上海地区2009至2011年儿童诺如病毒腹泻病的监测研究  

Surveillance of norovirus-associated diarrhea in children in Shanghai, 2009-2011

作　　者：姚玮蕾[1] 蔡洁皓[1] 王相诗[1] 葛艳玲[1] 朱启镕[1] 曾玫[1] 

机构地区：[1]复旦大学附属儿科医院感染传染科,上海201102

出　　处：《中华儿科杂志》2014年第5期339-344,共6页Chinese Journal of Pediatrics

基　　金：益普生腹泻基金（IDF-2010-03）

摘　　要：目的 监测2009至201 1年上海地区儿童诺如病毒腹泻的流行病学及流行株的基因型特征.方法 2009年1月至2011年12月我们连续采集2 288份门诊急性腹泻患儿的粪便标本,采用实时荧光RT-PCR检测诺如病毒GⅠ和GⅡ基因组,对部分GⅡ基因组阳性标本经RT-PCR扩增诺如病毒部分衣壳蛋白（VP1）和多聚酶蛋白（RdRp）序列,对核苷酸序列进行基因分型.结果 在2 288份门诊急性腹泻患儿的粪便标本中,531份（23.2％）标本系诺如病毒阳性,GⅠ和GⅡ基因组阳性标本分别有4份（0.75％）和527份（99.25％）.诺如病毒每月检出率7.7％ ～ 47.3％,每年7至10月份检出率高于年平均检出率.4岁以下儿童累积病例数占95.2％,4岁以下腹泻患儿的诺如病毒检出率明显高于≥4岁儿童（24.4％ vs.10.7％,x2=10.66,P＜0.05）.239株诺如病毒的VP1分型包括7种基因型,依次为：154株（64.4％）为GⅡ.4[9株为2009（New Orleans）,145株为2006b变异株],66株（27.6％）为GⅡ.3,7株（2.9％）为GⅡ.2,6株（2.5％）为GⅡ.6,4株（1.7％）为GⅡ.12,GⅡ.7和GⅡ.14各1株（0.4％）.244株RdRp分型包括7种基因型,依次为：189株（77.5％）为GⅡ.4[14株为2009（New Orleans）变异株,175株为2006b变异株],47株（19.3％）为GⅡ.12,GⅡ.16、GⅡ.b和GⅡ.g各2株（0.8％）,GⅡ.2和GⅡ.6各1株（0.4％）.GⅡ.4-2010变异株自2010年6月被首次检测到,随后散发流行.198株诺如病毒的VP1和RdRp同时测序分型,56株（28.3％）存在不同的RdRp/ VP1基因型组合,以GⅡ.12/GⅡ.3（69.6％）和GⅡ.4/GⅡ.3（8.9％）常见.结论 诺如病毒是上海地区儿童腹泻常见的病原,诺如病毒腹泻全年流行.上海地区诺如病毒流行株具有多种基因型,存在不同基因型间重组株.GⅡ.4-2006b型变异株仍然为优势流行株,并未被新的变异株GⅡ.4-2009（New Orleans）所取代.Objective To monitor the epidemiology of norovirus infection in diarrheal children in Shanghai between 2009 and 2011 and characterize the genotypes of norovirus strains.Method The stool samples were collected from children visiting outpatient clinic for acute non-dysenteric diarrhea between 2009 and 2011.One step real-time RT-PCR was used for screening norovirus genogroups G Ⅰ and G Ⅱ.The genotypes of norovirus genogroup G Ⅱ were classified based on the nucleotide sequences of both partial capsid and polymerase fragments.Result A total of 2 288 outpatient children with acute diarrhea were included in this study,out of whom,531 （23.1％） were positive for norovirus in the fecal specimens based on real-time RT-PCR test.Norovirus was prevalent throughout the year and an increased activity of norovirus infection was usually observed between July and October.Children ＜ 4 years of age accounted for 95.2％ of norovirusinfected cases,and the detection rate of norovirus was significantly higher in diarrheal children ＜ 4 years than in those ≥4 years （24.4％ vs.10.7％,x2 =10.66,P ＜0.05）.Of 531 norovirus-positive specimens,4 （1.7％） were positive for genogroup G Ⅰ and 527 （98.3％） positive for genogroup G Ⅱ.Seven distinct capsid genotypes were identified in 234 norovirus strains,including 153 （64.4％） G Ⅱ.4 （9 belonging to 2010 variants and 145 belonging to 2006b variants）,66 （27.6％） GⅡ.3,7 （2.9％） GⅡ.2,6 （2.5％） GⅡ.6,4 （1.7％） GⅡ.12,1 （0.4％） GⅡ.7 and GⅡ.14 in each.Seven polymerase genotypes were identified in 244 norovirus strains,including 189 （77.5％） G Ⅱ.4 （14 belonging to 2010 variants and 175 belonging to 2006b variants）,47 （19.3％） G Ⅱ.12,2 （0.8％） G Ⅱ.16,G Ⅱ.b and G Ⅱ.g in each,1 （0.4％） G Ⅱ.2 and G Ⅱ.6 in each.A new G Ⅱ.4-2010 （New Orleans） variant was first detected in June 2010 and sporadically circulated afterwards.Of 198 norovirus strains in which both polymerase and capsid genotyp

关 键 词：腹泻 儿童 基因型 诺如病毒 

分 类 号：R725.1[医药卫生—儿科]