Li J, Yang Y, Liang Z C, Gao Z Y, Jia L, Liu B W, Chen L J, Wang Q Y
Institute for HIV/AIDS and STD Prevention and Control, Beijing Center for Disease Prevention and Control, Research Center for Preventive Medicine of Beijing, Beijing 100013, China.
Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Research Center for Preventive Medicine of Beijing, Beijing 100013, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2020 Oct 6;54(10):1104-1110. doi: 10.3760/cma.j.cn112150-20191129-00892.
To understand the epidemiological characteristics and clinical features of rotavirus-, norovirus-, adenovirus-and astrovirus-associ ated acute gastroenteritis in children under 5 years old in Beijing from Octorber, 2015 to March, 2017. In the intestinal clinic of 6 hospitals in 6 districts of Beijing, information and stool samples of the first 30 patients with acute gastroenteritis who are under the age of 5 years are collected monthly.Rotavirus, norovirus, adenovirus and astrovirus are identified by PCR.Descriptive epidemiological method was used to describe the epidemiological characteristics of diarrhea caused by rotavirus, norovirus, adenovirus and astrovirus in Beijing. One-way analysis of variance was used to analyze the Vesikari clinical severity score of of acute gastroenteritis caused by each virus. Unconditional logistic regression analysis was used to analysis the associated factors of clinical features. Of the 2 052 samples, 709 (34.6%) were non-mixed infections: the positive rate of rotavirus, norovirus, adenovirus and astrovirus were 20.0%, 7.5%, 4.2% and 2.9%, respectively. A total of 135 cases (6.6%) were mixed infection. The mean and standard deviation of Vesikari clinical severity score was 8.0±3.1 for rotavirus associated acute gastroenteritis, which was significantly higher than norovirus (6.4±2.4, <0.001), adenovirus (6.2±2.1, <0.001) and astrovirus (6.1±2.0, <0.001). The comparison of clinical features showed that compared with astrovirus, the children under 5 years old infected with rotavirus were more likely to have a diarrhea ≥5 days (=3.334), have vomiting ≥3 times within one day (=8.788), have vomiting≥1 day (=3.963), have a Vesikari clinical severity score ≥11 severe cases (=13.194). Norovirus infected cases were prone to have vomiting≥3 times in 1 day (=5.710).Adenovirus infected cases were prone to have a diarrhea≥5 days (=2.616). When using rotavirus as a reference, children under 5 years of age were less likely to develop fever≥38.4 ℃ after infection with norovirus (=0.397) or adenovirus (=0.280). The results of this study showed that the characteristics of acute gastroenteritis caused by different viruses are different. The clinical symptoms caused by rotavirus are more serious. Children under 24 months of age are at high risk of rotavirus infection. Effective preventive measures such as vaccination should be taken as soon as possible.
为了解2015年10月至2017年3月间北京5岁以下儿童轮状病毒、诺如病毒、腺病毒和星状病毒所致急性胃肠炎的流行病学特征及临床特点。在北京6个区的6家医院肠道门诊,每月收集前30例5岁以下急性胃肠炎患儿的信息及粪便样本。采用聚合酶链反应(PCR)鉴定轮状病毒、诺如病毒、腺病毒和星状病毒。采用描述性流行病学方法描述北京轮状病毒、诺如病毒、腺病毒和星状病毒所致腹泻的流行病学特征。采用单因素方差分析各病毒所致急性胃肠炎的Vesikari临床严重程度评分。采用非条件logistic回归分析临床特征的相关因素。在2052份样本中,709份(34.6%)为非混合感染:轮状病毒、诺如病毒、腺病毒和星状病毒的阳性率分别为20.0%、7.5%、4.2%和2.9%。共有135例(6.6%)为混合感染。轮状病毒所致急性胃肠炎Vesikari临床严重程度评分的均值及标准差为8.0±3.1,显著高于诺如病毒(6.4±2.4,<0.001)、腺病毒(6.2±2.1,<0.001)和星状病毒(6.1±2.0,<0.001)。临床特征比较显示,与星状病毒感染相比,5岁以下轮状病毒感染患儿更易出现腹泻≥5天(=3.334)、1天内呕吐≥3次(=8.788)、呕吐≥1天(=3.963)、Vesikari临床严重程度评分≥11分(重症)(=13.194)。诺如病毒感染病例易出现1天内呕吐≥3次(=5.710)。腺病毒感染病例易出现腹泻≥5天(=2.616)。以轮状病毒为对照,5岁以下儿童感染诺如病毒(=0.397)或腺病毒(=0.280)后发热≥38.4℃的可能性较小。本研究结果表明,不同病毒所致急性胃肠炎的特点不同。轮状病毒所致临床症状更严重。24个月以下儿童轮状病毒感染风险高。应尽快采取如接种疫苗等有效的预防措施。