2022—2024年中国10省（直辖市）5岁及以下儿童病毒性腹泻病原谱及流行特征

罗梦欣; 申晓靖; 高艳艳; 何潆; 彭杨; 李利利; 孙晓曼; 李丹地; 高璐; 赵文娜; 孙思浓; 艾静; 刘雨婷; 李彩霞; 曹亿会; 刘晨霞; 康倩; 李金松; 段招军

doi:10.3784/jbjc.202511140752

2022—2024年中国10省（直辖市）5岁及以下儿童病毒性腹泻病原谱及流行特征

Pathogen spectrum and epidemiological characteristics of viral diarrhea in children aged ≤5 years in 10 provinces (municipalities), China, 2022–2024

摘要

摘要:
目的分析2022—2024年中国10省（直辖市）5岁及以下儿童的病毒性腹泻哨点监测数据，阐述病毒性腹泻流行病学特征，为其防控措施优化和落实提供依据。
方法按照《全国病毒性腹泻监测方案（2021）》，2022—2024年在全国开展病毒性腹泻哨点监测，选择具有代表性的10个省（直辖市）15个哨点医院采集的5岁及以下腹泻儿童粪便样本和流行病学信息，检测诺如病毒（NoV）、轮状病毒（RV）、肠道腺病毒（AdV）、星状病毒（AstV）及札如病毒（SaV），并鉴定NoV基因群和A组RV基因型。采用卡方检验和Fisher精确检验统计分析腹泻病毒流行特征和临床特征的差异。
结果 2022—2024在10个省（直辖市）中共收集8 338例因腹泻住院儿童的流行病学信息和标本。5种病毒平均检出率为44.00%，各年检出率分别为35.52%、48.38%和47.24%，其中NoV、RV、AdV、AstV及SaV平均检出率分别为17.15%、11.78%、3.11%、1.91%和1.66%；病毒共感染检出率平均为8.41%，其中RV+NoV最常见，占共感染病例的35.81%。24～<60月龄儿童的检出率高于0～<24月龄儿童（χ²=16.393，P<0.001）；春冬季高于夏秋季（χ²=349.04，P<0.001）；A类地区低于B类地区（χ²=40.736，P<0.001）。较单一感染RV，RV+ NoV、RV+AstV共感染未加重胃肠炎症状；但较单一感染AdV，AdV+ NoV、AdV+RV共感染可加重症状。NoV以GⅡ群为主，检出率为18.21%，RV以G9P8（4.38%）和G8P8（5.90%）型为主。
结论 2022—2024年中国部分地区5岁及以下儿童广泛接种RV疫苗后，NoV成为主要致腹泻病毒；与AdV相关的共感染可能加重临床症状。需进一步强化多病原监测和落实综合防控策略。

Abstract:
Objectives To analyze sentinel surveillance data of viral diarrhea in children aged ≤5 years in 10 provinces (municipalities) of China from 2022 to 2024, describe the epidemiological characteristics of viral diarrhea, and provide evidence for the improvement of viral diarrhea prevention and control.
Methods According to the National Viral Diarrhea Surveillance Protocol (2021), sentinel surveillance for viral diarrhea was conducted nationwide during 2022–2024. Stool samples and epidemiological data were collected from children aged ≤5 years hospitalized due to diarrhea at 15 sentinel hospitals in 10 representative provinces (municipalities). Specimens were tested for norovirus (NoV), rotavirus (RV), enteric adenovirus (AdV), astrovirus (AstV), and sapovirus (SaV). The genogroups of NoV and the genotypes of RV group A A were further identified. In addition, χ² test and Fisher’s exact test were used to compare differences in epidemiological and clinical characteristics.
Results A total of 8,338 hospitalized children with diarrhea were included in this study during 2022–2024. The overall average detection rate of the five viruses was 44.00%, with annual detection rates of 35.52%, 48.38%, and 47.24%, respectively. The average detection rates were 17.15% for NoV, 11.78% for RV, 3.11% for AdV, 1.91% for AstV, and 1.66% for SaV. The average co-infection rate was 8.41%, RV+NoV infection was the common, accounting for 35.81%. The detection rate was higher in children aged 24–<60 months than in those aged 0–<24 months (χ²=16.393, P<0.001), higher in winter and spring than in summer and autumn (χ²=349.04, P<0.001), and lower in class A region than in class B region (χ²=40.736, P<0.001). Compared with single RV infection, the co-infections of RV+NoV and RV+AstV showed no more severe gastrointestinal symptoms; however, compared with single AdV infection, the co-infections of AdV+NoV and AdV+RV were associated with more severe symptoms. NoV II were predominated (18.21%), while RV G9P8 (4.38%) and G8P8 (5.90%) were the most common.
Conclusion During 2022–2024, due to widespread RV vaccination in children aged ≤5 years in some areas of China, NoV became the leading viral pathogen causing diarrhea. Co-infection with AdV might result in more severe clinical symptoms. It is still necessary to strengthen multi-pathogen surveillance and take comprehensive prevention and control measures.

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