2018—2019年昆明市发热呼吸道综合征患者人呼吸道腺病毒的初步基因分型及流行特征分析

Preliminary genotyping and epidemiological analysis of human respiratory adenovirus in patients with febrile respiratory syndrome from 2018 to 2019 in Kunming city of China

目的了解2018—2019年云南省昆明市人呼吸道腺病毒(human adenovirus, HAdV)流行病学特征及其基因分型特征,为下一步防控工作提供科学依据。方法对云南省2018年1月1日—2019年12月31日昆明市6家哨点医院收集的650份发热呼吸道综合征监测病例标本进行实时逆转录-聚合酶链反应(real-time reverse transcription polymerase chain reaction, real-time RT-PCR)并筛选腺病毒阳性样本,使用Hep-2细胞对阳性标本进行病毒分离,用SPSS 20.0软件对数据进行统计学分析。对成功分离的腺病毒毒株进行hexon基因片段测序,使用MEGA5.0进行序列分析。结果 650份发热呼吸道综合征病例样本中共检测出50份腺病毒阳性,阳性检出率为7.69%(50/650)。经分离培养成功获得24株腺病毒毒株,分离率为48.00%(24/50)。其中1型占8.33%(2/24),2型占16.67%(4/24),3型占33.33%(8/24),5型占8.33%(2/24),7型占29.17%(7/24),未分型占4.17%(1/24)。男性腺病毒阳性检出率为8.27%(31/375),女性腺病毒阳性检出率为6.91%(19/275),不同性别阳性检出率差异无统计学意义(χ^(2)=0.412,P=0.554);鼻咽拭子腺病毒阳性检出率为7.13%(41/575),支气管肺泡灌洗液、痰液阳性检出率为12.00%(9/75),不同样本类型阳性检出率差异无统计学意义(χ^(2)=2.216,P=0.163);各年龄组阳性检出率差异有统计学意义(χ^(2)=12.347,P=0.006),最高的为<5岁年龄组(10.26%,35/341);9种不同职业间阳性检出率差异有统计学意义(χ^(2)=17.896,P=0.022),最高的职业类型是幼托儿童(13.10%,22/168);不同类型医院阳性检出率差异有统计学意义(χ^(2)=20.467,P<0.01),非综合医院(13.28%,36/271)高于综合医院(3.69%,14/379);不同发病月份阳性检出率差异有统计学意义(χ^(2)=7.872,P=0.049),夏季最高(13.19%,12/91),其次是秋季(9.66%,17/176)。结论 2018—2019年云南省昆明市腺病毒感染人群主要以5岁以下幼托儿童为主,随着年龄的上升,阳性检出率降低,检出高峰在夏季,非综合医院阳性检出率高于综合医院。

Objective To understand the epidemiological characteristics and genotypes of human respiratory adenovirus(HAdV) in Kunming city of China from 2018 to 2019. Methods A total of 650 respiratory samples of febrile respiratory syndrome cases were collected in 6 sentinel hospitals from January 1, 2018 to December 31, 2019 in Kunming city of China.Real-time RT-PCR was employed to detect HAdV from these samples.Hep-2 cells were used for viral isolation from positive specimens.SPSS 20.0 was used to analyze the data.Those successfully isolated HAd Vstrains were sequenced with hexon gene fragments, and MEGA5.0 was used for sequence analysis. Results A total of 50 HAd V positive specimen were detected from 650 samples of febrile respiratory syndrome cases, and the positive rate was 7.69%(50/650) and among which, 24 strains of HAd Vwere successfully isolated, with an isolation rate of 48.00%(24/50).Among them, HAd V1-accounted for 8.33%(2/24), HAd V2-16.67%(4/24), HAd V3-33.33%(8/24), HAd V5-8.33%(2/24), HAd V7-29.17%(7/24), untyped HAd V4.17%(1/24).The positive rate of HAd Vwas 8.27%(31/375) in males and 6.91%(19/275) in females(χ^(2)=0.412, P=0.554).The positive rate of adenovirus in nasopharyngeal swabs was 7.13%(41/575), and that in bronchoalveolar lavage fluid and sputum was 12.00%(9/75) χ^(2)=2.216, P=0.163.The difference in the positive detection rate of each age group was statistically significant(χ^(2)=12.347, P=0.006), and the highest rate(10.26%, 35/391) was in the <5 years old group.There was a statistically significant difference in the positive detection rate among 9 different occupations(χ^(2)=17.896, P=0.022) with the highest positive rate(13.10%, 22/168) in the kindergarten children.The difference in positive detection rates in different types of hospitals was statistically significant(χ^(2)=20.467, P<0.01), and positive detection rate of non-general hospitals(13.28%, 36/271) are higher than that in general hospitals(3.69%, 14/379).There was a peak of influenza in summer throughout the year and the difference in positive detection rate in different months was statistically significant(χ^(2)=7.872, P=0.049) with a peak in the summer(13.19%, 12/91), followed by autumn(9.66%, 17/176). Conclusions During 2018 and 2019, the HAd Vinfected-population in Kunming city of China mainly concentrates in children under 5 years old in kindergartens.With the increase of age, the positive detection rate decreases.The detection peak is in summer, and the positive detection rate in non-general hospitals was higher than that in general hospitals.The prevalent strains are HAd V3-and HAd V7-, and HAd V1-, HAd V2-, and HAd V5-viruses are also scattered.