肠道病毒 A 感染在健康澳大利亚儿童的前 2 年生活:一个基于社区的纵向出生队列研究。
Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study.
机构信息
Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.
Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
出版信息
Clin Infect Dis. 2020 Jun 24;71(1):116-127. doi: 10.1093/cid/ciz761.
BACKGROUND
Hospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study.
METHODS
Australian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated.
RESULTS
PeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128-160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0-11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age <3 months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%).
CONCLUSIONS
In contrast with hospital-based studies, this study showed that diverse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children.Parechovirus can cause severe illnesses in children. However, studies focus mainly on hospitalized populations. True disease burden in the community remains largely unknown. From our community-based cohort, we found diverse parechovirus genotypes in the community, causing mild or subclinical infections in children.
CLINICAL TRIALS REGISTRATION
NCT01304914.
背景
基于医院的研究表明，肠道病毒（PeV），主要是 PeV-A3，是导致幼儿严重感染的重要原因。然而，很少有基于社区的研究发表，PeV 的真实感染负担尚不清楚。我们调查了参加基于社区的纵向出生队列研究的健康儿童中的 PeV 流行病学。
方法
澳大利亚儿童（n=158）参加了观察性儿童传染病研究（ORChID），从出生到两岁生日进行随访。每周采集粪便和鼻拭子，并每天记录症状日记。通过逆转录聚合酶链反应检测拭子中的 PeV，并通过亚基因组测序确定基因型。调查了感染率、感染特征、临床关联和病毒共检出情况。
结果
在 11124 个粪便拭子和 8100 个鼻拭子中，分别检测到 1423 个（12.8%）和 17 个（0.2%）PeV。在确定的 306 个感染病例中，主要基因型为 PeV-A1（47.9%）、PeV-A6（20.1%）和 PeV-A3（18.3%）。每 100 个儿童年发生 144 例（95%置信区间，128-160）感染。首次感染的中位年龄为 8 个月（四分位间距，6.0-11.7）。观察到 PeV-A1 向 PeV-A3 的季节性年度高峰变化。感染与年龄≥6 个月、夏季、<3 个月时非纯母乳喂养以及<12 个月时参加正规儿童保育有关。单独的 PeV 感染要么无症状（38.4%），要么轻度（32.7%），而粪便拭子中与其他病毒的共同检出很常见（64.4%）。
结论
与基于医院的研究相比，本研究表明，不同且不断变化的 PeV 基因型在社区中传播，导致儿童出现轻度或亚临床感染。PeV 可导致儿童发生严重疾病。然而，研究主要集中在住院人群。社区中的真实疾病负担仍知之甚少。从我们的社区队列中，我们发现社区中有多种肠道病毒基因型，导致儿童出现轻度或亚临床感染。
临床试验注册
NCT01304914。
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