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  

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

作　　者：匡小舟[1] 肖文佳[1] 刘捷宸 张曦[1] 滕峥[1] 潘浩[1] Kuang Xiaozhou;Xiao Wenjia;Liu Jiechen;Zhang Xi;Teng Zheng;Pan Hao(Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市疾病预防控制中心,上海200336

出　　处：《疾病监测》2021年第10期1069-1074,共6页Disease Surveillance

基　　金：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)。

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(χ^(2)=17.337,P<0.001;χ^(2)=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。Objective To understand the molecular epidemiological characteristics of viral gastroenteritis in pediatric inpatients under five years old in Shanghai and provide scientific evidence for the prevention and control of viral diarrhea and the development and application of vaccines.Methods Stool samples were collected from the inpatients aged<5 years due to acute gastroenteritis in a pediatric hospital in Shanghai,while epidemiological data were also collected.Laboratory tests,such as ELISA,real-time PCR and nested PCR,were performed to detect rotavirus,calicivirus,including norovirus and sapovirus,astrovirus and adenovirus.Results A total of 805 stool samples were collected from 543 boys and 262 girls,the virus positive detection rate was 47.33%.Calicivirus and rotavirus A were the top two most common viruses,with a detection rate of 31.18%and 17.64%respectively.Norovirus GⅡaccounted for the largest percentage in calicivirus(95.62%).For rotavirus,the predominant genotype was G9P[8](90.85%).While for norovirus GⅡ,GⅡ.4[P31]and GⅡ.3[P12]were the most common genotypes,accounting for 32.08%and 19.58%respectively.However since 2020 the detection rates of emerging genotypes GⅡ.4[P16]and GⅡ.2[P16]have increased significantly compared with 2018 and 2019(χ^(2)=17.337,P<0.001,χ^(2)=11.044,P=0.001).In addition,a RotaTeq vaccine strain of rotavirus was detected for the first time from the stool sample of a 4-month-old child.Conclusion The tendency of higher detection rate of calicivirus than rotavirus was more obvious,indicating that the development and marketing of calicivirus(mainly norovirus)vaccine are more urgent.For the first time,the study revealed the main circulating and emerging genotypes of norovirus GⅡin hospitalized children,providing references for the development of multivalent norovirus vaccine.In addition,the recent increase in detection rates of rotavirus G9 also suggested the necessity of continuous vigilance and more in-depth follow-up studies on the genotypic changes of rotavirus.

关 键 词：婴幼儿 住院 病毒性腹泻 A组轮状病毒 诺如病毒GⅡ型 

分 类 号：R211[医药卫生—中医学] R512.5