庆阳市14岁以下儿童急性上呼吸道病原体感染及流行病学分析

Pathogen detection and epidemiological analysis of acute upper respiratory tract infection in children under 14 years old in Qingyang City

目的了解甘肃省庆阳市人民医院因急性上呼吸道感染入院儿童的病原谱信息,为本地呼吸道疾病预防诊断提供参考依据。方法采取2019年12月至2020年11月共472份急性呼吸道症状血清样本,用间接免疫荧光法(indirect immunofluorescence assay, IFA)检测9项上呼吸道病原体IgM抗体,包括常见肺炎支原体(Mycoplasma pneumoniae, MP)、乙型流感病毒(influenza B virus, INFB)、腺病毒(adenovirus, ADV)、副流感病毒(parainfluenza virus, PIVs)、呼吸道合胞病毒(respiratory syncy-tial virus, RSV)、甲型流感病毒(influenza A virus, INFA)、肺炎衣原体(Chlamydia pneumoniae, CPn)、嗜肺军团菌血清1型(Legionella pneumophila serogroup 1, LP1)和Q热立克次体(Coxiella burneti, COX)并进行流行病学分析。结果在472份样本中,病原体阳性样本309例,阳性率65.47%。MP感染153例,阳性率49.51%,COX未检出。1种病原体感染218例,阳性率70.55%;混合感染2种及其以上91例,阳性率29.45%;2种病原体感染中,MP合并其他占比最高。西峰区阳性样本最多,有62例,阳性率为20.06%;正宁县最少,有14例,阳性率是4.53%。MP阳性率最高样本中,环县MP阳性率9.71%最高,正宁县仅为1.29%。一年四季均有急性上呼吸道病原体感染,冬季感染阳性样本最多,有132例,阳性率42.72%;MP阳性率高达24.60%;夏季急性上呼吸道病原体阳性率较其他季节低,仅13.92%,但PIVs阳性率较高,比其他季节PIVs阳性率要高,为4.53%;阳性率季节差异有统计学意义(χ^(2)=49.391,P<0.05)。幼托儿童人群阳性率最高,占74.11%;初中生最低为0.97%;不同人群阳性率差异有统计学意义(χ^(2)=49.850,P<0.05)。不同年龄组分布以>0~6月龄组阳性率最高,为35.60%;3~14岁组较低,仅占9.39%;4个年龄组中,MP阳性率最高,不同年龄组MP阳性率差异有统计学意义(χ^(2)=16.734,P<0.05)。结论庆阳市急性上呼吸道感染以MP、INFB、ADV病原体为主,混合感染又以MP混合其他病原体为主,不同区县病原体阳性率差异很大,冬季病原体阳性率最高,>0~6月龄儿童和幼托儿童易感染急性上呼吸道病原体。

Objective To evaluate the pathogen spectrum of children admitted to Qingyang People’s Hospital due to acute upper respiratory tract infection, and to provide a reference for prevention and diagnosis of local respiratory disease. Methods A total of 472 serum specimens with acute respiratory symptoms were collected from December 2019 to November 2020. Indirect immunofluorescence assay was used to detect IgM antibodies against 9 upper respiratory pathogens, including Mycoplasma pneumoniae(MP), influenza B virus(INFB), adenovirus(ADV), parainfluenza virus(PIVs), respiratory syncytial virus(RSV), influenza A virus(INFA), Chlamydia pneumoniae(CPn), Legionella pneumophila serogroup 1(LP1) and Coxiella burnetii(COX), and epidemiological analysis was conducted. Results 309 of 472 specimens for all detected samples were positive, and the positive rate was 65.47%. Among them, the positive rate of MP was the highest(49.51%, 153 specimens), and COX was not detected;single pathogen infection was found in 218 specimens(70.55%) and mixed infection was detected in 91 specimens(29.45%);co-infection was mainly combined with MP and others. The positive rate of pathogens was highest in Xifeng District(20.06%, 62 specimens) and lowest in Zhengning County(4.53%, 14 specimens);the area with highest incidence of MP belonged to Huan County(9.71%) and lowest to Zhengning County(1.29%). The epidemic peak appeared in winter(42.72%, 132 specimens), with a highest positive rate of MP(24.60%);the nadir was in summer(13.92%), and unexpectedly the positive rate of PIVs in this reason was higher than other seasons(4.53%). The differences of positive rate between seasons were statistically significant(χ^(2)=49.391,P<0.05). Among different population distributions, the positive rate of pathogens in kindergarten children was the highest(74.11%), while the positive rate of junior high school children was the lowest(0.97%), with statistical significance(χ^(2)=49.850,P<0.05). Likewise, among different age groups, the highest positive rate of pathogens was in children > 0-6 months old(35.60%), and the lowest in group 3-14 years old(9.39%);for all four age groups, the positive rate of MP was the highest, and the differences between them were statistically significant(χ^(2)=16.734,P<0.05). Conclusion The main pathogens of acute upper respiratory tract infection in Qingyang were MP, INFB, and ADV, and co-infections were mainly MP mixed with others. The positive rate of pathogens in winter was highest. Children aged >0-6 months and children in kindergartens were susceptible to those diseases.