中国河北省卢龙县儿童轮状病毒腹泻研究

Rotavirus Diarrhea among Children in Lulong County,Hebei Province,China

轮状病毒是我国儿童重症腹泻的主要病原。按照WHO轮状病毒监测方案,于1999年7月至2003年6月,在河北省卢龙县开展了医院和社区为基础<5岁儿童轮状病毒腹泻的监测。结果表明:卢龙县<5岁儿童腹泻的发病率为1 3次/人/年。4年中全县共有2350名<5岁急性腹泻患儿住院,占所有住院儿童的38%(2350/6213)。住院的腹泻患儿每年有两个高峰,一个是夏季(6～8月),占全年腹泻住院病例的22%;另一个在冬季(12月至次年2月),占58%。住院的轮状病毒腹泻只有一个高峰,是在冬季(12月至次年2月),高峰期的轮状病毒腹泻住院患儿数占全年轮状病毒腹泻患儿住院数的86%。按全年统计,轮状病毒腹泻占住院腹泻患儿的46%,轮状病毒腹泻的住院率为11/1000儿童/年。在门诊腹泻患儿中轮状病毒腹泻患儿占28%,在社区腹泻患儿中轮状病毒腹泻占10%。轮状病毒毒株的分布,G3型(45%)最常见,其次为G1型(35%)、G2型(8%)、G4型(3%)、G9型(0 6%),混合感染较少(1%)。还有8%的毒株未能分出型别。在轮状病毒腹泻患者中,9～11月龄的儿童检出率最高(53%),其次是12～17月龄(51%)、18～23月龄(36%)和6～8月龄(30%)。在4年研究期间共有5～10名1～59月龄儿童可能因为轮状病毒腹泻死亡,其中有1例确诊为P[8]G1型毒株感染。初步估计。

Rotavirus is the leading cause of severe gastroenteritis among children in China.We conducted community-based and hospital-based surveillance for rotavirus disease in children <5 years old in Lulong County,a rural farming area in Northern China.Fecal specimens were collected and tested using a rotavirus enzyme immunoassay(IDEIA,DAKO,United Kingdom).Rotavirus strains were G serotyped and P genotyped by reverse transcription-polymerase chain reaction. From July 1999 to June 2003,in total,(2 350) inpatients with acute diarrhea were enrolled,accounting for 38%((2 350)/(6 213)) of children hospitalizations in Lulong hospitals. Rotavirus was the most common etiologic agent of diarrhea identified;46% of inpatients,28% of outpatients,and 10% of children treated by village doctors had laboratory-confirmed rotavirus diarrhea. Rotavirus G serotyping results identified G3(45%) to be the most common strain, followed by G1(35%),G2(8%),G4(3%) and G9(0.6%).Mixed infections(1%) were rare,and 8% of the strains remained untypeable.The incidence of diarrhea in children under 5 years old was 1.3 episodes/child/year.Among rotavirus diarrhea hospitalizations,virus detection rate was the highest in infants aged 9-11 months(53%),followed by 12-17 months(51%),18-23 months (36%), 6-8 months(30%) and 95% of all rotavirus episodes occurred in the first 2 years of life. The annual rate of rotavirus-associated hospitalization was 11/(1 000) in children <5 years old.Eleven diarrhea-associated deaths occurred during the study period accounting for 11% of the total 1-59 months old childrens' deaths in Lulong County.Five to ten of these 11 deaths possibly were caused by rotavirus. The estimated mortality rate of rotavirus diarrhea was 5～10/(100 000) in children of 1-59 months old. So, in Lulong County,childhood diarrhea and rotavirus cause substantial morbidity and mortality among children.Additional public health interventions to prevent serious diarrhea due to rotavirus in children should be considered including use of new rotavirus vaccines with demonstrated safety and efficacy.