中国大陆一项多中心研究结果显示，病原体传播模式的改变和免疫刺激减弱可能是2023年成人呼吸道感染病例增加的原因。
Alterations of pathogen transmission patterns and attenuated immune stimulation might be the cause of increased adult respiratory infections cases in 2023, results from a multi-center study in mainland China.
作者信息
Ai Jingwen, Wang Hongyu, Zhang Haocheng, Song Jieyu, Zhang Yi, Lin Ke, Qu Lihong, Zhang Yanliang, Zhang Shiliang, Xiang Qiyun, Geng Jiawei, Jin Guangxia, Song Wei, Zhang Liaoyun, Hu Xiaoli, Liu Hongyan, Yuan Guanmin, Jiang Ning, Zhou Yang, Xu Yuanyuan, Ying Jun, Wu Jiqin, Xing Yajiao, Fang Kai, Yan Hui, Chen Feiying, Xu Tailin, Wang Sen, Qian Zhaohui, Zhang Wenhong
机构信息
Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China.
Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China.
出版信息
Heliyon. 2024 Jun 3;10(12):e32304. doi: 10.1016/j.heliyon.2024.e32304. eCollection 2024 Jun 30.
BACKGROUND
Several respiratory infections outbreaks have been observed in mainland China after reduction of non-pharmaceutical interventions. Other countries have seen increases in respiratory infections outside typical seasons post-COVID-19, warranting investigation into underlying causes.
METHODS
We established monitoring networks for suspected respiratory infection in 14 tertiary hospitals nationwide. PCR for SARS-CoV-2, influenza A and B were performed on 3708 respiratory specimens and deep sequencing were conducted to identify co-infections or newly emerging microbes in 2023. Viral evolutionary analysis was completed. We retrospectively detected serum antibody level for various respiratory pathogens from 4324 adults without respiratory infections over 7 years to observe its dynamic curves.
FINDINGS
SARS-CoV-2 and influenza A were the main pathogens during outbreaks in 2023, bacterial-virus and bacterial-bacterial co-infections were most detected, but community co-infections didn't significantly increase pneumonia incidence. Different SARS-CoV-2 and influenza variants were present in different outbreaks, and no novel pathogens were found. The epidemiological patterns of influenza A, COVID-19 and etc. were altered, exhibiting characteristics of being "staggered" compared to most global regions, and potentially led to "overlapping prevalence". Binding antibody testing showed regular fluctuation, without significant decrease against common respiratory pathogens in adults. Influenza A antibody stimulation was attenuated during the 2023 outbreak.
CONCLUSIONS
"Misaligned" alteration in seasonal respiratory disease patterns possibly caused combined epidemics, leading to cases spike in China, 2023. In adults, antibody levels didn't show significant decline, but reduced immune response to influenza during 2020-2023 emphasizes the need for consistent vaccination during pandemics.
背景
在中国大陆减少非药物干预措施后，已观察到几起呼吸道感染暴发事件。其他国家在新冠疫情后，非典型季节的呼吸道感染有所增加，这值得对潜在原因进行调查。
方法
我们在全国14家三级医院建立了疑似呼吸道感染监测网络。对3708份呼吸道标本进行了新冠病毒、甲型和乙型流感的聚合酶链反应检测，并在2023年进行了深度测序，以鉴定合并感染或新出现的微生物。完成了病毒进化分析。我们回顾性检测了4324名7年以上无呼吸道感染的成年人针对各种呼吸道病原体的血清抗体水平，以观察其动态曲线。
研究结果
新冠病毒和甲型流感是2023年疫情期间的主要病原体，最常检测到细菌 - 病毒和细菌 - 细菌合并感染，但社区合并感染并未显著增加肺炎发病率。不同疫情中存在不同的新冠病毒和流感变体，未发现新病原体。甲型流感、新冠等的流行模式发生了改变，与全球大多数地区相比呈现“交错”特征，并可能导致“重叠流行”。结合抗体检测显示有规律波动，成年人针对常见呼吸道病原体的抗体没有显著下降。2023年疫情期间甲型流感抗体刺激减弱。
结论
季节性呼吸道疾病模式的“错位”变化可能导致合并流行，致使2023年中国病例数激增。在成年人中，抗体水平没有显著下降，但2020 - 2023年期间对流感的免疫反应减弱，这凸显了在大流行期间持续接种疫苗的必要性。
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