20212022年上海<5岁住院儿童病毒性腹泻的病原学特征

Etiological characteristics of viral gastroenteritis in pediatric inpatients under five years old in Shanghai, 2021‒2022

  • 摘要:
    目的 了解新型冠状病毒感染(简称“新冠”)疫情防控期间住院儿童病毒性腹泻病原谱变化及主要病原体基因型别的流行变迁。
    方法 采集上海市某哨点儿科医院本地<5岁腹泻住院患儿的粪便标本,采用荧光聚合酶链反应(PCR)方法对轮状病毒、诺如病毒、札如病毒、星状病毒和肠道腺病毒进行分子检测,对主要病原体进行分子分型和序列分析。
    结果 共收集546份标本,总体病毒阳性检出率为37.55%,依次为诺如病毒GⅡ型(22.16%)、A组轮状病毒(16.12%)、星状病毒(2.93%)、肠道腺病毒(2.38%)、札如病毒(0.92%)和诺如病毒GⅠ型(0.18%)。诺如病毒GⅡ型以GⅡ.4[P31]和GⅡ.4[P16]为主要流行株(占比分别为24.79%和14.05%),其中GⅡ.4[P31]检出占比明显下降(χ2=16.140,P<0.001)。此外,还发现国内罕见轮状病毒基因型G8P[8]型在本地的首次流行,且占比呈上升趋势,总体达到7.95%。该基因型代表株在基因进化分析上与东南亚的DS⁃1⁃like G8P[8]毒株进化距离更近。
    结论 诺如病毒基因亚型的分布变化和轮状病毒罕见型别的发现都凸显持续性病原监测和基因分型检测的重要性。少见株的本地化流行对上市疫苗的效果评价和潜在疫苗的开发提出了新的要求。

     

    Abstract:
    Objective To investigate the changes in the pathogen spectrum of viral diarrhea in local pediatric inpatients as well as any variations in genotypes of major pathogens during the COVID-19 control period.
    Methods Fecal samples were collected from the children <5 years who were hospitalized due to acute gastroenteritis in a pediatric hospital in Shanghai. PCR test was carried out to detect rotavirus, norovirus, sapovirus, astrovirus and enteric adenovirus, and then genotyping was performed for major pathogens.
    Results Out of 546 samples, 37.55% tested positive for virus with the following positive rate ranking: norovirus GⅡ (22.16%), group A rotavirus (16.12%), astrovirus (2.93%), enteric adenovirus (2.38%), sapovirus (0.92%) and norovirus GⅠ (0.18%). The predominant genotype within norovirus GⅡ were GⅡ.4[P31] and GⅡ.4[P16] with a proportion of 24.79% and 14.05% respectively. The detection rate of GⅡ.4[P31] dropped significantly over the 2-year period (χ2=16.140,P<0.001). In addition, an emerging rotavirus genotype G8P [8], which was rarely found nationally, was discovered for the first time locally with an increasing proportion, accounting for 7.95% of all rotavirus positive cases. Phylogenic analysis demonstrated that the representative strains of this genotype were genetically closer to the DS-1-like G8P [8] strain found in Southeast Asia.
    Conclusion The changes in the prevalence of various norovirus genotypes together with the emergence of rare rotavirus genotype in the local area illustrate the importance of continuous monitoring of viral diarrhea and genotyping of key pathogens. Increased local activity of the rare genotype also adds new parameters in the efficacy evaluation of marketed vaccines and development of potential new vaccines in near future.

     

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