2014-2015年河北省5岁以下婴幼儿病毒性腹泻病原学监测及流行特征分析

Analysis on surveillance and epidemiological characteristics of viral diarrheal disease among children under five years old in Hebei Province, 2014-2015

目的 了解河北省5岁以下婴幼儿病毒性腹泻病原构成及流行特点,为病毒性腹泻的防治提供参考依据.方法 收集河北省哨点医院2014年1月-2015年12月0-59月龄腹泻患儿粪便标本686份,同时填写个案调查表,采用ELISA方法检测轮状病毒（HRV）,采用PCR或RT-PCR法检测杯状病毒（HuCV）、星状病毒（HAstV）和肠道腺病毒（HAdV）,并对轮状和杯状阳性标本进行分型鉴定.结果 686份标本病毒性病原总检出率64.14％ （440/686）,2014年62.71％（222/354）,稍低于2015年的65.66％ （218/332） （x2=0.649,P=0.421）,其中单纯轮状、杯状、星状和肠道腺病毒检出率分别为35.13％（241/686）、11.37％（78/686）、1.75％（12/686）和4.96％（34/686）,合并感染率10.93％（75/686）（合并2种69份,合并3种6份）.轮状病毒阳性检出率以13-24月龄最高（x2=22.289,P＜0.001）,随月龄增长呈现先升高后降低趋势,且季节性分布明显,秋冬季（11月-次年2月）高发,以G9P[8]型为主（87.95％,270/307）.杯状病毒全年呈多峰分布,3-6月份检出率较高,2015年（24.70％,82/332）高于2014年（13.56％,48/354）（x2=13.841,P＜0.001）.结论 河北省5岁以下儿童病毒性腹泻病原复杂,混合感染比例较大,轮状病毒为主要致病病原体,该病毒主要侵犯2岁以下儿童,秋冬季高发,其中G9P[8]型成为本地区主要流行株.

Objective To explore the etiological spectrum of viral diarrhea and its epidemiological characteristics among infants/children under five years old in sentinel hospitals in Hebei province in order to provide targeted scientific basis for the prevention and control of viral diarrhea.Methods 686 stool specimens and epidemiological data were collected from hospitalized children less than 5 years old with diarrhea in Hebei province from January 2014 to December 2015.Rotavirus（HRV） was detected by ELISA.Caliciviruses（HuCV）,adenovirus（HAdV） and astrovirus（HAstV） were detected by PCR or RT-PCR.Meanwhile,the serotype/genotype were identified on those HRV and HuCV positive specimens.Results A total of 686 stool samples were collected and detected with an overall detection-positive rate of 64.14% （440/686）.The overall viral-positive rate in 2014 were 62.71% （222/354）,which was lower than 2015（65.66%,218/ 332） （x2 =0.649,P =0.421）.The detection-positive isolation rate of HRV,HuCV,HAstV and HAdV were 35.13% （241/686）,11.37% （78/686）,1.75% （12/686） and 4.96% （34/686）,respectively.Mixed infections with multiple enteric viruses were present in 10.93% （75/686） （69 with two,6 with three） of all samples.The positive detection rate of HRV was higher in children aged between 13-24 months than children of other age group（x2 =22.289,P 〈0.001） and was up-regulated from 0 ～ 12 month but down-regulated from 12 ～ 59 month.Moreover,there were remarkable seasonal distributions of HRV infections and the rotavirus diarrhea predominated in autumn and winter （from November to February of next year）.G9P [8] was the most common genotype,87.95%,270/307） among 307 rotavirus positive samples.However,the positive detection rate of HuCV presented a multimodal distribution,which scattered predominantly from March to June.The positive detection rate of HuCV in 2015 was 24.70% （82/332）,which was significant higher than that in 2014（13.56%,48/354） （x2 =13.841,P 〈 0.001）.Conclusions The etiological spectrum of viral diarrhea among children under five years old in Hebei was diverse.Co-infections was observed in a relative proportion.Rotavirus was the predominant pathogen.The children less than 2 years old were predominantly infected.Besides,the season peak of rotavirus occurred in autumn and winter.Rotavirus G9P[8] genotype had become a major strains in Hebei.