Page N A, Groome M J, Nadan S, Netshikweta R, Keddy K H, Poonsamy B, Moyes J, Walaza S, Kahn K, Madhi S A, Taylor M B, Mans J, Cohen C
National Institute for Communicable Diseases,Private Bag x4, Sandringham, 2131,South Africa.
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit,University of the Witwatersrand,Johannesburg,South Africa.
Epidemiol Infect. 2017 Jul;145(9):1942-1952. doi: 10.1017/S0950268817000668. Epub 2017 Apr 10.
Public health interest in norovirus (NoV) has increased in recent years following improved diagnostics, global burden estimates and the development of NoV vaccine candidates. This study aimed to describe the detection rate, clinical characteristics and environmental features associated with NoV detection in hospitalized children <5 years with diarrhoea in South Africa (SA). Between 2009 and 2013, prospective diarrhoeal surveillance was conducted at four sites in SA. Stool specimens were collected and screened for NoVs and other enteric pathogens using molecular and serological assays. Epidemiological and clinical data were compared in patients with or without detection of NoV. The study detected NoV in 15% (452/3103) of hospitalized children <5 years with diarrhoea with the majority of disease in children <2 years (92%; 417/452). NoV-positive children were more likely to present with diarrhoea and vomiting (odds ratio (OR) 1·3; 95% confidence interval (CI) 1·1-1·7; P = 0·011) with none-to-mild dehydration (adjusted OR 0·5; 95% CI 0·3-0·7) compared with NoV-negative children. Amongst children testing NoV positive, HIV-infected children were more likely to have prolonged hospitalization and increased mortality compared with HIV-uninfected children. Continued surveillance will be important to consider the epidemic trends and estimate the burden and risk of NoV infection in SA.
近年来，随着诊断方法的改进、全球疾病负担估计以及诺如病毒（NoV）候选疫苗的研发，公共卫生领域对诺如病毒的关注有所增加。本研究旨在描述南非（SA）5岁以下腹泻住院儿童中与诺如病毒检测相关的检出率、临床特征和环境特征。2009年至2013年期间，在南非的四个地点进行了前瞻性腹泻监测。收集粪便标本，使用分子和血清学检测方法筛查诺如病毒和其他肠道病原体。对检测到或未检测到诺如病毒的患者的流行病学和临床数据进行了比较。该研究在5岁以下腹泻住院儿童中检测到15%（452/3103）的诺如病毒，其中大多数病例发生在2岁以下儿童（92%；417/452）。与未感染诺如病毒的儿童相比，感染诺如病毒的儿童更易出现腹泻和呕吐（优势比（OR）1·3；95%置信区间（CI）1·1 - 1·7；P = 0·011），且无至轻度脱水（校正OR 0·5；95%CI 0·3 - 0·7）。在检测为诺如病毒阳性的儿童中，与未感染艾滋病毒的儿童相比，感染艾滋病毒的儿童住院时间更长，死亡率更高。持续监测对于了解南非诺如病毒感染的流行趋势、估计疾病负担和风险非常重要。
