Fau C, Billaud G, Pinchinat S, Lina B, Kaplon J, Pothier P, Derrough T, Marcelon L, Largeron N, Caulin E, Bellemin B, Cao Nong T, Gaspard C, Mamoux V, Floret D
Médecins référents des crèches municipales de la ville de Lyon, France.
Arch Pediatr. 2008 Jul;15(7):1183-92. doi: 10.1016/j.arcped.2008.02.016. Epub 2008 May 5.
Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24 h period, a fecal specimen was tested by Elisa test IDEIA Rotavirus (Dako) and the immunochromatographic test VIKIA Rota-Adeno (BioMérieux). Sequencing by RT-PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT-PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4-3.0] per 100 child-months in children aged less than 36 months of age, increasing to 3.4 per 100 child-months among children aged less than 24 months. Vomiting (P<0.0005) and behavior modification (P<0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54 euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France.
轮状病毒是婴幼儿严重脱水腹泻的主要病因。在工业化国家，小儿轮状病毒性肠胃炎（PRGE）发病率很高，尤其是在3岁以下入托日托中心（DCCs）的儿童中。本研究的目的是评估PRGE在日托中心的发病率、治疗情况及费用。我们还描述了A组轮状病毒基因型的特征。本研究还比较了不同诊断技术的性能。研究于2004年11月至2005年5月进行。年龄小于36个月、每周至少去参与研究的日托中心4次的儿童被纳入研究。对于任何急性肠胃炎（AGE）发作，定义为24小时内出现3次或更多水样便或比正常更稀的粪便和/或剧烈呕吐，粪便标本采用酶联免疫吸附测定（ELISA）法检测IDEIA轮状病毒（达科公司）以及免疫层析法检测VIKIA轮状 - 腺病毒（生物梅里埃公司）。通过逆转录 - 聚合酶链反应（RT - PCR）测序来鉴定轮状病毒基因型。在联系的41个日托中心中，18个（43.9%）同意参与。在966名儿童中，547名每周至少去参与研究的日托中心4次并符合纳入标准。总共302名被纳入研究。通过ELISA检测，63份粪便标本中AGE的临床诊断得到确认和验证，其中29份（46%）轮状病毒抗原呈阳性，以P[8]G9为主（86%）。与RT - PCR相比，我们的结果显示VIKIA和ELISA方法具有良好的敏感性和特异性。在PRGE病例中，36%为男性，中位年龄为12.2个月。首例轮状病毒病例于2004年12月发现，2005年1月达到高峰。年龄小于36个月儿童中PRGE病例的发病率为每100儿童月2.2[1.4 - 3.0]例，在年龄小于24个月的儿童中增至每100儿童月3.4例。PRGE病例中呕吐（P<0.0005）和行为改变（P<0.001）明显更频繁。总共85.7%的PRGE病例寻求医疗护理。在这些病例中，58.3%的情况是至少有一位家长不得不请假，平均请假时长为2.1天。寻求医疗护理的轮状病毒病例的总成本（无论有无处方药、家长请假天数或额外尿布消耗）估计为275.54欧元/例。PRGE发病率与在日托中心进行的欧洲研究估计的发病率相似。这些发现证实轮状病毒不仅在日托中心传播，也在家庭内部传播。这是第一项对法国日托中心轮状病毒感染的发病率和成本进行评估的研究。
