儿童医院呼吸道合胞病毒感染的流行病学特征及控制措施

Epidemiological characteristics of hospital-acquired respiratory tract infection with syncytial virus in children and control measures

目的分析儿童医院呼吸道合胞病毒(HA-RSV)感染的流行病学特征及感染控制措施,为临床有效防治提供依据,防止医院内暴发流行。方法调查2005年1月-2011年12月HA-RSV感染患儿的流行病学资料,分析感染控制措施的有效性。结果 82例患儿年龄1~29月龄,中位年龄7月龄;原发病以腹泻为主,32例占39.0%,其次为婴儿肝炎综合征30例占36.6%和急性下呼吸道感染15例占18.3%;23例患儿占28.0%有基础疾病;临床诊断毛细支气管炎占50.0%,肺炎占36.6%和支气管炎占13.4%;HA-RSV感染全年均可发病,其中秋冬季发病63例占76.8%;8例占9.8%患儿因病情加重转入PICU,有基础疾病患儿入住PICU的比例明显高于无基础疾病患儿(P<0.005);对确诊HA-RSV感染的患儿实施接触隔离、分组护理、减少探视、加强手卫生和环境、物品消毒等措施后,感染得到控制,71例治愈86.8%,11例好转出院13.4%,无死亡病例。结论 HARSV感染好发于1岁以内,尤其是3月龄以内的婴儿,以秋冬季发病为多,主要表现为毛细支气管炎;有基础疾病者病情较重,入住PICU比例较高,总体预后良好;及时隔离患儿、分组护理、严格执行手卫生和消毒措施,对于控制HA-RSV感染的蔓延起着关键的作用。

OBJECTIVE To analyze the epidemiological characteristics of hospital-acquired respiratory tract infections with syncytial virus （HA-RSV） in children in the children and put forward control measures so as to provide bases for effective clinical treatment and prevention of the infections. METHODS The epidemiological data of the children x with confirmed HA-RSV infections who were treated in the hospital from Jan 2005 to Dec 2011 were investigated, then the effectiveness of the infection control measures was analyzed. RESULTS Totally 82 children were aged between 1 and 29 months, with the median age of 7 months, among which there were 32 （39. 0%） cases of diarrhea, 30 （36.60%） cases of infantile hepatitis syndrome, and 15 （18.3%） cases of acute lower respiratory tract infections. There were 23 （28.0%） cases of complicated underlying diseases, among which the cases of bronehiolitis accounted for 50.0%, the cases of pneumonia 36.6%, the cases of bronchitis 13.4%. The HA-RSV infections occurred through the whole year, with the peak in autumn and winter （63 cases, 76.8%）; 8（9.8%） cases were transferred to pediatric intensive care unit （PICU） due to the aggravation of illness; the proportion of the cases who were hospitalized the PICU was significantly higher among the subjects with primary diseases than among those without primary diseases（P^0. 005）. The confirmed HA-RSV infections have been under control through the contact isolation, grouping nursing, enhancement of hand hygiene, and disinfection of environment and objects. Totally 71 （86.8~/00） cases were cured, 11 （13.4~/oo） cases were improved and discharged, and no case died. CONCLUSION The HA-RSV infection is prone to occur in the children aged less than one year, especially the neonates aged less than three months, with the peak of incidence in autumn and winter; the major clinical manifestation is bronchiolitis; the condition of the children with underlying disease is more severe, with higher proportion of PICU stay, and the prognosis is good as a whole; the timely isolation, grouping nursing, and strict implementation of hand hygiene and disinfection measures are crucial to the control of spread of HA-RSV infections.