Cherry Charlotte Buehler, Griffin Marie R, Edwards Kathryn M, Williams John V, Gil Ana I, Verastegui Hector, Lanata Claudio F, Grijalva Carlos G
From the *Vanderbilt Institute for Global Health, Nashville, Tennessee; †Department of Health Policy and ‡Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; §Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and ‖Instituto de Investigación Nutricional, Lima, Perú.
Pediatr Infect Dis J. 2016 Oct;35(10):1057-61. doi: 10.1097/INF.0000000000001234.
Few studies have described patterns of transmission of viral acute respiratory infections (ARI) in children in developing countries. We examined the spatial and temporal spread of viral ARI among young children in rural Peruvian highland communities. Previous studies have described intense social interactions in those communities, which could influence the transmission of viral infections.
We enrolled and followed children <3 years of age for detection of ARI during the 2009 to 2011 respiratory seasons in a rural setting with relatively wide geographic dispersion of households and communities. Viruses detected included influenza, respiratory syncytial virus (RSV), human metapneumovirus and parainfluenza 2 and 3 viruses (PIV2, PIV3). We used geospatial analyses to identify specific viral infection hot spots with high ARI incidence. We also explored the local spread of ARI from index cases using standard deviational ellipses.
Geospatial analyses revealed hot spots of high ARI incidence around the index cases of influenza outbreaks and RSV outbreak in 2010. Although PIV3 in 2009 and PIV2 in 2010 showed distinct spatial hot spots, clustering was not in proximity to their respective index cases. No significant aggregation around index cases was noted for other viruses. Standard deviational ellipse analyses suggested that influenza B and RSV in 2010, and human metapneumovirus in 2011 spread temporally in alignment with the major road network.
Despite the geographic dispersion of communities in this rural setting, we observed a rapid spread of viral ARI among young children. Influenza strains and RSV in 2010 had distinctive outbreaks arising from their index cases.
很少有研究描述发展中国家儿童病毒性急性呼吸道感染（ARI）的传播模式。我们研究了秘鲁农村高地社区幼儿中病毒性ARI的空间和时间传播情况。此前的研究描述了这些社区中频繁的社交互动，这可能会影响病毒感染的传播。
我们招募并跟踪了3岁以下儿童，在2009年至2011年呼吸道疾病季节期间，在一个家庭和社区地理分布相对广泛的农村地区检测ARI。检测到的病毒包括流感病毒、呼吸道合胞病毒（RSV）、人偏肺病毒以及副流感2型和3型病毒（PIV2、PIV3）。我们使用地理空间分析来确定ARI发病率高的特定病毒感染热点地区。我们还使用标准偏差椭圆法探究了ARI从索引病例的局部传播情况。
地理空间分析揭示了2010年流感爆发和RSV爆发的索引病例周围ARI高发病率的热点地区。尽管2009年的PIV3和2010年的PIV2显示出不同的空间热点，但聚集区域并不靠近各自的索引病例。其他病毒在索引病例周围未发现明显聚集现象。标准偏差椭圆分析表明，2010年的乙型流感和RSV以及2011年的人偏肺病毒在时间上的传播与主要道路网络一致。
尽管该农村地区社区地理分布分散，但我们观察到病毒性ARI在幼儿中迅速传播。2010年的流感毒株和RSV由其索引病例引发了独特的疫情爆发。
