2018-2020年上海市5岁以下住院儿童病毒性腹泻病原学特征分析

匡小舟 肖文佳 刘捷宸 张曦 滕峥 潘浩

匡小舟, 肖文佳, 刘捷宸, 张曦, 滕峥, 潘浩. 2018-2020年上海市5岁以下住院儿童病毒性腹泻病原学特征分析[J]. 疾病监测, 2021, 36(10): 1069-1074. doi: 10.3784/jbjc.202106020317
引用本文: 匡小舟, 肖文佳, 刘捷宸, 张曦, 滕峥, 潘浩. 2018-2020年上海市5岁以下住院儿童病毒性腹泻病原学特征分析[J]. 疾病监测, 2021, 36(10): 1069-1074. doi: 10.3784/jbjc.202106020317
Kuang Xiaozhou, Xiao Wenjia, Liu Jiechen, Zhang Xi, Teng Zheng, Pan Hao. Etiological characteristics of viral gastroenteritis in pediatric inpatients under five years old in Shanghai, 2018–2020[J]. Disease Surveillance, 2021, 36(10): 1069-1074. doi: 10.3784/jbjc.202106020317
Citation: Kuang Xiaozhou, Xiao Wenjia, Liu Jiechen, Zhang Xi, Teng Zheng, Pan Hao. Etiological characteristics of viral gastroenteritis in pediatric inpatients under five years old in Shanghai, 2018–2020[J]. Disease Surveillance, 2021, 36(10): 1069-1074. doi: 10.3784/jbjc.202106020317

2018-2020年上海市5岁以下住院儿童病毒性腹泻病原学特征分析

doi: 10.3784/jbjc.202106020317
基金项目: 上海市公共卫生体系建设三年行动计划 (2020–2022)(No. GWV-10.1-XK03,No. GWV-2)
详细信息
    作者简介:

    匡小舟,女,上海市人,副主任技师,主要从事腹泻病毒检测和研究工作,Email:kuangxiaozhou@scdc.sh.cn

    肖文佳,男,上海市人,副主任医师,主要从事腹泻病监测及相关流行病调查工作,Email:xiaowenjia@scdc.sh.cn

    通讯作者:

    滕峥,Tel:021–62758710,Email:tengzheng@scdc.sh.cn

    潘浩,Tel:021–627758710,Email:panhao@scdc.sh.cn

  • 中图分类号: R211;R512.5

Etiological characteristics of viral gastroenteritis in pediatric inpatients under five years old in Shanghai, 2018–2020

Funds: This study was supported by Three-Year Action Plan of Shanghai Public Health System Construction (2020–2022) (No. GWV-10.1-XK03, No. GWV-2)
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  • 摘要:   目的  对2018 — 2020年上海市5岁以下感染性肠胃炎住院患儿进行主要病毒病原学检测,了解目标人群中病毒的分子流行病学迁移变化特征,为病毒性腹泻的防控和疫苗研发及应用提供数据支撑。   方法  采集上海市某儿科医院5岁以下腹泻住院患儿的粪便标本,并收集相关流行病学资料。 采用ELISA、荧光PCR以及巢式PCR方法对轮状病毒、杯状病毒(包括诺如病毒和札如病毒)、星状病毒和肠道腺病毒进行检测和分子分型。   结果  共采集粪便标本805份(男性543份,女性262份),病毒检出率为47.33%,检出率最高的病毒为杯状病毒(31.18%),其次为A组轮状病毒(17.64%);杯状病毒中诺如病毒GⅡ型的占比最高(95.62%)。 轮状病毒以G9P[8]为主要流行型别(占比90.85%)。 诺如病毒GⅡ型以GⅡ.4[P31]和GⅡ.3[P12]为主要流行株(占比分别为32.08% 和19.58%);但2020年以来,新兴亚型GⅡ.4[P16]和GⅡ.2[P16]检出率明显高于2018和2019年(χ2=17.337,P0.001; χ2=11.044,P=0.001)。 此外本地首次从1名4月龄患儿粪便中发现1株乐儿德轮状病毒疫苗株。   结论  杯状病毒检出率高于轮状病毒的趋势加剧,使杯状病毒(主要是诺如病毒)疫苗的研发和上市需求愈发迫切。研究首次揭示了住院儿童中诺如病毒GⅡ型的主要流行和新兴亚型,为多效价的诺如疫苗研发提供了参考依据。轮状病毒G9型别近年检出率升高,需要对轮状病毒型别变化保持警戒、追踪和深究。
  • 图  1  2018-2020年上海市5岁以下住院儿童腹泻病原体检出率和气温关系

    Figure  1.  Seasonal change of virus detection rate in pediatric inpatients aged <5 yearrs in Shanghai, 2018–2020

    图  2  不同年龄组儿童诺如病毒G型亚型分布

    Figure  2.  Distribution of genotypes of norovirus GⅡ in children in different age groups

    表  1  2018-2020年上海市5岁以下住院儿童腹泻病毒检出情况

    Table  1.   Detection rate of different gastroenteric viruses in pediatric inpatients aged <5 yearrs in Shanghai, 2018–2020

     病毒种类2018年(n=237)2019年(n=294)2020年(n=274)总计(n=805)χ2P
    杯状病毒93(39.24)107(36.39)51(18.61)251(31.18)31.067<0.001
    A组轮状病毒32(13.50)59(21.07)51(18.61)142(17.64)4.1650.125
    星状病毒18(7.59)33(11.22)6(2.19)57(7.08)17.730<0.001
    肠道腺病毒6(2.53)3(1.02)0(0.00)9(1.12)7.174<0.05
     合计128 (54.01)159(54.08)94(34.31)381(47.33)28.259<0.001
    下载: 导出CSV

    表  2  不同年龄组儿童杯状病毒检出率

    Table  2.   Detection rate of calicivirus in children in different age groups

    年龄组
    (月龄)
    2018年2019年2020年总计χ2P
    病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)
    0~1103834.55952930.53132118.333377823.1527.227<0.001
    7~944345.741174941.88792531.6529011740.343.7370.154
    25~16956.25371437.8415320.00682638.244.3130.116
    37~17317.65451533.33481225.001103027.271.7520.459
    合计2379339.2429410736.392745118.6180525131.1831.067<0.001
    下载: 导出CSV

    表  3  不同年龄组儿童A组轮状病毒检出率

    Table  3.   Detection rate of rotavirus A in children in different age groups

    年龄组
    (月龄)
    2018年2019年2020年总计χ2P
    病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)病例数(例)阳性数(例)阳性率(%)
    0~1101110.00951414.741322720.453375215.434.4860.214
    7~941819.151173025.64791518.992906321.725.0740.079
    25~1616.2537718.921516.6768913.242.2840.394a
    37~17211.7645817.7848816.671101816.360.3320.888a
    合计2373213.502945920.072745118.6180514217.644.1650.125
      注:a. Fisher确切检验
    下载: 导出CSV

    表  4  不同年度儿童A组轮状病毒型别分布

    Table  4.   Annual distribution of genotypes of rotavirus A in children

    型别2018年2019年2020年总计
    病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)
    G9P[8]2681.255593.224894.1212990.85
    G3P[8]412.5023.3900.0064.23
    G1P[8]00.0011.6923.9242.82
    G2P[4]26.2511.6900.0032.11
    G1P[5]00.0000.0011.9610.70
    合计3222.545941.555135.92142100.00
    下载: 导出CSV

    表  5  各年龄组中儿童A组轮状病毒基因型别分布

    Table  5.   Distribution of genotypes of rotavirus A in children in different age groups

    年龄组
    (月龄)
    G1P[8]G2P[4]G3P[8]G9P[8]G1P[5]阴性总计(例)
    病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)病例数(例)百分比(%)
    0~30.8920.5910.30 4513.3510.3028584.57337
    7~00.0010.3451.72 5719.6600.0022778.28290
    25~00.0000.0000.00 913.2400.00 5986.76 68
    37~00.0000.0000.00 1816.3600.00 9283.64110
    合计40.5030.3760.7512916.0200.0066382.36805
    下载: 导出CSV

    表  6  诺如病毒GⅡ型的基因亚型年度分布

    Table  6.   6Annual distribution of genotypes of norovirus GⅡ

    基因亚型2018年2019年2020年总计χ2P
    阳性数
    (份)
    百分比
    (%)
    阳性数
    (份)
    百分比
    (%)
    阳性数
    (份)
    百分比
    (%)
    阳性数
    (份)
    百分比
    (%)
    GⅡ.4[P31]1112.645754.29918.757732.0842.758<0.001
    GⅡ.3[P12]2022.992120.00612.504719.582.1810.336
    GⅡ.4[P16]00.0065.71918.75156.2517.337<0.001a
    GⅡ.2[P16]11.1510.95612.5083.3311.044<0.001a
    GⅡ.13[P21]00.0021.9000.0020.831.7230.681a
    GⅨ.1[P15]11.1500.0000.0010.421.8130.562a
    GⅡ.1[P16]00.0000.0012.0810.423.0020.200a
    GⅡ.17[P17]11.1500.0000.0010.421.8130.562a
    GⅡ.6[P7]11.1500.0000.0010.421.8130.562a
    GⅡ.3[P31]00.0010.9500.0010.421.4371.000a
    未能分型5259.771716.191735.428635.8339.303<0.001
     合计8736.2510543.754820.00240100.00
      注:a. Fisher确切检验
    下载: 导出CSV
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  • 收稿日期:  2021-06-02
  • 网络出版日期:  2021-09-28
  • 刊出日期:  2021-10-30

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