两起发热伴血小板减少综合征聚集性疫情流行病学及病原学分析

doi:10.16288/j.yczz.23-176

遗传 ›› 2023, Vol. 45 ›› Issue (11): 1062-1073.doi: 10.16288/j.yczz.23-176

两起发热伴血小板减少综合征聚集性疫情流行病学及病原学分析

杨鑫¹(), 武永祥¹, 冷昱¹, 李佳宸², 王超杰¹, 袁义美³, 王震³, 张兰³, 黎浩¹(), 刘玮¹()

1.军事医学研究院微生物流行病研究所，病原微生物生物安全全国重点实验室，媒介生物危害和自然疫源性疾病北京市重点实验室，北京 100071
2.北部战区疾病预防控制中心，沈阳 110034
3.信阳一五四医院，信阳 464000

收稿日期:2023-06-29 修回日期:2023-09-15 出版日期:2023-11-20 发布日期:2023-09-29
通讯作者: 黎浩,刘玮 E-mail:499163792@qq.com;lwbime@163.com;lihao_1986@126.com
作者简介:杨鑫，硕士，医师，研究方向：公共卫生。E-mail: 499163792@qq.com。
基金资助:
国家自然科学基金面上项目(82172270)

Epidemiololgical and etiological analysis of two clusters of severe fever with thrombocytopenia syndrome

Xin Yang¹(), Yongxiang Wu¹, Yu Leng¹, Jiachen Li², Chaojie Wang¹, Yimei Yuan³, Zhen Wang³, Lan Zhang³, Hao Li¹(), Wei Liu¹()

1. Institute of Microbiology and Epidemiology,Academy of Military Medical Sciences; state Key Laboratory of Pathogen and Biosecurity; Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing 100071, China
2. Center for Disease Control and Prevention in Northern Theater Command，Shenyang 110034, China
3. Xinyang 154th Hospital, Xinyang 464000, China

Received:2023-06-29 Revised:2023-09-15 Published:2023-11-20 Online:2023-09-29
Contact: Hao Li,Wei Liu E-mail:499163792@qq.com;lwbime@163.com;lihao_1986@126.com
Supported by:
National Natural Science Foundation of China(82172270)

摘要/Abstract

摘要：

发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome, SFTS)是一种新发传染病，主要通过蜱虫叮咬传播，其病原体为发热伴血小板减少综合征病毒(severe fever with thrombocytopenia syndrome virus, SFTSV)。人际传播引发的SFTS聚集性疫情在国内外均有报道，人们重点关注了人际传播的感染途径，然而SFTS聚集性疫情和病毒基因型之间的相关性研究却未见报道。本文主要报道了2022~2023年河南省信阳市发生的两起SFTS聚集性疫情，探讨了SFTSV出现人际传播感染的可能途径，并对SFTS聚集性疫情与病毒基因型进行了关联分析。通过4例确诊患者的病毒序列分析，发现两起聚集性疫情中的2组SFTSV分别聚集在隶属于不同基因型的两个分支。将本研究病毒序列与GenBank中获得的SFTS聚集性疫情报道过的病毒序列进行系统发育分析，进一步发现人际传播病例报道的SFTSV涉及3种基因型，提示SFTS聚集性疫情的发生可能和病毒基因型无明显关联。本研究表明血液接触感染可能是SFTS聚集性疫情发生的主要传播途径，为揭示SFTS聚集性疫情的人际传播链提供了遗传学证据，为SFTS的人际传播防控提供了科学数据支撑。

关键词: 发热伴血小板减少综合征, 蜱传疾病, 人际传播

Abstract:

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease, caused by severe fever with thrombocytopenia syndrome virus (SFTSV), which is primarily transmitted via tick bites. Clusters of SFTS caused by human-to-human transmission have been reported both at home and abroad, mainly focused on the transmission or exposure modes. However, the correlation between SFTS clusters and viral genotypes has not been investigated. This study mainly reported two clusters of SFTS in Xinyang City, Henan Province, from 2022 to 2023, discussed the possible route of person-to-person transmission of SFTSV infection and analyzed the association between SFTS clusters and virus genotypes. We found that two groups of SFTSV in two clusters were clustered separately into different genotypes through viral sequence analysis of 4 confirmed patients. We also performed phylogenetic analysis, after including SFTSV sequences obtained from SFTS clusters deposited in the GenBank. Three SFTSV genotypes have been reported among cases of human-to-human transmission, suggesting that the occurrence of SFTS clusters may not be related to SFTSV genotypes. This study provided genetic evidence for revealing the chain of human-to-human transmission of SFTS clusters, indicating that contact with patients’ blood is an important transmission route of SFTSV. The findings laid the foundation for preventing and controlling human-to-human transmission of SFTS.

Key words: severe fever with thrombocytopenia syndrome, tick-borne diseases, human-to-human transmission

杨鑫, 武永祥, 冷昱, 李佳宸, 王超杰, 袁义美, 王震, 张兰, 黎浩, 刘玮. 两起发热伴血小板减少综合征聚集性疫情流行病学及病原学分析[J]. 遗传, 2023, 45(11): 1062-1073.

Xin Yang, Yongxiang Wu, Yu Leng, Jiachen Li, Chaojie Wang, Yimei Yuan, Zhen Wang, Lan Zhang, Hao Li, Wei Liu. Epidemiololgical and etiological analysis of two clusters of severe fever with thrombocytopenia syndrome[J]. Hereditas(Beijing), 2023, 45(11): 1062-1073.

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人员信息	聚集性疫情1				聚集性疫情2
人员信息	原发病例1	继发病例1	密接1	密接2	原发病例2	继发病例2	密接1	密接2	密接3	密接4
姓名	张某	高某田	高某超	沈某慧	彭某芳	易某山	李某秀	易某霞	李某英	易某军
人物关系	N/A	儿子	丈夫	儿媳	N/A	儿子1	弟媳	女儿	儿媳	儿子2
性别	女	男	男	女	女	男	女	女	女	男
年龄	68	43	67	46	75	50	70	53	51	57
入院日期	2022/5/12	2022/5/27	N/A	N/A	2023/5/27	2023/6/7	N/A	N/A	N/A	N/A
发病日期	2022/5/8	2022/5/23	N/A	N/A	2023/5/20	2023/6/3	N/A	N/A	N/A	N/A
结局	死亡	幸存	无症状	无症状	死亡	幸存	无症状	无症状	无症状	无症状
出/转院日期	2022/5/16	2022/6/6	N/A	N/A	2023/5/27	2023/6/12	N/A	N/A	N/A	N/A
发病间隔(天)	7	5	N/A	N/A	N/A	7	N/A	N/A	N/A	N/A
入院延迟(天)	4	4	N/A	N/A	7	4	N/A	N/A	N/A	N/A
死亡延迟(天)	10	N/A	N/A	N/A	8	N/A	N/A	N/A	N/A	N/A
入院病毒CT值	29.08	33.42	N/A	N/A	12.5	27.84	N/A	N/A	N/A	N/A
最低病毒CT值	17.89	30.5	N/A	N/A	12.5	22.36	N/A	N/A	N/A	N/A
感染方式	蜱虫叮咬	血液接触	N/A	N/A	野外活动	血液接触	N/A	N/A	N/A	N/A
血常规
WBC(×10⁹/L)	1.8↓	1.9↓	N/A	N/A	5.4	1.9↓	N/A	N/A	N/A	N/A
PLT(×10⁹/L)	16↓	59↓	N/A	N/A	31↓	94↓	N/A	N/A	N/A	N/A
血生化
ALT(U/L)	128↑	91↑	N/A	N/A	250↑	44↑	N/A	N/A	N/A	N/A
AST(U/L)	461↑	111↑	N/A	N/A	1183↑	43↑	N/A	N/A	N/A	N/A
LDH(U/L)	1024↑	325↑	N/A	N/A	3597↑	234	N/A	N/A	N/A	N/A
CK(U/L)	301↑	435↑	N/A	N/A	2668↑	495↑	N/A	N/A	N/A	N/A

聚集性事件编号	PMID	流行地区	暴露方式	SFTSV基因序列accession
聚集性事件编号	PMID	流行地区	暴露方式	L	M	S
1	28722592	山东	血液体液黏膜	KR706567	KR706566	KR706565
2	32410583	辽宁	血液	MT309099	MT309102	MT309105
				MT309100	MT309103	MT309106
				MT309101	MT309104	MT309107
3	23225899	河南	血液	HQ642766	HQ642767	HQ642768
3	23225899	河南	血液	JF682776	JF682777	JF682778
4	22028437	江苏	血液	JF837593	JF837594	JF837595
5	35987469	河南	血液	ON402247	ON402253	ON402259
				ON402248	ON402254	ON402260
				ON402249	ON402255	ON402261
				ON402250	ON402256	ON402262
				ON402251	ON402257	ON402263
				ON402252	ON402258	ON402264
6	N/A	河南	血液	22-169-L_Henan^*	22-169-M_Henan^*	22-169-S_Henan^*
				22-234-L_Henan^*	22-234-M_Henan^*	22-234-S_Henan^*
				23-368-L_Henan^*	23-368-M_Henan^*	23-368-S_Henan^*
				23-466-L_Henan^*	23-466-M_Henan^*	23-466-S_Henan^*

两起发热伴血小板减少综合征聚集性疫情流行病学及病原学分析

Epidemiololgical and etiological analysis of two clusters of severe fever with thrombocytopenia syndrome

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