儿童流感样疾病患者病毒病原学检测及流行病学特征分析

Etiological detection and epidemiological analysis of children with influenza-like illness

目的分析门诊流感样疾病患儿呼吸道病毒感染情况及流行病学特征,为本地区流感样疾病患儿的防治提供依据。方法采集2021年7月至2022年3月因流感样疾病在浙江大学医学院附属儿童医院发热门诊就诊患儿的鼻咽拭子标本,采用逆转录聚合酶链反应法(RT-PCR)对6种呼吸道病毒核酸进行检测。收集患儿一般信息(性别和年龄),按性别和年龄(0~<6个月、6~<12个月、1~<3岁、3~<6岁和≥6岁)分组,采用χ2检验对各组间进行统计学分析,探究呼吸道病毒流行规律。结果1609例流感样疾病患儿标本共检出呼吸道病毒739例(45.9%,739/1609),其中单纯感染检出651例(40.5%,651/1609),多重感染检出88例(5.5%,88/1609)。呼吸道合胞病毒(RSV)检出率居首位,为18.6%(300/1609),其次是乙型流感病毒(FluB)为11.9%(192/1609)、腺病毒(ADV)为8.3%(134/1609)、副流感病毒3型(PIV-3)为7.6%(123/1609)、副流感病毒1型(PIV-1)为4.9%(79/1609)、甲型流感病毒(FluA)为0.4%(6/1609)。多重感染形式为双重或三重感染,双重感染81例(92.0%,81/88),最常见是ADV+RSV(22.7%,20/88),三重感染7例(8.0%,7/88)。各年龄组间病毒检出率差异有统计学意义(χ2=17.078,P=0.002),以3~<6岁组病毒检出率最高(49.7%,286/575)。单一病毒感染检出中,FluB以≥6岁组患儿检出率最高(26.6%,98/369),RSV和PIV-1以3~<6岁组患儿检出率最高(20.0%,115/575;5.9%,34/575);每月病毒总检出率从7月26.8%(37/138)升至次年1月63.0%(58/92),2月和3月下降至46.1%(106/230)和26.8%(37/138)。RSV在8—11月检出率最高,FluB在12月至次年3月检出率最高,ADV在12月和次年1月检出率上升,PIV-3在10—12月检出率上升;PIV-1检出率无明显波动,FluA散在检出。结论流感样疾病患儿呼吸道病毒感染以RSV为主,大多数呼吸道病毒以单纯感染形式存在,多重感染以双重感染多见。FluB、RSV和PIV-1感染呈现一定的年龄分布特征,尤其在3岁以上的患儿感染率更高。呼吸道病毒感染流行特征呈现出夏季到秋冬季逐渐流行达到高峰,春季转而流行下降的特征。RSV在秋季相对流行,FluB在冬春季流行,ADV和PIV-3在冬季不同程度流行,PIV-1则持续低水平流行,FluA未呈现流行特征。

Objective To analyze the status and epidemiological characteristics of respiratory virus infection in children with influenza-like illness in outpatient department,and to provide evidence for the prevention and treatment of children in this area.Methods Nasopharyngeal swab samples were collected from children who attended the fever clinic of The Children′s Hospital,Zhejiang University School of Medicine due to influenza-like illness from July 2021 to March 2022,and six common respiratory virus nucleic acids were detected by reverse transcription-polymerase chain reaction(RT-PCR).The general information of the children was collected and grouped by gender and age(0-<6 months,6-<12 months,1-3<year-old,3-<6 year-old,and≥6 year-old),and the chi-square test was used for statistical analysis between the groups to explore the epidemic pattern of respiratory viruses.Results A total of 739 cases(45.9%,739/1609)of respiratory viruses were detected from children with influenza-like illness,including 651 cases(40.5%,651/1609)of simple infection and 88 cases(5.5%,88/1609)of multiple infections.Respiratory syncytial virus(RSV)was detected in 18.6%(300/1609),followed by influenza B virus(FluB)in 11.9%(192/1609),adenovirus(ADV)in 8.3%(134/1609),parainfluenza virus type 3(PIV-3)in 7.6%(123/1609),parainfluenza virus type 1(PIV-1)in 4.9%(79/1609),and influenza A virus(FluA)in 0.4%(6/1609).Multiple infections including double or triple infections,with 81(92.0%,81/88)cases of double infection and the most common being ADV+RSV(22.7%,20/88)and 7(8.0%,7/88)cases of triple infection.There was a significant difference in the virus detection rate between the age groups(χ²=17.078,P=0.002),with the highest virus detection rate in the 3-<6 years of age group(49.7%,286/575).Among the detection of simple infection,FluB had the highest detection rate in the≥6 years of age group(26.6%,98/369),and RSV and PIV-1 had the highest detection rate in the 3-<6 years of age group(20.0%,115/575 and 5.9%,34/575).The total monthly virus detection rate increased from 26.8%(37/138)in July to 63.0%(58/92)in January,and decreased to 46.1%(106/230)and 26.8%(37/138)in February and March.The detection rate of RSV was the highest from August to November,the detection rate of FluB was the highest from December to March,the detection rate of ADV increased in December and January,and the detection rate of PIV-3 increased from October to December;the detection rate of PIV-1 did not fluctuate significantly,and FluA was sporadically detected.Conclusions RSV is the main respiratory virus in children with influenza-like illness.Most respiratory viruses are present as single infections.Multiple infections are more common in double infections.FluB,RSV and PIV-1 infections showed certain age distribution characteristics,especially in children over 3 years of age.The epidemic characteristics of respiratory virus infection show that the epidemic gradually peaks from summer to autumn and winter,and turns into an epidemic decline in spring.RSV was relatively prevalent in autumn,FluB was prevalent in winter and spring,ADV and PIV-3 were prevalent to varying degrees in winter,PIV-1 continued to circulate at a low level,and FluA did not present epidemic characteristics.