2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究

Epidemiological study of pathogens leading to lower respiratory infection among hospitalized children in Shanghai,2011- 2014

目的分析近3年上海一家医院下呼吸道感染（LRTI）住院患儿中呼吸道合胞病毒（RSV）、腺病毒（ADV）、副流感病毒（PIV）、流感病毒（FLU）、人偏肺病毒（MV）、沙眼衣原体（CT）和肺炎支原体（MP）7种常见病原体的流行病学特征,为上海地区儿童LRTI的预防与诊治提供数据支持。方法收集2011年10月至2014年9月于复旦大学附属儿科医院就诊的LRTI住院患儿,取其鼻咽部抽吸物,使用直接免疫荧光法或实时荧光定量PCR技术检测上述7种呼吸道病原体,并对其流行病学特征行描述性分析。结果 3年的呼吸道病原体总检出率为44.0%（6 301/14 334）,MP的检出率最高（17.5%）,其次为RSV（13.9%）和PIV（5.6%）。男、女呼吸道病原体的总检出率差异无统计学意义（χ2=0.68,P=0.408）。0~6月龄患儿以RSV检出率最高,〉2岁患儿以MP检出率最高。RSV和CT随着年龄的增长检出率显著降低,MP的检出率随着年龄增长而显著升高。RSV的检出率高峰出现在冬季,夏季少见。ADV在春夏季检出率较高,而在秋季少见。PIV和MP检出率的高峰主要出现在夏季,FLU在1月份有暴发性的流行,MV的检出高峰主要出现在每年3月份;CT全年散发,无明显季节特征。病原体混合感染的总检出率为2.9%,在7~12月龄患儿中检出率最高,其中以MP合并其他病原体感染为主,最常见为MP＋RSV的混合感染。结论多种病原体导致上海地区儿童的LRTI,不同病原体显示出不同的流行季节、年龄分布等流行特征。

Objective An epidemiological study on respiratory syncytial virus（ RSV）,adenovirus（ ADV）,parainfluenza virus（ PIV）,influenza virus（ FLU）,human metapneumovirus（ MV）,chlamydia trachomatis（ CT） and mycoplasma pneumoniae（ MP） was conducted in hospitalized children with lower respiratory infection（ LRTI） in Shanghai. The objective of this study was to provide the basic data support for prevention,diagnosis and treatment of LRTI in children. Methods A total of 14 334 hospitalized children with LRTI from Children＇ s Hospital of Fudan University during October 2011 and September 2014 were enrolled,and nasopharyngeal aspirates（ NPA） were collected and tested by direct immunofluorescence assay（ DFA） or real time PCR,and then the epidemiological characteristics of different respiratory pathogens were analyzed. Results The total detection rate of respiratory pathogens was 44. 0%（ 6301 /14 334）. The most frequent detected pathogen was MP which accounted for 17. 5%（ 2 509 /14 334）,followed by RSV（ 1 996 /14 334,13. 9%） and PIV（ 803 /14 334,5. 6%）. The detection rate did not significantly differ between genders（ χ2= 0. 68,P = 0. 408）. The detection rates of pathogens had significant correlation with age and season. RSV was the most prevalent pathogen in the youngest children below or at 6 months old,while the most frequent detected pathogen in children over 2 years old was MP. The detection rates of RSV and CT significantly declined with age,meanwhile the detection rate of MP increased with age. RSV infection peaked in winter,but was rarely detected in summer. The detection of ADV increased in spring and summer,but was rarely detected in autum. PIV and MP infections peaked in summer.FLU caused an explosive epidemic in January of 2012 and 2014. The peak of MV occurred around March. CT activity was observed throughout the year without significant seasonality. Co-infection rate was 2. 6%（ 373 /14 334） and the highest rate of co-infection was found in children aged- 12 months. The combination of MP plus another pathogen was the most common co-infection and MP ＋ RSV was the predominant co-infection type. Conclusion A variety of pathogens lead to children＇ s lower respiratory tract infections in Shanghai. Different pathogens demonstrated different epidemiological pattern concerning seasons and ages distribution.