尼泊尔小于 5 岁急性肠胃炎住院患儿轮状病毒的监测和分子特征。
Hospital based surveillance and molecular characterization of rotavirus in children less than 5 years of age with acute gastroenteritis in Nepal.
机构信息
Public Health Research Laboratory, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
Public Health Research Laboratory, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
出版信息
Vaccine. 2018 Dec 14;36(51):7841-7845. doi: 10.1016/j.vaccine.2018.07.044. Epub 2018 Oct 29.
BACKGROUND
Rotavirus remains a significant causative agent of childhood acute gastroenteritis, particularly among children less than 5 years of age. Although precise data on childhood mortality associated with diarrheal disease in Nepal is not available, it is estimated that22% of all rotavirus deaths globally occurs in neighboring country of India. In spite of the substantial burden of rotavirus gastroenteritis in the Indian subcontinent, rotavirus vaccine has not been introduced in Nepal. Continuous surveillance for monitoring rotavirus disease burden and molecular characterization is needed prior to rotavirus vaccine introduction in Nepal.
METHODS
A total of 3310 stool samples (2849 hospitalized cases and 461 non-hospitalized cases), were collected from patients <5 years of age from January 2013 to December 2016 and tested for rotavirus antigen by ELISA (ProSpecT, USA). A subset of ELISA positive stool samples was genotyped. Demographic data were collected.
RESULTS
During the four-year surveillance period, the overall burden of rotavirus infection was 24% among hospitalized children which was much higher than among non-hospitalized children (12%). The majority of children hospitalized with rotavirus gastroenteritis were less than 2 years of age (86%). Rotavirus-associated gastroenteritis hospitalizations occur year-round in Nepal, but a distinct peak in winter (up to 40% among hospitalized) was observed. Of 735 ELISA positive samples, 492 were genotyped by RT-PCR. The most prevalent genotype was G12P[6] (45.3%), followed byG2P4, G1P[8] (9.6%), G9P4, and G9P8. Mixed infection accounted for 4.4% of cases, 6.2% were partially typed and 10.5% of the samples were G and P untypable.
CONCLUSIONS
A high burden of rotavirus gastroenteritis and a diversity of circulating rotavirus strains in Nepal were observed. Recommendation to introduce a rotavirus vaccine with known vaccine effectiveness would help in reducing the severity of Rotavirus diarrheal disease in children less than 5 years of age.
背景
轮状病毒仍然是导致儿童急性肠胃炎的主要病原体，尤其是在 5 岁以下的儿童中。尽管尼泊尔儿童腹泻相关死亡率的确切数据尚未公布，但据估计，全球 22%的轮状病毒死亡病例发生在邻国印度。尽管在印度次大陆轮状病毒肠胃炎的负担很重，但尼泊尔尚未引入轮状病毒疫苗。在尼泊尔引入轮状病毒疫苗之前，需要进行连续监测，以监测轮状病毒疾病负担和分子特征。
方法
共收集了 2013 年 1 月至 2016 年 12 月 5 岁以下住院和非住院患者的 3310 份粪便样本（2849 例住院病例和 461 例非住院病例），并通过 ELISA（ProSpecT，美国）检测轮状病毒抗原。对 ELISA 阳性粪便样本进行了亚组基因分型。收集了人口统计学数据。
结果
在四年的监测期间，住院儿童轮状病毒感染的总负担为 24%，远高于非住院儿童（12%）。因轮状病毒肠胃炎住院的大多数儿童年龄不到 2 岁（86%）。轮状病毒相关肠胃炎在尼泊尔全年都有发生，但冬季有明显高峰（住院病例中高达 40%）。在 735 份 ELISA 阳性样本中，492 份通过 RT-PCR 进行了基因分型。最常见的基因型是 G12P[6]（45.3%），其次是 G2P[4]（12.2%）、G1P[8]（9.6%）、G9P[4]（7.3%）和 G9P[8]（4.5%）。混合感染占病例的 4.4%，6.2%部分分型，10.5%的样本无法确定 G 型和 P 型。
结论
在尼泊尔观察到轮状病毒肠胃炎负担沉重，循环轮状病毒株多样化。建议引入具有已知疫苗效力的轮状病毒疫苗，有助于降低 5 岁以下儿童轮状病毒腹泻病的严重程度。
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