LeBaron C W, Furutan N P, Lew J F, Allen J R, Gouvea V, Moe C, Monroe S S
Department of Pediatrics, Emory University.
MMWR Recomm Rep. 1990 Apr 27;39(RR-5):1-24.
Each year, infectious gastroenteritis causes greater than 210,000 children in the United States to be hospitalized and 4-10 million children to die worldwide. Since the mid-1970s, knowledge has increased dramatically concerning the viral agents that are responsible for much of this public health burden. Rotavirus, the most common cause of diarrhea among children, infects virtually every child in the United States by the age of 4 years and causes potentially lethal dehydration in 0.75% of children less than 2 years of age. Other recently identified pathogens include the enteric adenoviruses, calicivirus, astrovirus, and the Norwalk family of agents. Conclusive diagnosis of these viruses requires electron microscopic examination of stool specimens, a laboratory technique that is available only at a few large centers, including CDC. Stool samples from an outbreak that are submitted to CDC for detection of viral pathology should be collected in bulk from 10 ill persons during their first 48 hours of illness, while feces are still liquid, and should be stored at 4 C (not frozen). Acute- and convalescent-phase serum samples should be collected from the same persons, plus from an equal number of controls, during the first week of illness and 3 weeks thereafter. Control measures for outbreaks of viral gastroenteritis should focus on the removal of an ongoing common source of infection (e.g., an ill food handler or the contamination of a water supply) and on the interruption of person-to-person transmission that can perpetuate an outbreak in a population after the common source has been removed. Because improvements in environmental hygiene may not be accompanied by reductions of endemic diarrhea caused by viruses, immunization may play an important role in future control; vaccine trials for rotavirus are in progress. In anticipation of vaccine development and use, CDC recently began national surveillance for the viral agents of gastroenteritis. Health-care facilities involved in the detection of rotavirus or the other viral agents of diarrhea can participate.
在美国，每年有超过21万名儿童因感染性肠胃炎住院，全球范围内有400万至1000万儿童因此死亡。自20世纪70年代中期以来，人们对造成这种公共卫生负担的主要病毒病原体的了解大幅增加。轮状病毒是儿童腹泻最常见的病因，在美国，几乎每个4岁儿童都会感染轮状病毒，2岁以下儿童中有0.75%会因感染轮状病毒而出现可能致命的脱水症状。其他最近发现的病原体包括肠道腺病毒、杯状病毒、星状病毒以及诺如病毒属病原体。要确诊这些病毒，需要对粪便样本进行电子显微镜检查，这是一项只有少数大型中心（包括疾病控制与预防中心）才具备的实验室技术。对于提交给疾病控制与预防中心进行病毒病理学检测的疫情粪便样本，应在患病的前48小时内，从10名患者身上采集大量样本，此时粪便仍为液态，并应保存在4摄氏度（不要冷冻）。急性期和恢复期血清样本应从同一批患者以及相同数量的对照者身上采集，患病第一周和之后3周各采集一次。病毒性肠胃炎疫情的控制措施应着重于消除持续存在的共同感染源（如患病的食品处理人员或水源污染），以及在消除共同感染源后，阻断人与人之间的传播，因为这种传播可能会在人群中使疫情持续下去。由于环境卫生的改善可能不会降低由病毒引起的地方性腹泻，免疫接种在未来的控制中可能会发挥重要作用；针对轮状病毒的疫苗试验正在进行中。为了预期疫苗的研发和使用，疾病控制与预防中心最近开始对肠胃炎病毒病原体进行全国性监测。参与检测轮状病毒或其他腹泻病毒病原体 的医疗机构均可参与。
