Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China.
Division of Global Health Protection, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2022 Jun 28;17(6):e0270586. doi: 10.1371/journal.pone.0270586. eCollection 2022.
Southern China is at risk for arborvirus disease transmission, including Zika virus and dengue. Patients often present to clinical care with non-specific acute febrile illnesses (AFI). To better describe the etiology of AFI, we implemented a two-year AFI surveillance project at five sentinel hospitals in Yunnan and Guangdong Provinces.
Between June 2017 and August 2019, we enrolled patients between 2 and 65 years of age presenting at one sentinel hospital in Mengla County, Yunnan, and four in Jiangmen City, Guangdong, with symptoms of AFI (acute onset of fever ≥ 37.5°C within the past 7 days) without respiratory symptoms or diarrhea. Demographic, epidemiologic, and clinical information was obtained and entered into a web-based AFI surveillance database. A custom TaqMan Array card (TAC) was used to test patients' whole blood specimens for 27 different pathogens using real-time polymerase chain reaction assays.
During the two-year project period, 836 patients were enrolled; 443 patients from Mengla County and 393 patients from Jiangmen City. The median age was 33 years [range: 2-65], and most were hospitalized [641, 77%]. Of 796 patients with valid TAC results, 341 (43%) were positive for at least one of the 10 unique pathogens detected. This included 205 (26%) patients positive for dengue virus, 60 (8%) for Orientia tsutsugamushi, and 42 (5%) for Coxiella burnetii. Ten patients (1%) in Jiangmen City tested positive for malaria, 8 of whom reported recent travel outside of China. TAC results were negative for 455 (57%) patients. None of the patients had a positive TAC detection for Zika virus.
The project detected variability in the etiology of AFI in Southern China and highlighted the importance of differential diagnosis. Dengue, O. tsutsugamushi, and C. burnetii were the most frequently identified pathogens among enrolled AFI patients. As a non-notifiable disease, the frequent detection of C. burnetii is noteworthy and warrants additional investigation. The project provided a framework for routine surveillance for persons presenting with AFI.
中国南方地区存在 arbovirus 疾病传播的风险，包括 Zika 病毒和登革热。患者通常因非特异性急性发热性疾病（AFI）就诊于临床。为了更好地描述 AFI 的病因，我们在云南省和广东省的五家哨点医院实施了为期两年的 AFI 监测项目。
在 2017 年 6 月至 2019 年 8 月期间，我们招募了在云南省勐腊县一家哨点医院和广东省江门市四家哨点医院就诊的 2 至 65 岁的发热患者，症状为 AFI（7 天内急性发热，体温≥37.5°C），但无呼吸道症状或腹泻。我们收集了患者的人口统计学、流行病学和临床信息，并将其输入到基于网络的 AFI 监测数据库中。使用定制 TaqMan 微阵列芯片（TAC），通过实时聚合酶链反应检测患者全血标本中的 27 种不同病原体。
在两年的项目期间，共纳入 836 例患者；其中 443 例来自勐腊县，393 例来自江门市。中位年龄为 33 岁[范围：2-65]，大多数患者住院治疗[641 例，77%]。在 796 例具有有效 TAC 结果的患者中，有 341 例（43%）至少对检测到的 10 种独特病原体中的一种呈阳性。这包括 205 例（26%）登革热病毒阳性患者，60 例（8%）东方体阳性患者，42 例（5%）伯氏考克斯体阳性患者。在江门市的 10 例（1%）患者中检测到疟疾，其中 8 例患者报告有近期在中国境外旅行史。455 例（57%）患者的 TAC 结果为阴性。没有患者的 TAC 检测结果呈 Zika 病毒阳性。
该项目检测到中国南方 AFI 病因的变化，并强调了鉴别诊断的重要性。登革热、东方体和伯氏考克斯体是纳入的 AFI 患者中最常检测到的病原体。作为一种非法定报告疾病，频繁检测到伯氏考克斯体值得关注，需要进一步调查。该项目为因 AFI 就诊的患者的常规监测提供了框架。
