河南省2008年至2015年5岁以下儿童病毒性腹泻病原谱及流行病学分析

Etiological agents distribution and epidemiology of viral diarrhea in children below 5 years old in He＇ nan province, 2008--2015

目的分析2008年至2015年河南省5岁以下腹泻患儿轮状病毒（A、B、C组）、杯状病毒（诺如病毒Ⅰ/Ⅱ型、札如病毒）、星状病毒及肠道腺病毒的感染状况及病原学、流行病学特征。方法采集河南省4个监测哨点医院5岁以下腹泻患儿的粪便样本2 541份，双抗体夹心法检测A组轮状病毒，A组轮状病毒G/P基因分型采用套式PCR，采用二步法多重反转录（RT）-PCR检测B、C组轮状病毒、杯状病毒、星状病毒和肠道腺病毒。结果2 541份腹泻样本中共检出阳性样本1 421份（包括混合感染样本102份），总阳性率为55.9%。检出轮状病毒914份（A组785份，B组36份，C组93份），阳性率为36.0%；检出杯状病毒308份（诺如病毒Ⅰ型64份，诺如病毒Ⅱ型193份，札如病毒51份），阳性率为12.1%；检出星状病毒151份，阳性率5.9%；检出肠道腺病毒48份，阳性率为1.9%。A组轮状病毒型别以G9[8]、G1P[8]、G3P[8]、G2P[4]为主，G9P[8]为优势型别，每年9月至11月和3月至5月为感染季节；杯状病毒以诺如Ⅱ型为主，3月至5月为感染季节。4～12月龄婴儿主要感染轮状病毒，3～5岁幼儿主要感染杯状病毒。临床症状均存在不同程度的发热、腹泻、呕吐、脱水等症状，性别及地区分布存在病原学差异。结论河南省5岁以下腹泻患儿以感染A组轮状病毒和诺如病毒Ⅱ型为主。不同类别病毒感染呈现不同的流行病学及临床特点。

Objective To investigate the infectious status, etiological spectrum and epidemiological characteristics of rotavirus （group A/B/C）, cahcivirus （novovirus Ⅰ / Ⅱ , sapovirus）, astrovirus and enteric adenovirus in diarrhea cases below 5 years old from 2008 to 2015 in Henan provinces. Methods Totally 2541 stool samples were collected from cases below 5 years old in four sentinel hospitals. All stool specimens were tested for group A rotavirus by double antibody sandwich ELISA method. G/P genotyping of group A rotavirus was determined by nested multiplex PCR. Viral RNA was extracted from all samples and rotavirus （group B/C）, calicivirus, astrovirus and enteric adenovirus were detected by two-step reverse transcription-polymerase chain reation （RT-PCR）/PCR. Results One thousand four hundred and twenty-one out of 2 541 samples were positive with a total positive rate of 55.9%, among which, 102 were mixed infection. The isolation rate of rotavirus was 36.0% （914 samples） （group A： 785 cases, group B： 36 cases, group C： 93 cases）, calieivirus was 12.1% （308 samples） （novovirus Ⅰ ： 64 cases, novovirus Ⅱ ： 193 cases, sapovirus： 51 cases）, astrovirus was 5.9% （151 samples）, enteric adenovirus was 1.9% （48 samples）. The group A rotavirus gene type combinations were composed mainly of G9P[8], G2P[4], G3P[8], G1P[8] and most cases were identified from September to November and March to May. Novovirus Ⅱ was predominant in calicivirus and most cases were identifed between March and May. Rotavirus or calicivirus infection was mainly among children aged 4--12 months or 3 5 years, respectively. Clinical manifestations included fever, diarrhea, vomiting, dehydration. Gender and region distributions differed according to the types of pathogen. Conclusions Group A rotavirus and novovirus Ⅱ are the major viral pathogen in diarrhea cases younger than 5 years old in Henan province. Different viral infections exhibit extinct epidemiologic and clinical characteristics.