From the *CDC-Hubert Global Health Fellow, Centers for Disease Control and Prevention, Atlanta, GA; †International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; ‡Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA; §National Institute of Health, Thailand Ministry of Public Health, Nonthaburi, Thailand; ¶Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA; ‖Nakhon Phanom Provincial Hospital, Nakhon Phanom; **Crown Prince Hospital, Sa Kaeo, Thailand; and ††Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA.
Pediatr Infect Dis J. 2014 Feb;33(2):e45-52. doi: 10.1097/INF.0000000000000062.
Pneumonia remains a leading cause of under-five morbidity and mortality globally. Comprehensive incidence, epidemiologic and etiologic data are needed to update prevention and control strategies.
We conducted active, population-based surveillance for hospitalized cases of acute lower respiratory tract infections (ALRI) among children <5 years of age in rural Thailand. ALRI cases were systematically sampled for an etiology study that tested nasopharyngeal specimens by polymerase chain reaction; children without ALRI were enrolled as controls from outpatient clinics.
We identified 28,543 hospitalized ALRI cases from 2005 to 2010. Among the 49% with chest radiographs, 76% had findings consistent with pneumonia as identified by 2 study radiologists. The hospitalized ALRI incidence rate was 5772 per 100,000 child-years (95% confidence interval: 5707, 5837) and was higher in boys versus girls (incidence rate ratio 1.38, 95% confidence interval: 1.35-1.41) and in children 6-23 months of age versus other age groups (incidence rate ratio 1.76, 95% confidence interval: 1.69-1.84). Viruses most commonly detected in ALRI cases were respiratory syncytial virus (19.5%), rhinoviruses (18.7%), bocavirus (12.8%) and influenza viruses (8%). Compared with controls, ALRI cases were more likely to test positive for respiratory syncytial virus, influenza, adenovirus, human metapneumovirus and parainfluenza viruses 1 and 3 (P ≤ 0.01 for all). Bloodstream infections, most commonly Streptococcus pneumoniae and nontyphoidal Salmonella, accounted for 1.8% of cases.
Our findings underscore the high burden of hospitalization for ALRI and the importance of viral pathogens among children in Thailand. Interventions targeting viral pathogens coupled with improved diagnostic approaches, especially for bacteria, are critical for better understanding of ALRI etiology, prevention and control.
肺炎仍然是全球导致五岁以下儿童发病和死亡的主要原因。为了更新预防和控制策略，需要综合发病率、流行病学和病因学数据。
我们在泰国农村地区对 5 岁以下住院的急性下呼吸道感染（ALRI）儿童进行了主动、基于人群的监测。对 ALRI 病例进行了系统抽样，以进行病因研究，通过聚合酶链反应检测鼻咽标本；从门诊诊所招募没有 ALRI 的儿童作为对照。
我们在 2005 年至 2010 年期间确定了 28543 例住院 ALRI 病例。在接受胸部 X 光检查的 49%的病例中，有 76%的病例符合由 2 位研究放射科医生确定的肺炎影像学表现。住院 ALRI 的发病率为 5772 例/10 万儿童年（95%置信区间：5707，5837），男孩的发病率高于女孩（发病率比 1.38，95%置信区间：1.35-1.41），6-23 个月龄儿童的发病率高于其他年龄组（发病率比 1.76，95%置信区间：1.69-1.84）。在 ALRI 病例中最常检测到的病毒是呼吸道合胞病毒（19.5%）、鼻病毒（18.7%）、博卡病毒（12.8%）和流感病毒（8%）。与对照组相比，呼吸道合胞病毒、流感、腺病毒、人类偏肺病毒和副流感病毒 1 型和 3 型的 ALRI 病例更有可能检测为阳性（所有病毒 P ≤ 0.01）。血流感染最常见的病原体是肺炎链球菌和非伤寒沙门氏菌，占病例的 1.8%。
我们的研究结果强调了泰国儿童住院治疗 ALRI 的负担沉重，以及病毒病原体的重要性。针对病毒病原体的干预措施加上改进的诊断方法，特别是针对细菌的方法，对于更好地了解 ALRI 的病因、预防和控制至关重要。
