腹泻综合征的病因、表现及危险因素：3 个撒哈拉以南非洲国家在引入轮状病毒疫苗后的情况，来自非洲疫苗对腹泻影响（VIDA）研究。
Etiology, Presentation, and Risk Factors for Diarrheal Syndromes in 3 Sub-Saharan African Countries After the Introduction of Rotavirus Vaccines From the Vaccine Impact on Diarrhea in Africa (VIDA) Study.
机构信息
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
出版信息
Clin Infect Dis. 2023 Apr 19;76(76 Suppl 1):S12-S22. doi: 10.1093/cid/ciad022.
BACKGROUND
Diarrheal disease is heterogeneous, including watery diarrhea (WD) and dysentery, some cases of which become persistent diarrhea (PD). Changes in risk over time necessitate updated knowledge of these syndromes in sub-Saharan Africa.
METHODS
The Vaccine Impact on Diarrhea in Africa (VIDA) study was an age-stratified, case-control study of moderate-to-severe diarrhea among children <5 years old in The Gambia, Mali, and Kenya (2015-2018). We analyzed cases with follow-up of about 60 days after enrollment to detect PD (lasting ≥14 days), examined the features of WD and dysentery, and examined determinants for progression to and sequelae from PD. Data were compared with those from the Global Enteric Multicenter Study (GEMS) to detect temporal changes. Etiology was assessed from stool samples using pathogen attributable fractions (AFs), and predictors were assessed using χ2 tests or multivariate regression, where appropriate.
RESULTS
Among 4606 children with moderate-to-severe diarrhea, 3895 (84.6%) had WD and 711 (15.4%) had dysentery. PD was more frequent among infants (11.3%) than in children 12-23 months (9.9%) or 24-59 months (7.3%), P = .001 and higher in Kenya (15.5%) than in The Gambia (9.3%) or Mali (4.3%), P < .001; the frequencies were similar among children with WD (9.7%) and those with dysentery (9.4%). Compared to children not treated with antibiotics, those who received antibiotics had a lower frequency of PD overall (7.4% vs 10.1%, P = .01), and particularly among those with WD (6.3% vs 10.0%; P = .01) but not among children with dysentery (8.5% vs 11.0%; P = .27). For those with watery PD, Cryptosporidium and norovirus had the highest AFs among infants (0.16 and 0.12, respectively), while Shigella had the highest AF (0.25) in older children. The odds of PD decreased significantly over time in Mali and Kenya while increasing significantly in The Gambia.
CONCLUSIONS
The burden of PD endures in sub-Saharan Africa, with nearly 10% of episodes of WD and dysentery becoming persistent.
背景
腹泻病具有异质性，包括水样腹泻（WD）和痢疾，有些病例会转为持续性腹泻（PD）。随着时间的推移，风险发生变化，因此有必要了解撒哈拉以南非洲地区这些综合征的最新知识。
方法
疫苗对非洲腹泻影响（VIDA）研究是在冈比亚、马里和肯尼亚开展的一项年龄分层病例对照研究，纳入 5 岁以下儿童中中度至重度腹泻病例。我们分析了随访约 60 天后发生 PD（持续时间≥14 天）的病例，检查了 WD 和痢疾的特征，并研究了 PD 进展和后遗症的决定因素。我们将数据与全球肠道疾病多中心研究（GEMS）的数据进行了比较，以发现时间变化。使用病原体归因分数（AFs）从粪便样本评估病因，使用 χ2 检验或多变量回归评估预测因素，具体取决于情况。
结果
在 4606 例中度至重度腹泻患儿中，3895 例（84.6%）为 WD，711 例（15.4%）为痢疾。与 12-23 个月（9.9%）或 24-59 个月（7.3%）的儿童相比，婴儿（11.3%）中 PD 更常见，P =.001，与冈比亚（9.3%）或马里（4.3%）相比，肯尼亚（15.5%）中 PD 更常见，P <.001；WD 患儿（9.7%）与痢疾患儿（9.4%）中 PD 频率相似。与未接受抗生素治疗的患儿相比，接受抗生素治疗的患儿总体 PD 发生率较低（7.4% vs 10.1%，P =.01），特别是 WD 患儿（6.3% vs 10.0%，P =.01），但痢疾患儿（8.5% vs 11.0%，P =.27）并非如此。对于水样 PD 患儿，在婴儿中，隐孢子虫和诺如病毒的 AF 最高（分别为 0.16 和 0.12），而在大龄儿童中，志贺菌的 AF 最高（0.25）。在马里和肯尼亚，PD 的发生几率随着时间的推移显著下降，而在冈比亚则显著上升。
结论
撒哈拉以南非洲地区 PD 的负担持续存在，近 10%的 WD 和痢疾病例转为持续性。
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