新型冠状病毒感染疫情前及流行期苏州地区≤14岁住院儿童5种下呼吸道常见病原体感染情况分析

Detection rate of five respiratory pathogens before and during COVID-19 pandemic among ALRI hospitalizations of children aged 0–14 years at a tertiary children's hospital in Suzhou city,2018–July 2022

目的探讨新型冠状病毒感染疫情前及流行期间苏州地区儿童常见呼吸道病原体的感染情况,为急性下呼吸道感染(ALRI)的预防及诊治提供参考。方法纳入2018年1月—2022年7月在苏州大学附属儿童医院呼吸科因急性下呼吸道感染住院的≤14岁患儿为研究对象,检测甲型流感病毒(FluA)、乙型流感病毒(FluB)、呼吸道合胞病毒(RSV)、肺炎链球菌(Spn)、流感嗜血杆菌(Hi)等病原体。比较新冠疫情大流行前(2018—2019年)与新冠疫情大流行期间(2020—2022年7月)5种常见呼吸道病原体不同时间阳性检出率。结果2018年1月—2022年7月共检测9005例患儿。与2018—2019年同期比较,FluA检出率在2020年(1.3%)、2021年(0.1%)、2022年(3.5%)明显降低(均P<0.05);2020—2022年FluB检出率显著降低,分别为1.7%、1.0%、3.2%(均P<0.05);2020年RSV检出率与疫情前相比差异无统计学意义(P>0.05),但RSV检出率在2021年(20.8%)和2022年(18.9%)显著增高(均P<0.05);Spn检出率在2020年(11.2%)和2022年(8.9%)明显降低(均P<0.05),2021年Spn检出率差异无统计学意义(P>0.05);Hi检出率在2020年(6.8%)、2021年(7.5%)、2022年(4.0%)明显降低(均P<0.05)。新冠疫情前混合病原体感染主要为“Hi+Spn”、“Hi+Flu”,2020年主要混合感染类型为“Hi+Spn”、“Flu+Hi”及“RSV+Spn”。2021年、2022年,“RSV+Spn”混合感染最为常见。随着非药物干预措施的放松,RSV在2021年夏季出现了反季节的流行,2021年7—11月检出率分别为13.9%、9.2%、28.8%、43.5%、35.3%,显著高于疫情前平均水平(均P<0.001);FluA在2022年夏季结束了持续2年的低流行趋势;FluB也于2021年11月逐渐恢复至流行前水平。不同病原体感染年龄分布存在差异,RSV感染多见于<1岁儿童,FluA、FluB感染以≥1岁儿童为主,而Spn及Hi感染大多为<6岁儿童。结论新型冠状病毒感染疫情防控的非药物干预措施对5种常见呼吸道病原体的传播产生了一定的影响,但随着新冠疫情变化及防控措施的调整,部分呼吸道病原体感染出现不同程度的反弹,需持续进行病原体的监测。

Objective To analyze the variation in positivity rates of five respiratory pathogens before and during coronavirus disease 2019(COVID-19)pandemic among 0–14 years old child inpatients with acute lower respiratory infection(ALRI)in Suzhou city for the prevention and treatment of ALRI in children.Methods The participants of the study were 9005 children aged 0–14 years and hospitalized from 2018 through July 2022 due to ALRI(with discharge diagnosis codes of J09-J18 and J20-J22 of International Classification of Diseases,10th Revision)at a tertiary children′s hospital of Suzhou city.We extracted the participants′medical records and results of sputum specimen detection on respiratory syncytial virus(RSV),influenza virus A(FluA),influenza virus B(FluB),Streptococcus pneumoniae(Spn),and Haemophilus influenzae(Hi).The yearly and monthly detection rates of the five respiratory pathogens were described and compared to examine variations in the detection rates before(2018–2019)and during(2020–July 2022)the COVID-19 pandemic.Results Compared to those in the same period of 2018–2019,the detection rate of FluA and FluB decreased significantly in 2020(1.3%and 1.7%),2021(0.1%and 1.0%),and January–July of 2022(3.5%and 3.2%)(all P<0.05);there was no significant alteration in detection rate of RSV in 2020(P>0.05),but the detection rate was significantly higher in 2021(20.8%)and in 2022(18.9%)(both P<0.05);the detection rate of Spn decreased significantly in 2020(11.2%)and 2022(8.9%)(both P<0.05),while there was no significant change in the detection rate of Spn in 2021(P>0.05);significantly decreased detection rate of Hi was observed in 2020(6.8%),2021(7.5%),and 2022(4.0%)(all P<0.05).In comparison to the average levels of non epidemic season,the monthly detection rate of RSV increased significantly to 13.9%,9.2%,28.8%,43.5%,and 35.3%for the months of July–November,2021(P<0.001 for all).Before 2020,the main co-infection detected was the infection of Hi and Spn or Flu,but in 2020,mainly detected co-infections were Hi plus Spn,Flu plus Hi,and RSV plus Spn;in 2021 and 2022,the main co-infection of RSV plus Spn was detected.There were differences in age group-specific detection rates of the five pathogens,with more RSV infections detected among the hospitalized children under one year of age,FluA or FluB infection in those age one year and over,and Spn or Hi infection in the hospitalized children under age of 6 years.Conclusion Non-pharmaceutical interventions on the COVID-19 pandemic could have a certain impact on detection rates of five common respiratory pathogens among 0–14 years old hospitalized children with ALRI in Suzhou city.The result suggests the necessity of pathogen surveillance in prevention and control of respiratory infections in children.