化分析显示该9株属于同一分支.对该病例VDPV株VP1区扩增测序分析,与SabinⅡ相比,有包括U2909A在内的6个位点发生突变,其中2个位点发生氨基酸突变.遗传进化分析显示,该病例VDPV分离株不同于以往发现的VDPV.结论该病例为CA6手足口病合并VDPVⅡ感染,其手足口病症状由CA6感染引起,推测该病例无AFP症状可能是接种脊髓灰质炎疫苗所致.分离的VDPV为当地新发现毒株,但未造成VDPV循环.
목적 조사엄주시1례가살기A6형(CA6)수족구병합병척수회질염병독(PV)Ⅱ형역묘연생주(VD PVⅡ)감염병례,명학기감염병원급특정.방법 통과현장조사획취병례상관류행병학자료,수집병례표본급기밀절접촉자분편표본공16빈진행장도병독(EV)분리감정.대병례취진의원당월수집수족구병병례표본공21빈,채용실시형광RT-PCR검측수족구병상관병원,병용RT-PCR방법검측PV,CA6급PV양성표본용RT-PCR방법확증기VP1구기인편단진일보측서분석.결과 해병례림상부표현위수족구병증상,무급성이완성마비(AFP).16빈병례급기밀절접촉자분편표본균미검출EV,입호주동수색조사미발현유사병례.재해병례당월취진의원수집적수족구병병례표본중,EV71양성4례,CA16양성2례,포괄해병례재내적기여15례균위CA6양성,단부해병례동시검출VDPVⅡ.대포괄해병례재내적9례CA6양성표본적VPI구확증측서병진행동원성분석,9주병독핵감산동원성위98.9％～100.0％,추도적안기산동원성위96.0％～100.0％.유전진화분석현시해9주속우동일분지.대해병례VDPV주VP1구확증측서분석,여SabinⅡ상비,유포괄U2909A재내적6개위점발생돌변,기중2개위점발생안기산돌변.유전진화분석현시,해병례VDPV분리주불동우이왕발현적VDPV.결론 해병례위CA6수족구병합병VDPVⅡ감염,기수족구병증상유CA6감염인기,추측해병례무AFP증상가능시접충척수회질염역묘소치.분리적VDPV위당지신발현독주,단미조성VDPV순배.
Objective To identify the pathogen and characteristics on a case of hand-footmouth disease (HFMD) caused by coxsackie-virus A6 (CA6) associated with vaccine-derived poliovirus (VDPV) co-infection.Methods Field epidemiological study at the epidemic area was conducted and 16 stool samples including from the patient and close contacts were collected for isolation and identification of the enterovirus (EV).21 stool samples from patients diagnosed as HFMD were collected in the same hospital at the same month to detect CA 16,EV71,CA6 and PV by real-time RT-PCR or RT-PCR.The VP1 gene of the CA6 was amplified by RT-PCR and PCR products were sequenced and analyzed.Results The patient showed only HFMD symptoms,but no symptoms related to acute flaccid paralysis (AFP).No EVs were isolated from 16 samples collected from the patient and close contacts.And no AFP cases were found by an active search.A total of 21samples from patients diagnosed as HFMD were collected in the same hospital at the same month and 4 were found to be EV71,2 were CA16 and 15 (include the patient) were CA6.Only this patient was found to have had VDPV Ⅱ infection.The CA6 VP1 gene was amplified from the HFMD patient and 9 other cases from the same hospital at the same month.Nucleotide sequences of the VP 1 gene among the 9 strains shared 98.9％-100.0％ in homology and 96.0％-100.0％ in the deduced amino acid sequences.Phylogenetic analysis of the VP1 sequences categorized the 9 strains into the same branch.There were 6 nucleotides changes including U2909A between the VP1 region of the VDPV strain of the case and Sabin Ⅱ.Results from phylogenetic analysis on the VP1 sequences indicated that the VDPV strain of the case was different from other VDPVs strains isolated in the world.Conclusion This case was a HFMD which caused by CA6 co-infection with VDPV Ⅱ and the VDPV was newly discovered.HFMD symptoms of the case were caused by CA6.The reason why this case did not have AFP symptoms was probably due the protective effect of IPV vaccine.No AFP cases were found by the active search for AFP cases conducted in the area,which indicated that VDPV did not cause virus circulation in this area.