轮状病毒基因组 I 和 II 引起的儿童急性胃肠炎发作和急诊科就诊的归因分析。
Attribution of Pediatric Acute Gastroenteritis Episodes and Emergency Department Visits to Norovirus Genogroups I and II.
机构信息
Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada.
出版信息
J Infect Dis. 2021 Feb 13;223(3):452-461. doi: 10.1093/infdis/jiaa391.
BACKGROUND
Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics.
METHODS
We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data.
RESULTS
From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%-100%) and 91.6% (88.8%-94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103-129) and 59 (51-67) ED visits per 10 000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively.
CONCLUSIONS
In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.
背景
诺如病毒是急性肠胃炎的主要病因。随着疫苗的研发，需要对基于人群的诺如病毒负担进行估计，以确定目标人群、量化潜在效益并了解疾病动态。
方法
我们估计了儿童感染诺如病毒的归因分数（AF），其定义为诺如病毒检测呈阳性的儿童中，其肠胃炎归因于诺如病毒的比例。我们使用省级肠胃炎就诊行政数据，计算了归因于诺如病毒的标准化发病率和急诊就诊率。
结果
在 3731 例肠胃炎病例患者和 2135 例对照中，我们确定诺如病毒 I 型（GI）和 II 型（GII）的 AF 分别为 67.0%（95%置信区间 [CI]，31.5%-100%）和 91.6%（88.8%-94.4%）。诺如病毒 GII 的 AF 随季节而变化，但与年龄无关。我们归因于所有年龄段的 116 例（95%CI，103-129）和 59 例（51-67）ED 就诊，与诺如病毒 GII 相关的就诊分别占所有医疗就诊肠胃炎病例和 ED 就诊的 20%和 18%。
结论
在儿童中，很大一部分 GII 诺如病毒检测反映了病因，表明 GII 诺如病毒疫苗具有很大的潜力。GII 诺如病毒 AF 的季节性变化可能对了解无症状携带在疾病动态中的作用具有影响。
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