上海地区小儿急性病毒性下呼吸道感染临床流行病学特征

The epidemiologic feature of viral infection in the children with acute lower respi-ratory tract infections in Shanghai

目的了解近年上海地区小儿急性病毒性下呼吸道感染的流行特征。方法采用直接免疫荧光法(DIF),对2002年10月-2004年4月住院的4534例0～16岁呼吸道感染患儿鼻咽分泌物进行6种病毒检测。结果4534例患儿中有1837例病毒检测阳性,总阳性率40.5%。呼吸道合胞病毒(RSV)检出最多,为831例(45.2%),其余依次为流感病毒A(IFVA)330例(18.0%),副流感病毒1、3(PIV1,3)232例(12.6%),流感病毒B(IFVB)201例(10.9%),副流感病毒2(PIV2)114例(6.2%),腺病毒(ADV)96例(5.2%)和混合感染33例(1.8%)。7个月～1岁年龄组阳性率最高,为65.8%,3岁以下儿童阳性率为88.7%。RSV阳性患儿的平均月龄为5个月(0.1～156个月),明显低于其他病毒阳性的患儿。RSV季节性较明显,2003和2004年高峰主要集中在1-2月份,2004年的高峰在2003年12月份提前出现。IFVA,IFVB在2002年10-12月份有一个小高峰。毛细支气管炎病毒阳性率为53.4%,其中RSV占79.5%,IFVA13.5%,PIV22.6%,ADV2.6%。肺炎、支气管炎、喉气管支气管炎、有喘息症状的支气管炎和哮喘患儿病毒阳性率分别为41.3%、35.3%、40.3%、42.5%和36.5%。结论病毒依然是上海地区小儿下呼吸道感染的主要病原。发病年龄主要在婴幼儿,其中RSV和IFVA最常见。毛细支气管炎主要病原仍是RSV。IFVA多见于其他有喘息症状的患儿。

Objective To understand the epidemiologic feature of viral infection in the children with acute lower respiratory tract infections in Shanghai. Methods From October 2002 to April 2004, a total of 4 534 hospitalized children with acute respiratory tract infection were studied. Nasopharyngeal aspirates were screened for virus by direct immunofluorescent (DIF) assay. Results Virus was identified in 1 837 patients (~40.2% ), 1 630 (~88.7% ) of them were under 3 years of age. The most prevalent was respiratory syncytial viruses (RSV) (831, ~45.2% ), followed by influenza A (330, 18.0%), parainfluenza 1, 3 (232, ~12.6% ),influenza B (201, ~10.9% ), parainfluenza 2 (114, ~6.2% ),adenovirus (96, ~5.2% ) and mixed viral infection (33, ~1.8% ). The children with RSV infection was younger (median age 5 months, range ~0.1 -156 months) than those with other viral infection. The seasonal change of RSV was more obvious. The peak of RSV appeared from January to February in 2003 and 2004. Influenza A and B also had a small peak from October to December in 2002. Positive rate of virus was 53.4% in children with bronchiolitis. RSV accounted for 79.5%, followed by influenza A (~13.5% ),parainfluenza 2 (~2.6% ) and adenovirus (~2.6% ). The prevalence of viral infection in children with pneumonia, bronchitis, laryngotracheobronchitis, asthmatic bronchitis and asthma were ~41.3% , ~35.3% , ~40.3% , ~42.6% and ~36.5% respectively. Conclusions The respiratory viruses are still a main cause of lower respiratory tract infections in children, especially in infants and younger children, in Shanghai. RSV and influenza A was the most common viruses in these years. Both RSV and influenza had their own seasonality in epidemic. RSV remains the main pathogen of bronchiolitis, while influenza A was prominent in the patients with ‘wheezing’ symptom.