Banerji A, Bell A, Mills E L, McDonald J, Subbarao K, Stark G, Eynon N, Loo V G
Department of Pediatrics, University of British Columbia, Vancouver, BC.
CMAJ. 2001 Jun 26;164(13):1847-50.
It has long been suspected that Canadian Inuit children suffer from frequent severe lower respiratory tract infections (LRTIs), but the causes and risk factors have not been documented. This study assessed the infectious causes and other epidemiologic factors that may contribute to the severity of LRTI in young Inuit children on Baffin Island.
A prospective case study was carried out at the Baffin Regional Hospital in Iqaluit, Nunavut, of infants less than 6 months of age, who were admitted to hospital between October 1997 and June 1998 with a diagnosis of LRTI. Immunofluorescent antibody testing was used to identify respiratory viruses, and enzyme immunoassay (EIA) and polymerase chain reaction (PCR) were used to test for Chlamydia trachomatis. Demographic and risk factor data were obtained through a questionnaire.
The annualized incidence rate of admission to hospital for bronchiolitis at Baffin Regional Hospital was 484 per 1000 infants who were less than 6 months of age; 12% of the infants were intubated. Probable pathogens were identified for 18 of the 27 cases considered in our study. A single agent was identified for 14 infants: 8 had respiratory syncytial virus, 2 adenovirus, 1 rhinovirus, 1 influenza A, 1 parainfluenza 3 and 1 had cytomegalovirus. For 4 infants, 2 infectious agents were identified: these were enterovirus and Bordetella pertussis, adenovirus and enterovirus, cytomegalovirus and respiratory syncytial virus, and respiratory syncytial virus and adenovirus. C. trachomatis was not identified by either EIA or PCR. All infants were exposed to maternal smoking in utero, second-hand smoke at home and generally lived in crowded conditions.
Inuit infants in the Baffin Region suffer from an extremely high rate of hospital admissions for LRTI. The high frequency and severity of these infections calls for serious public health attention.
长期以来一直怀疑加拿大因纽特儿童经常患严重的下呼吸道感染（LRTIs），但病因和风险因素尚未有记录。本研究评估了可能导致巴芬岛因纽特幼儿LRTI严重程度的感染病因和其他流行病学因素。
在努纳武特地区伊卡卢伊特的巴芬地区医院对1997年10月至1998年6月期间因诊断为LRTI而入院的6个月以下婴儿进行了一项前瞻性病例研究。采用免疫荧光抗体检测来识别呼吸道病毒，酶免疫测定（EIA）和聚合酶链反应（PCR）用于检测沙眼衣原体。通过问卷调查获得人口统计学和风险因素数据。
巴芬地区医院毛细支气管炎的年化入院率为每1000名6个月以下婴儿中有484例；12%的婴儿需要插管。在我们研究的27例病例中，有18例确定了可能的病原体。14名婴儿确定了单一病原体：8例为呼吸道合胞病毒，2例为腺病毒，1例为鼻病毒，1例为甲型流感病毒，1例为副流感病毒3型，1例为巨细胞病毒。4名婴儿确定了2种感染病原体：分别是肠道病毒和百日咳博德特氏菌、腺病毒和肠道病毒、巨细胞病毒和呼吸道合胞病毒、呼吸道合胞病毒和腺病毒。EIA或PCR均未检测到沙眼衣原体。所有婴儿在子宫内都接触过母亲吸烟，在家中接触过二手烟，并且通常生活在拥挤的环境中。
巴芬地区的因纽特婴儿因LRTI入院的比例极高。这些感染的高频率和严重性需要引起公共卫生的高度关注。
