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目的分析2008-2015年河南省5岁以下腹泻儿童A组轮状病毒的感染状况,分子型别变迁及流行病学特征,为A组轮状病毒感染的监测、防控及爆发病例的调查及疫苗研发提供基线数据和方法学参考。方法采集河南省4个监测哨点医院5岁以下儿童腹泻病例粪便样本2 510份,双抗体夹心ELISA法检测A组轮状病毒,阳性样本抽提病毒RNA,两步巢式多重RT-PCR进行G-P基因分型,同时收集患者流行病学与临床信息进行分析。结果 2510份腹泻样本共检出A组轮状病毒784份,总阳性率31.2%,各年的阳性率在17.4%~46.9%间,其中2013年阳性率最高(46.9%),2008年阳性率最低(17.4%)。轮状病毒检出率的季节性特征显著,存在秋季(9-11月份)和春季(3-5月份)两个较为显著的高峰。784株A组轮状病毒G分型以G1、G2、G3、G9为主;P分型以P[4]、P[8]为主;型别组合以G9P[8]、G2P[4]、G3P[8]、G1P[8]为主,还存在G13P[8]、G234P[8]、G39P[8]等混合感染型别;G1[8]、G3P[8]逐年递减,G9P[8]逐年递增,已成为河南省A组轮状病毒优势型别。A组轮状病毒感染病例男女性别比1.3∶1(450/334);阳性病例主要为4~12个月龄的婴幼儿患者(61.4%,481/784);城市阳性病例257例,阳性率26.4%(257/974);农村阳性病例527例,阳性率34.3%(527/1536),农村显著高于城市(χ2=18.15,P<0.001)。从临床体征看,大部分感染病例无发热、呕吐、脱水症状,出现发热、腹泻、呕吐、脱水等临床症状的病例多以轻症为主。结论河南省5岁以下腹泻患儿中存在较高的A组轮状病毒感染率,以秋季和春季为主,秋季高于春季且存在混合感染病例;病原体可分为多种基因型别,G9P[8]为主要优势型别;病毒感染病例呈现不同的流行病学及临床特点,值得深入研究。
Objective To analyze the status of infection, molecular type change and epidemiology of group A rotavirus in children under 5 years of age in Henan province during 2008-2015 and to investigate the surveillance, prevention and control of outbreaks of rotavirus A in group A Vaccine development provides baseline data and methodological references. Methods A total of 2 510 cases of diarrhea were collected from 4 surveillance sentinel hospitals in Henan Province. A group of rotavirus was detected by double antibody sandwich ELISA, and viral RNA was extracted from positive samples. Two-step nested multiplex RT-PCR GP genotyping, while collecting the patient’s epidemiological and clinical information for analysis. Results A total of 784 rotavirus positive samples were obtained from 2510 samples of diarrhea, with a positive rate of 31.2% and a positive rate of 17.4% to 46.9% in each year. Among them, the positive rate was highest in 2013 (46.9%), and the positive rate in 2008 Lowest (17.4%). The detection rate of rotavirus seasonal characteristics are significant, there are autumn (September-November) and spring (March-May) two more significant peak. The G genotypes of 784 strains of group A rotavirus were mainly G1, G2, G3 and G9; P type was mainly P [4] and P [8]; type combinations were G9P [8], G2P [4] , G3P [8] and G1P [8]. There are also mixed infection types such as G13P [8], G234P [8] and G39P [8] ] Increasing year by year, Henan Province has become the dominant group of rotavirus type. The ratio of male to female in group A was 1.3: 1 (450/334). The majority of positive cases were infants and young children aged 4 to 12 months (61.4%, 481/784). The positive rate was 257 (257/974). There were 527 positive cases in rural areas, the positive rate was 34.3% (527/1536) in rural areas and significantly higher in rural areas than in urban areas (χ2 = 18.15, P <0.001). From the clinical signs, most of the infected cases without fever, vomiting, dehydration symptoms, fever, diarrhea, vomiting, dehydration and other clinical symptoms are mostly mild cases. Conclusions There is a high infection rate of rotavirus A in children with diarrhea under 5 years old in Henan Province in autumn and spring, autumn is higher than that in spring and there are cases of mixed infection. Pathogen can be divided into multiple genotypes, G9P [8] as the main advantage type; virus infection shows different epidemiological and clinical features, it is worth further study.