Mathisen Maria, Strand Tor A, Sharma Biswa N, Chandyo Ram K, Valentiner-Branth Palle, Basnet Sudha, Adhikari Ramesh K, Hvidsten Dag, Shrestha Prakash S, Sommerfelt Halvor
Centre for International Health, University of Bergen, PO Box 7804, N-5020 Bergen, Norway.
BMC Med. 2009 Jul 27;7:35. doi: 10.1186/1741-7015-7-35.
Pneumonia is among the main causes of illness and death in children <5 years of age. There is a need to better describe the epidemiology of viral community-acquired pneumonia (CAP) in developing countries.
From July 2004 to June 2007, we examined nasopharyngeal aspirates (NPA) from 2,230 cases of pneumonia (World Health Organization criteria) in children 2 to 35 months old recruited in a randomized trial of zinc supplementation at a field clinic in Bhaktapur, Nepal. The specimens were examined for respiratory syncytial virus (RSV), influenza virus type A (InfA) and B (InfB), parainfluenza virus types 1, 2 and 3 (PIV1, PIV2, and PIV3), and human metapneumovirus (hMPV) using a multiplex reverse transcriptase polymerase chain reaction (PCR) assay.
We identified 919 virus isolates in 887 (40.0%) of the 2,219 NPA specimens with a valid PCR result, of which 334 (15.1%) yielded RSV, 164 (7.4%) InfA, 129 (5.8%) PIV3, 98 (4.4%) PIV1, 93 (4.2%) hMPV, 84 (3.8%) InfB, and 17 (0.8%) PIV2. CAP occurred in an epidemic pattern with substantial temporal variation during the three years of study. The largest peaks of pneumonia occurrence coincided with peaks of RSV infection, which occurred in epidemics during the rainy season and in winter. The monthly number of RSV infections was positively correlated with relative humidity (rs = 0.40, P = 0.01), but not with temperature or rainfall. An hMPV epidemic occurred during one of the three winter seasons and the monthly number of hMPV cases was also associated with relative humidity (rs = 0.55, P = 0.0005).
Respiratory RNA viruses were detected from NPA in 40% of CAP cases in our study. The most commonly isolated viruses were RSV, InfA, and PIV3. RSV infections contributed substantially to the observed CAP epidemics. The occurrence of viral CAP in this community seemed to reflect more or less overlapping micro-epidemics with several respiratory viruses, highlighting the challenges of developing and implementing effective public health control measures.
肺炎是5岁以下儿童患病和死亡的主要原因之一。有必要更好地描述发展中国家病毒性社区获得性肺炎（CAP）的流行病学特征。
2004年7月至2007年6月，我们在尼泊尔巴克塔普尔的一家现场诊所对2230例符合世界卫生组织标准的2至35个月大儿童肺炎病例的鼻咽抽吸物（NPA）进行了检测。这些病例来自一项锌补充剂随机试验。使用多重逆转录聚合酶链反应（PCR）检测法对标本进行呼吸道合胞病毒（RSV）、甲型流感病毒（InfA）和乙型流感病毒（InfB）、1、2和3型副流感病毒（PIV1、PIV2和PIV3）以及人偏肺病毒（hMPV）检测。
在2219份有有效PCR结果的NPA标本中，我们在887份（40.0%）中鉴定出919株病毒分离株，其中334份（15.1%）为RSV，164份（7.4%）为InfA，129份（5.8%）为PIV3，98份（4.4%）为PIV1，93份（4.2%）为hMPV，84份（3.8%）为InfB，17份（0.8%）为PIV2。在三年的研究期间，CAP呈流行模式，具有明显的时间变化。肺炎发病的最大高峰与RSV感染高峰一致，RSV感染高峰出现在雨季和冬季的流行期间。RSV感染的月数与相对湿度呈正相关（rs = 0.40，P = 0.01），但与温度或降雨量无关。在三个冬季中的一个冬季发生了hMPV流行，hMPV病例的月数也与相对湿度有关（rs = 0.55，P = 0.0005）。
在我们的研究中，40%的CAP病例的NPA中检测到呼吸道RNA病毒。最常分离出的病毒是RSV、InfA和PIV3。RSV感染在观察到的CAP流行中起了很大作用。该社区病毒性CAP的发生似乎或多或少反映了几种呼吸道病毒的重叠微流行，突出了制定和实施有效的公共卫生控制措施的挑战。
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