2019—2023年扬州地区诺如病毒感染监测分析  

Norovirus infection surveillance in Yangzhou area,2019-2023

作　　者：黄瑶 朱倩 徐娅雯 张秀玲 董玉颖 李鑫娜 周信 周乐 HUANG Yao;ZHU Qian;XU Yawen;ZHANG Xiuling;DONG Yuying;LI Xinna;ZHOU Xin;ZHOU Le(Yangzhou Municipal Center for Disease Control and Prevention,Yangzhou,Jiangsu 225001,China;Jiangsu Provincial Key Laboratory of Food Safety Risk Monitoring,Yangzhou,Jiangsu 225001,China;Jiangsu Key Laboratory of Zoonosis,Yangzhou,Jiangsu 225100,China)

机构地区：[1]扬州市疾病预防控制中心,江苏扬州225001 [2]江苏省食品安全风险监测重点实验室,江苏扬州225001 [3]江苏省人兽共患病学重点实验室,江苏扬州225100

出　　处：《实用预防医学》2025年第3期278-286,共9页Practical Preventive Medicine

基　　金：扬州市科技局社会发展项目(YZ2023150);江苏省人兽共患病学重点实验室开放课题(R2002);扬州市“绿扬金凤计划”优秀博士资助项目(YZLYJFH2021YXBS051);扬州市卫生健康委医学科研项目(2023-2-33)。

摘　　要：目的了解扬州地区诺如病毒(norovirus,NoV)流行特征及基因特征,为该地区NoV疫情防控提供科学依据。方法收集2019年1月—2023年2月扬州地区食源性疾病主动监测及腹泻暴发疫情监测病例肛拭、粪便标本及病例信息,荧光RT-PCR检测NoV,扩增NoV聚合酶区(RNA-dependent RNA polymerase,RdRp)-衣壳区(viral capsid protein 1,VP1)区域后序列测定,进行基因分型、进化树构建及重组分析。结果食源性疾病监测标本4167例,NoV阳性率4.03%,年阳性检出率呈逐年下降趋势(P<0.05),第一季度阳性检出率最高(P<0.05),GⅠ、GⅡ及GⅠ+GⅡ共感染构成比为16.07%、76.79%和7.14%。21起腹泻疫情中20起为NoV暴发疫情,占95.24%,10起发生在第一季度,占比50.00%,暴发机构均为托幼机构与小学,476例标本中NoV阳性327例,阳性率68.70%;年阳性检出率差异无统计学意义(P>0.05)。GⅠ、GⅡ及GⅠ+GⅡ共感染构成比为10.09%、88.99%及0.92%,与食源性疾病监测标本基因组别构成比差异有统计学意义(P<0.05)。食源性疾病监测与腹泻暴发疫情监测中,不同性别NoV阳性检出率差异均无统计学意义(P>0.05);除55岁以上年龄段人群在食源性疾病监测中NoV感染率显著较低(P<0.05),在暴发疫情监测中未监测到,其余年龄段人群NoV阳性检出率差异均无统计学意义(P>0.05)。97株RdRp-VP1序列,GⅠ组23株,分为四种基因型,GⅠ.3[P13]为持续流行株;GⅡ组74株,分为八种基因型,其中GⅡ.2[P16]、GⅡ.6[P7]及GⅡ.3[P12]为持续流行。Blast比对结果显示NoV呈跨地域传播全球流行趋势,该地区每年流行基因型构成均不相同。RdRp及VP1区系统进化树分析显示同基因型序列均聚集成簇,与参考株属于同一进化分支,型内序列同源性96.8%~100.0%。Simplot和RDP4重组分析显示,7种NoV重组毒株均为型间重组,RDP4算法对应P值范围为6.984×10^(-20)~1.471×10^(-2)。结论扬州地区NoV感染处于低位散发流行状态,小学和托幼机构Objective To understand the epidemiological and genetic characteristics of norovirus(NoV)in Yangzhou area so as to provide a scientific basis for prevention and control of NoV outbreaks in this area.Methods We collected anal swabs,fecal specimens and case information of cases from the active surveillance of foodborne diseases and the surveillance of diarrhea outbreaks in Yangzhou area from January 2019 to February 2023.Real-time RT-PCR was used to detect NoV,and the amplified gene fragments in NoV RNA-dependent RNA polymerase(RdRp)-viral capsid protein 1(VP1)region were sequenced for genotyping,phylogenetic tree construction and recombination analysis.Results The positive rate of NoV in 4,167 samples from the foodborne disease surveillance was 4.03%.The annual positive detection rates showed a decreasing trend year by year(P<0.05),and the positive detection rate in the first quarter was the highest(P<0.05).The constituent ratios of GⅠinfection,GⅡinfection and GⅠ+GⅡco-infection were 16.07%,76.79%and 7.14%respectively.Among 21 diarrhea outbreaks,20 were NoV outbreaks,accounting for 95.24%,and 10 of them occurred in the first quarter,accounting for 50.00%.All the outbreaks had occurred in kindergartens and primary schools.Among 476 specimens,327 were positive for NoV,with the positive rate of 68.70%.No statistically significant difference was found in the annual positive detection rates(P>0.05).The constituent ratios of GⅠinfection,GⅡinfection and GⅠ+GⅡco-infection were 10.09%,88.99%and 0.92%respectively,which were statistically significantly different from the constituent ratios of NoV genome in specimens from the foodborne disease surveillance(P<0.05).Based on the surveillance of foodborne diseases and diarrhea outbreaks,there was no statistically significant difference in the positive detection rates of NoV between different genders(P>0.05).The NoV infection rate was found to be significantly lower in the group aged above 55 years based on the foodborne disease surveillance(P<0.05),but no NoV infe

关 键 词：诺如病毒 食源性疾病监测 基因型 重组 

分 类 号：R512.5[医药卫生—内科学]