2023年春季北京地区儿童急性呼吸道感染病原谱分析

Pathogenic agents causing acute respiratory tract infections in pediatric patients in Spring,2023,in Beijing

目的探讨北京地区儿童急性呼吸道感染(ARI)的病原谱。方法采用横断面研究,收集2023年2月6日(第6周)至5月28日(第21周)首都儿科研究所附属儿童医院因ARI就诊的9284例患儿呼吸道标本。根据标本来源,分为急诊就诊的流感样病例组、门诊ARI组及住院ARI组。流感样病例组进行流感病毒(Flu)及人偏肺病毒(HMPV)核酸检测;门诊ARI组进行Flu、呼吸道合胞病毒(RSV)、腺病毒、副流感病毒(PIV)核酸检测;住院ARI组进行Flu、RSV、HMPV、腺病毒、人博卡病毒(HBoV)、鼻病毒、PIV、冠状病毒、肺炎支原体(Mp)及衣原体核酸检测。结果流感样病例组320例患儿中男192例、女128例,就诊年龄4.7(3.6,6.9)岁,Flu A阳性117例(36.6%),其中甲型流感病毒H1N1亚型(H1N1)55例(47.0%),甲型流感病毒H3N2亚型(H3N2)62例(53.0%),第6~9周以H1N1为主(10.0%~50.0%),第10~16周以H3N2为主(15.0%~90.0%);HMPV阳性13例(4.1%),第15周检出率为5.0%(1/20),第20周达30.0%(6/20)。门诊ARI组7573例患儿中男4131例、女3442例,就诊年龄4.0(2.1,5.3)岁,阳性检出率RSV为32.9%(2491/7573),Flu A为12.1%(915/7573);第6~14周以Flu A为主(23.2%~74.7%),第15周开始以RSV为主,阳性检出率为24.8%(36/145)。住院ARI组1391例患儿中男804例、女587例,就诊年龄3.3(0.4,5.8)岁,阳性检出率鼻病毒为18.7%(260/1391)、RSV为12.4%(173/1391)、Flu A为10.2%(142/1391)[H1N1116例(81.7%)、H3N226例(18.3%)]及HMPV为3.1%(43/1391)。第7周开始检出H1N1[10%(6/60)],第11周达高峰[31.8%(21/66)],第8周开始检出H3N2[1.5%(1/68)]。住院ARI组Flu阳性患儿H1N1阳性检出率为81.7%(116/142)。第12周开始检出RSV,阳性检出率为1.3%(1/80),第19周达30.4%(35/115);第21周HMPV阳性检出率为12.1%(14/116)。结论北京地区2023年春季(2至5月)ARI患儿中首先出现Flu流行,前期以H1N1为主,后期以H3N2为主,RSV出现滞后流行,同时需密切关注HMPV。应加强对门诊监测,提前发出流行预警。

Objective To explore the pathogenic agents of acute respiratory infection(ARI)in children in Beijing.Methods In the cross-sectional study,3 groups of children from different departments were enrolled from Feb 6 th,2023(6 th week)to May 28 th(21 th week),2023,including influenza-like case group from emergency department for nucleic acid testing of influenza virus(Flu)and human metapneumovirus(HMPV),the outpatient ARI group under nucleic acid testing for Flu,respiratory syncytial virus(RSV),adenovirus(ADV),and parainfluenza virus(PIV),and the inpatient ARI group under nucleic acid testing for Flu,RSV,HMPV,ADV,human bocavirus(HBoV),Rhinovirus(Rh),PIV,coronavirus(HCoV),Mycoplasma pneumoniae(Mp)and Chlamydia pneumonia(Cp).Results There were 320 influenza-like cases enrolled,including 192 males and 128 females,aged 4.7(3.6,6.9)years,and 117 cases(36.6%)positive for Flu A,which contained similar proportion of pandemic H1N1(H1N1)47.0%(55/117)and H3N253.0%(62/117),and 13 cases for HMPV 4.1%(13/320).The rate of Flu reached its peak at the 10 th week,with H1N1 as the predominant one from the 6 th to 9 th week(10.0%-50.0%)and then H3N2 from the 10 th to 16 th week(15.0%-90.0%).HMPV was detected from the 15 th week 5.0%(1/20),and then reached to 30.0%(6/20)at the 20 th week.In the outpatient ARI group,7573 were enrolled,including 4131 males and 3442 females,aged 4.0(2.1,5.3)years,and the highest positive rate for RSV 32.9%(2491/7573),followed by Flu A 12.1%(915/7573).The dominant one was Flu A in weeks 6-14(23.2%-74.7%),then RSV in the 15 th week 24.8%(36/145).In the inpatient ARI group,1391 patients were enrolled,including 804 males and 587 females,aged 3.3(0.4,5.8)years,and the highest positive rate for Rh 18.7%(260/1391),followed by RSV 12.4%(173/1391),Flu A 10.2%(142/1391,of which 116 cases(81.7%)were H1N1,and 26 cases(18.3%)were H3N2)and HMPV 3.1%(43/1391).H1N1 was detected from the 7 th week 10%(6/60),to peak in the 11 th week 31.8%(21/66).H3N2 was detected from the 8 th week 1.5%(1/68),and then kept in low level.The proportion of H1N1 among Flu was 81.7%(116/142)in the inpatient ARI group.RSV was detected from 12 th week 1.3%(1/80),reaching 30.4%(35/115)at 19 th week.The positive rate of HMPV reached 12.1%(14/116)at 21 th week.Conclusions In the spring of 2023,the first one in Beijing is the Flu epidemic,with H1N1 being the predominant one in the early stage and H3N2 in the later stage.Then,there is a postponed RSV epidemic and an increased HMPV detection.In addition,nucleic acid testing for outpatient children should be strengthened to provide early warning of epidemics.