Asociación Benéfica PRISMA, Iquitos, Peru.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Pediatrics. 2018 Jan;141(1). doi: 10.1542/peds.2017-1326. Epub 2017 Dec 19.
Astroviruses are important drivers of viral gastroenteritis but remain understudied in community settings and low- and middle-income countries. We present data from 8 countries with high prevalence of diarrhea and undernutrition to describe astrovirus epidemiology and assess evidence for protective immunity among children 0 to 2 years of age.
We used 25 898 surveillance stools and 7077 diarrheal stools contributed by 2082 children for enteropathogen testing, and longitudinal statistical analysis to describe incidence, risk factors, and protective immunity.
Thirty-five percent of children experienced astrovirus infections. Prevalence in diarrheal stools was 5.6%, and severity exceeded all enteropathogens except rotavirus. Incidence of infection and diarrhea were 2.12 and 0.88 episodes per 100 child-months, respectively. Children with astrovirus infection had 2.30 times the odds of experiencing diarrhea after adjustment for covariates (95% confidence interval [CI], 2.01-2.62; < .001). Undernutrition was a risk factor: odds of infection and diarrhea were reduced by 10% and 13%, respectively, per increase in length-for-age score (infection: odds ratio, 0.90 [95% CI, 0.85-0.96]; < .001; diarrhea: odds ratio, 0.87 [95% CI, 0.79-0.96]; = .006). Some evidence of protective immunity to infection was detected (hazard ratio, 0.84 [95% CI, 0.71-1.00], = .052), although this was heterogeneous between sites and significant in India and Peru.
Astrovirus is an overlooked cause of diarrhea among vulnerable children worldwide. With the evidence presented here, we highlight the need for future research as well as the potential for astrovirus to be a target for vaccine development.
星状病毒是病毒性肠胃炎的重要驱动因素，但在社区环境和中低收入国家的研究仍较少。我们展示了 8 个腹泻和营养不良高发国家的数据，以描述星状病毒的流行病学，并评估 0 至 2 岁儿童中保护性免疫的证据。
我们使用了 25898 份监测粪便样本和 7077 份腹泻粪便样本，这些样本来自 2082 名儿童，用于检测肠道病原体，并进行纵向统计分析以描述发病率、危险因素和保护性免疫。
35%的儿童经历了星状病毒感染。腹泻粪便中的患病率为 5.6%，严重程度超过所有肠道病原体，仅次于轮状病毒。感染和腹泻的发病率分别为每 100 名儿童-月 2.12 和 0.88 次。调整了协变量后，星状病毒感染的儿童腹泻的可能性是未感染的 2.30 倍（95%置信区间 [CI]，2.01-2.62；<0.001）。营养不良是一个危险因素：每增加 1 个长度-年龄评分，感染和腹泻的可能性分别降低 10%和 13%（感染：优势比，0.90 [95%CI，0.85-0.96]；<0.001；腹泻：优势比，0.87 [95%CI，0.79-0.96]；=0.006）。检测到了一些针对感染的保护性免疫的证据（风险比，0.84 [95%CI，0.71-1.00]，=0.052），尽管这在不同地点之间存在异质性，并且在印度和秘鲁具有统计学意义。
星状病毒是全世界弱势儿童腹泻的一个被忽视的原因。根据这里提供的证据，我们强调了未来研究的必要性，以及星状病毒作为疫苗开发目标的潜力。
