天津市2007-2009年感染性腹泻病人诺如病毒感染状况分析

Norovirus infection and diarrhea from 2007 to 2009 in Tianjin,China

目的了解天津市诺如病毒(NV)腹泻发病状况及其临床和流行病学特征。方法在天津市不同区域设立5所医院,对就诊的成人和儿童其他感染性腹泻(除霍乱、细菌性和阿米巴性痢疾、伤寒和副伤寒以外的感染性腹泻)患者按设计的调查内容现场询问获得资料,同时收集患者粪便标本,采用ELISA方法检测NV抗原,并以RT-PCR方法做型别分析。结果 1 085例患者中129例检出NV抗原,阳性率为11.89%,其中≤5岁患者的阳性率达23.05%(68/295)。基因型以GⅡ为主,占80.62%(104/129)。感染不存在区域间的聚集性,冬春季节高发。散居儿童患者的阳性率达22.60%(66/292)。患者在发病15d内就诊可以检测出诺如病毒。NV腹泻患者每日腹泻的次数明显多于非NV腹泻患者,且多为水样便。便常规检测97.25%(813/836)的NV腹泻患者的白细胞数≤10/高倍镜视野(400倍)。结论天津市其他感染性腹泻患者中11.89%为NV所致,≤5岁患者该比例更高达23.05%,这已成为一个公共卫生问题。

Objective To investigate the norovirus infection status among patients with diarrhea and its clinical and epidemiological characteristics in Tianjin city,China.MethodsFive hospitals at different districts in Tianjin city were selected.The diarrhea patients were inquired to fill out a clinical and epidemiological questionnaire;and their stool samples were collected for detection of norovirus antigen by ELISA and genotyping by RT-PCR.ResultsAmong 1 085 diarrhea patients,129 patients were found norovirus antigen positive（11.89%） with the highest rate in the group of under five years（23.05%）.The incidence rate of norovirus diarrhea was higher in winter and spring but no significant district clusterings.Out of the 129 noroviruses positive specimens,GⅡ-type accounts for 80.62%.The norovirus antigen positive rate among scattered children patients was 22.60%.Norovirus can be detected within 15 days from the onset of diarrhea.Clinically,norovirus diarrhea（97.25% with detectable white blood cells in the stool specimen;WBC≤10/HPF） is more severe than non-norovirus patients.ConclusionsNorovirus diarrhea in Tianjin is a common public health problem and measures should be taken,especially for children under 5 years old.