From the Department of Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, The Gambia.
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Pediatr Infect Dis J. 2020 Oct;39(10):925-930. doi: 10.1097/INF.0000000000002761.
Knowledge regarding the prevalence, clinical features and etiology of pediatric influenza-like illness (ILI) remains limited in African settings. Furthermore, it is likely that many children presenting with ILI receive antibiotics unnecessarily. More data are required to develop antimicrobial stewardship practice and guide effective vaccine strategies. We undertook a 1-year prospective study of ILI in the Gambia.
Children <5 years of age presenting with ILI from March 2018 to March 2019 were recruited. Clinical and antibiotic prescribing data were collected. Nasopharyngeal swabs were collected and analyzed for 12 respiratory viruses using a multiplex polymerase chain reaction.
From a total of 735 ILI episodes, 530 (72.1%) nasopharyngeal swabs were positive for ≥1 virus. Of these, 36.7% were positive for rhinovirus, 14.7% for respiratory syncytial virus, 8.4% for influenza and 7.2% for human metapneumovirus. Compared with children <6 months of age, influenza was more common in 6- to 23-month-old children [odd ratio (OR): 5.68; 95% confidence interval (CI): 1.72-18.76; P = 0.004]. Respiratory syncytial virus and human metapneumovirus were associated with low peripheral oxygen saturations (OR: 2.13; 95% CI: 1.23-3.69; P = 0.007; and OR: 2.44; 95% CI: 1.13-5.27; P = 0.023, respectively). Antibiotics were prescribed in 78.3% of all ILI cases.
A broad range of viruses are responsible for pediatric ILI in the Gambia. Refined treatment guidelines, improved diagnostic capacity and vaccines to prevent respiratory viruses will all play a role in reducing antimicrobial use for these cases.
在非洲环境中，有关儿科流感样疾病（ILI）的流行情况、临床特征和病因的知识仍然有限。此外，许多出现 ILI 的儿童可能不必要地接受了抗生素治疗。为了制定抗菌药物管理实践并指导有效的疫苗策略，我们需要更多的数据。我们对冈比亚的 ILI 进行了为期 1 年的前瞻性研究。
我们招募了 2018 年 3 月至 2019 年 3 月期间出现 ILI 的 5 岁以下儿童。收集了临床和抗生素处方数据，并使用多重聚合酶链反应对鼻咽拭子进行了 12 种呼吸道病毒的分析。
在总共 735 例 ILI 发作中，530 例（72.1%）鼻咽拭子对至少 1 种病毒呈阳性。其中，36.7%为鼻病毒阳性，14.7%为呼吸道合胞病毒阳性，8.4%为流感病毒阳性，7.2%为人偏肺病毒阳性。与<6 个月的儿童相比，6-23 个月龄儿童流感更为常见[比值比（OR）：5.68；95%置信区间（CI）：1.72-18.76；P=0.004]。呼吸道合胞病毒和人偏肺病毒与低外周血氧饱和度相关（OR：2.13；95%CI：1.23-3.69；P=0.007；和 OR：2.44；95%CI：1.13-5.27；P=0.023）。所有 ILI 病例中，抗生素的使用率为 78.3%。
在冈比亚，广泛的病毒是导致儿科 ILI 的原因。改进治疗指南、提高诊断能力和预防呼吸道病毒的疫苗都将在减少这些病例的抗生素使用方面发挥作用。
