尼泊尔婴幼儿门诊腹泻的病原体特异性负担：多中心前瞻性病例对照研究。
Pathogen-Specific Burden of Outpatient Diarrhea in Infants in Nepal: A Multisite Prospective Case-Control Study.
机构信息
Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
出版信息
J Pediatric Infect Dis Soc. 2017 Sep 1;6(3):e75-e85. doi: 10.1093/jpids/pix009.
BACKGROUND
Nonsevere diarrheal disease in Nepal represents a large burden of illness. Identification of the specific disease-causing pathogens will help target the appropriate control measures.
METHODS
Infants aged 6 weeks to 12 months were recruited from 5 health facilities in eastern, central, and western Nepal between August 2012 and August 2013. The diarrhea arm included infants with mild or moderate diarrhea treatable in an outpatient setting; the nondiarrhea arm included healthy infants who presented for immunization visits or had a mild nondiarrheal illness. Stool samples were tested for 15 pathogens with a multiplex polymerase chain reaction (PCR) assay and real-time reverse-transcription (RT)-PCR assays for rotavirus and norovirus. Rotavirus- and norovirus-positive specimens were genotyped. We calculated attributable fractions (AFs) to estimate the pathogen-specific burden of diarrhea and adjusted for facility, age, stunting, wasting, and presence of other pathogens.
RESULTS
We tested 307 diarrheal and 358 nondiarrheal specimens. Pathogens were detected more commonly in diarrheal specimens (164 of 307 [53.4%]) than in nondiarrheal specimens (113 of 358 [31.6%]) (P < .001). Rotavirus (AF, 23.9% [95% confidence interval (CI), 14.9%-32.8%]), Salmonella (AF, 12.4% [95% CI, 6.6%-17.8%]), and Campylobacter (AF, 5.6% [95% CI, 1.3%-9.8%]) contributed most to the burden of disease. In these diarrheal specimens, the most common genotypes for rotavirus were G12P[6] (27 of 82 [32.9%]) and G1P[8] (16 of 82 [19.5%]) and for norovirus were GII.4 Sydney (9 of 26 [34.6%]) and GII.7 (5 of 26 [19.2%]).
CONCLUSIONS
The results of this study indicate that the introduction of a rotavirus vaccine in Nepal will likely decrease outpatient diarrheal disease burden in infants younger than 1 year, but interventions to detect and target other pathogens, such as Salmonella and Campylobacter spp, should also be considered.
背景
尼泊尔的非严重腹泻病是一个巨大的疾病负担。确定具体的致病病原体将有助于有针对性地采取控制措施。
方法
2012 年 8 月至 2013 年 8 月，在尼泊尔东部、中部和西部的 5 家卫生机构招募了 6 周至 12 个月大的婴儿。腹泻组包括在门诊治疗即可的轻度或中度腹泻婴儿；非腹泻组包括健康婴儿，他们因免疫接种就诊或患有轻度非腹泻疾病。使用多重聚合酶链反应（PCR）检测粪便样本中的 15 种病原体，并用实时逆转录（RT）-PCR 检测轮状病毒和诺如病毒。对轮状病毒和诺如病毒阳性标本进行基因分型。我们计算了归因分数（AF）来估计腹泻的病原体特异性负担，并针对医疗机构、年龄、发育迟缓、消瘦和其他病原体进行了调整。
结果
我们检测了 307 份腹泻和 358 份非腹泻标本。腹泻标本中检测到的病原体比非腹泻标本中更常见（307 份中的 164 份[53.4%]比 358 份中的 113 份[31.6%]）（P<0.001）。轮状病毒（AF，23.9%[95%置信区间（CI），14.9%-32.8%]）、沙门氏菌（AF，12.4%[95%CI，6.6%-17.8%]）和弯曲菌（AF，5.6%[95%CI，1.3%-9.8%]）对疾病负担的贡献最大。在这些腹泻标本中，轮状病毒最常见的基因型为 G12P[6]（82 份中的 27 份[32.9%]）和 G1P[8]（82 份中的 16 份[19.5%]），诺如病毒最常见的基因型为 GII.4 Sydney（26 份中的 9 份[34.6%]）和 GII.7（26 份中的 5 份[19.2%]）。
结论
本研究结果表明，在尼泊尔引入轮状病毒疫苗可能会降低 1 岁以下婴儿的门诊腹泻病负担，但也应考虑检测和针对其他病原体（如沙门氏菌和弯曲菌属）的干预措施。
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