2012-2020年海南省小儿腺病毒呼吸道感染多中心流行病学特征分析

Multicenter epidemiological characteristics of children's adenovirus respiratory tract infection in Hainan province from 2012 to 2020

目的了解海南省小儿急性呼吸道感染(ARI)中腺病毒(ADV)感染的流行病学特征,为预防和控制小儿ADV感染提供参考。方法选择2012年3月-2020年2月在海南省多家医院儿科住院的ARI患儿40587例,所有患儿均在入院时采取静脉血,采用间接免疫荧光法检测血清中ADV、肺炎支原体、肺炎衣原体、嗜肺军团菌、呼吸道合胞病毒、副流感病毒、甲型流感病毒、乙型流感病毒、Q热立克次体等9种呼吸道病原体IgM抗体,血清ADVIgM抗体阳性定义为ADV感染,对ADV感染病例的流行病学和临床资料进行回顾性分析。结果40587例ARI患儿血清ADV-IgM检测总阳性率为1.90%(771/40587)。2012-2020年各年的ADV-IgM阳性率分别为0.35%、5.31%、1.24%、0.17%、0.67%、1.49%、2.45%、1.92%和1.67%,其中2013、2018年的ADV-IgM阳性率显著高于其他年份,各年间ADV-IgM阳性率差异有统计学意义(χ^(2)=260.60,P<0.05)。女性ADV-IgM阳性率为2.09%,显著高于男性1.79%,差异有统计学意义(χ^(2)=4.36,P<0.05)。ADV-IgM阳性率幼儿期(2.68%)、学龄前期(2.10%)均明显高于婴儿期(1.51%)和学龄期(1.23%),差异均有统计学意义(P均<0.05)。春季、夏季ADV-IgM阳性率较高,各季节间差异有统计学意义(χ^(2)=34.44,P<0.05)。771例ADV-IgM阳性患儿临床诊断以下呼吸道感染为主占83.01%,临床特征主要为咳嗽占85.73%、发热占72.76%、喘息占16.99%、气促占6.10%、肺部湿性啰音占74.84%。胸部影像学为双肺纹理增多、增粗(83.01%)以及合并单侧或双侧不同程度的斑片状、条索状高密度影(42.97%)。儿童ARI中单纯ADVIgM阳性者占15.05%,混合感染占84.95%,其中ADV合并肺炎支原体占72.11%。结论ADV是海南省小儿ARI的重要病原体,女童感染率高于男童,好发于幼儿期和学龄前期。全年均可检出,春、夏季为高发季节。ARI儿童ADV感染以普通肺炎多见,临床表现无特异性。ADV常与其他病原体混合感染,其中ADV合并肺炎支原体感染多见。

Objective To understand the epidemiological characteristics of adenovirus(ADV)infection in children with acute respiratory infections(ARI)in Hainan province,and provide reference for the prevention and control of ADV infection in children.Methods The children with ARI hospitalized in pediatric departments of multiple hospitals in Hainan province from March 2012 to February 2020 were selected.Venous blood samples were collected for the detection of IgM antibodies against nine respiratory pathogens such as ADV,Mycoplasma pneumoniae,Chlamydia pneumoniae,Legionella pneumophila,respiratory syncytial virus,parainfluenza virus,influenza A virus,influenza B virus,and Rickettsia Q fever in the serum by indirect immunofluorescence method.The positive serum ADV-IgM antibody was defined as ADV infection.The epidemiological and clinical data of ADV infection cases were analyzed retrospectively.Results A total of 40587 hospitalized children with ARI eligible for inclusion of this study were tested for serum ADV-IgM,with a total positive rate of 1.9%(771/40587).The positive rates of ADV-IgM in 2012 to 2020 were 0.35%,5.31%,1.24%,0.17%,0.67%,1.49%,2.45%,1.92%and 1.67%,respectively.Among them,the positive rates of ADV-IgM in 2013 and 2018 were significantly higher than those in other years(χ^(2)=260.60,P<0.05).The positive rate of ADV-IgM in girls(2.09%)was significantly higher than that in boys(1.79%)(χ^(2)=4.36,P<0.05).The positive rates of ADV-IgM in toddler's age(2.68%)and preschool age(2.10%)were significantly higher than those in infancy(1.51%)and school age(1.23%)groups(P<0.05).The positive rate of ADV-IgM was higher in spring and summer(χ^(2)=34.44,P<0.05).The clinical diagnosis of 771 ADV-IgM positive children was mainly lower ARI(83.01%).The main clinical features were cough(85.73%),fever(72.76%),wheezing(16.99%),shortness of breath(6.10%)and wet rales(74.84%).Chest imaging showed increased and thickened markings of both lungs(83.01%)and patchy and cord like high-density shadows(42.97%)with varying degrees of unilateral or bilateral lesions.In children with ARI,simple ADV-IgM positive accounted for 15.05%,mixed infections accounted for 84.95%,and ADV combined with Mycoplasma pneumoniae accounted for 72.11%.Conclusions ADV was an important pathogen of children ARI in Hainan province.The infection rate of ADV in girls was higher than that in boys,and ADV infection tended to occur in toddler's age and preschool age.Although it could be detected throughout the year,ADV infection was more frequently occurred in spring and summer.ADV infection in ARI children mainly manifested as common pneumonia,and the clinical manifestations were not specific.Mixed infections were more often in ARI children with ADV infection;among which,ADV combined with Mycoplasma pneumoniae infections were more common.