资源有限环境下持续感染对0至24个月儿童生长发育的流行病学及影响

The epidemiology and impact of persistent infections on childhood growth among children 0-24 months of age in resource-limited settings.

作者信息

Schiaffino Francesca, Colston Josh M, Paredes Olortegui Maribel, Peñataro Yori Pablo, Mourkas Evangelos, Pascoe Ben, Lima Aldo A M, Mason Carl J, Ahmed Tahmeed, Kang Gagandeep, Mduma Estomih, Samie Amidou, Zaidi Anita, Liu Jie, Cooper Kerry K, Houpt Eric R, Parker Craig T, Lee Gwenyth O, Kosek Margaret N

机构信息

Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru.

Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA.

出版信息

EClinicalMedicine. 2024 Sep 28;76:102841. doi: 10.1016/j.eclinm.2024.102841. eCollection 2024 Oct.

DOI:10.1016/j.eclinm.2024.102841

PMID:39380966

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11460251/

Abstract

BACKGROUND

is the leading cause of bacterial gastroenteritis worldwide. It is generally associated with an acute gastrointestinal infection causing a self-limiting diarrheal episode. However, there is evidence that persistent/recurrent carriage of also occurs. In hyperendemic settings the epidemiology and consequences of persistent enteric infections is poorly studied.

METHODS

Risk factors for and growth consequences of persistent infections detected by polymerase chain reaction (qPCR) were evaluated with data from the MAL-ED birth cohort study in children 0-24 months of age between November 2009 and February 2012. A persistent infection was defined as three or more consecutive positive monthly stools.

FINDINGS

Across all study sites, 45.5% (781/1715) of children experienced at least one persistent episode. The average cumulative duration of days in which children with persistent were positive for spp. was 150 days (inter-quartile range: 28-236 days). Children who experienced a persistent episode had an attained 24-month length-for-age (LAZ) score that was 0.23 (95% (CI): -0.31, -0.15) less than children without a persistent episode. Among children who had at least one episode of over a 3-month or 9-month window, persistent episodes were not significantly associated with poorer 3-month weight gain (-28.7 g, 95% CI: -63.4 g, 6.0 g) but were associated with poorer 9-month linear growth (-0.134 cm 95% CI: -0.246, -0.022) compared to children with an episode that resolved within 31 days.

INTERPRETATION

Persistent/recurrent infection is common among children and has a measurable negative impact on linear growth in early childhood.

FUNDING

Funding for this study was provided by the Bill and Melinda Gates Foundation (OPP1066146 and OPP1152146), the National Institutes of Health United States (R01AI158576 and R21AI163801 to MNK and CTP; K43TW012298 to FS; K01AI168493 to JMC; GOL was supported by K01AI145080. This research was also supported in part by USDA-ARS CRIS project 2030-42000-055-00D. The funders had no role in study design, study implementation, data analysis, or interpretation of the results.

摘要

背景

是全球细菌性肠胃炎的主要病因。它通常与导致自限性腹泻发作的急性胃肠道感染有关。然而，有证据表明也会出现持续性/复发性携带。在高流行地区，持续性肠道感染的流行病学及后果研究较少。

方法

利用2009年11月至2012年2月间MAL-ED出生队列研究中0至24个月大儿童的数据，评估通过聚合酶链反应（qPCR）检测到的持续性感染的危险因素及生长后果。持续性感染定义为每月连续三次或更多次粪便检测呈阳性。

研究结果

在所有研究地点，45.5%（781/1715）的儿童至少经历过一次持续性发作。持续性儿童粪便中呈阳性的平均累计天数为150天（四分位间距：28 - 236天）。经历过持续性发作的儿童24个月龄身长别年龄（LAZ）得分比未经历持续性发作的儿童低0.23（95%置信区间：-0.31，-0.15）。在3个月或9个月内至少有一次发作的儿童中，与发作在31天内缓解的儿童相比，持续性发作与3个月体重增加较差（-28.7克，95%置信区间：-63.4克，6.0克）无显著关联，但与9个月线性生长较差（-0.134厘米，95%置信区间：-0.246，-0.022）有关。

解读

持续性/复发性感染在儿童中很常见，对幼儿期的线性生长有明显负面影响。

资金来源

本研究由比尔及梅琳达·盖茨基金会（OPP1066146和OPP1152146）、美国国立卫生研究院（给MNK和CTP的R01AI158576和R21AI163801；给FS的K43TW012298；给JMC的K01AI168493；GOL由K01AI145080资助）提供资金。本研究还部分得到美国农业部农业研究局CRIS项目2030 - 42000 - 055 - 00D的支持。资助者在研究设计、研究实施、数据分析或结果解读方面没有参与。