新型冠状病毒感染“乙类乙管”前后深圳市急性呼吸道感染儿童常见11种病原体变化分析

Analysis of 11 common pathogens spectrum in children with acute respiratory tract infection before and after COVID-19 under “the level B of management for class B”of infectious diseases:A cross-sectional survey

目的 分析新型冠状病毒感染(COVID-19)“乙类乙管”前后急性呼吸道感染(ARTI)住院患儿的病原学特征和病原谱的变化,为临床诊治及防控提供依据。方法 以2022年1月8日至2022年7月30日的数据作为“乙类乙管”前、2023年1月8日至2023年7月30日的数据作为“乙类乙管”后,回顾性分析“乙类乙管”前后,在深圳市儿童医院收治住院的ARTI患儿COVID-19和流感病毒、呼吸道合胞病毒、肺炎支原体等常见11种病原体检出情况。结果 ARTI住院患儿SARS-CoV-2核酸阳性共检出347例,“乙类乙管”前检出225例,合并检出其他病原体29例(12.89%,29/225),以HPIV最常见(31.03%,9/29);“乙类乙管”后检出122例,合并检出其他病原体28例(22.95%,28/122),以RSV最常见(28.57%,8/28),“乙类乙管”前后SARS-CoV-2核酸阳性合并其他病原体检出率差异有统计学意义(χ^(2)=5.834,P=0.016)。“乙类乙管”后春季(2023年1月8日至2023年4月30日)病原总检出率(至少1种病原体阳性)为60.82%(2 864/4 709),以IVA(22.64%,1 066/4 709)、HRV(19.86%,935/4 709)、RSV(13.29%,626/4 709)为主,混合感染301例(6.39%,301/4 709);夏季(2023年5月1日至2023年7月30日)病原总检出率为70.26%(4 012/5 710),以RSV(21.63%,1 235/5 710)、MP(13.91%,794/5 710)、HPIV(10.05%,574/5 710)为主,混合感染710例(12.43%,710/5 710),均显著高于“乙类乙管”前同期,差异具有统计学意义(P<0.05)。结论 COVID-19“乙类乙管”后ARTI病原总检出率显著升高,检出病原谱发生了明显变化。

Objective To analyze the etiological characteristics and the variation of pathogens spectrum in hospitalized children with acute respiratory tract infection(ARTI) before and after COVID-19 under “the level B of management for class B” of infectious diseases(Level B for Class B) in Shenzhen,in order to provide reference for the clinical diagnosis,treatment and prevention of ARTI.Methods The ARTI cases from January 8,2022 to July 30,2022 were selected as before “Level B for Class B”,and the cases from January 8,2023 to July 30,2023 were selected as after “Level B for Class B”.The pharyngeal swab samples submitted for analyzing 11 common pathogens,such as COVID-19,influenza virus(IV),respiratory syncytial virus(RSV) and mycoplasma pneumoniae(MP) in the children with ARTI admitted to Shenzhen Children′s Hospital.Results SARS-CoV-2 were detected as positive in 347 cases,among which 225 cases were before “Level B for Class B” including 29 cases combined with other pathogens(12.89%,29/225) and human parainfluenza viruses(HPIV) was the most common(31.03%,9/29).After “Level B for Class B”,SARS-CoV-2 were detected as positive in 122 cases,including 28 cases combined with other pathogens(22.95%,28/122),and RSV was the most common(28.57%,8/28).There was a statistical difference between the positive rate of SARS-CoV-2 combined with other pathogens before and after “Level B for Class B”(χ^(2)=5.834,P=0.016).After “Level B for Class B”,the total pathogen detection rate(positive for at least one pathogen) was 60.82%(2 864/4 709) in the spring(January 8,2023 to April 30,2023),and influenza virus A(IVA)(22.64%,1 066/4 709),rhinovirus(HRV)(19.86%,935/4 709) and RSV(13.29%,626/4 709) were the main pathogens,and there were 301 cases(6.39%,301/4 709) of mixed infections.In the summer(May 1,2023 to July 30,2023),the total detection rate of pathogens was 70.26%(4 012/5 710),among which RSV(21.63%,1 235/5 710),MP(13.91%,794/5 710),HPIV(10.05%,574/5 710) were the main pathogens,and there were 710 cases(12.43%,710/5 710) of mixed infections,all of which were significantly higher than the same period before “Level B for Class B ”.The difference was statistically significant(P<0.05).Conclusion After “Level B for Class B” for COVID-19,the detection rate of 11 common pathogens increased significantly and the pathogen spectrum of ARTI changed significantly.