Campylobacter diarrhea in children in South Asia: A systematic review

BackgroundCampylobacter spp. are one of the commonest causes of diarrhea in children under five and in resource poor settings also lead to malabsorption and stunting. The purpose of this systematic review was to understand the burden of Campylobacter spp. associated diarrhea among children in the South Asian countries.MethodsThis systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Databases were searched with defined keywords for publications from the years 1998–2018. Data on proportion of positive samples was extracted to compare the rates of Campylobacter infection among children (under the age of 19) from different study populations.ResultsOf the 359 publications screened, 27 eligible articles were included in this systematic review and categorized based on study design. In 8 case-control studies, Campylobacter spp. was detected more frequently among diarrheal cases (range, 3.2–17.4%) than non-diarrheal cases (0–13%). Although there were variations in the study population, overall, children under the age of two years experienced Campylobacter diarrhea more often than older children. Most studies reported stool culture as the method used to detect Campylobacter spp. however retesting using PCR-based methods significantly increased detection rates. Limited data were available on Campylobacter species. In 4 studies that provided species data, C. jejuni (3.2–11.2%) was shown to be the most common species, followed by C. coli.ConclusionIn South Asia, Campylobacter spp. are one of the most common bacterial diarrheal pathogens affecting children but there is a paucity of data on species, risk factors and attributable sources. Although a few studies were available, the epidemiology of campylobacteriosis remains uncertain. To understand the true burden and sources of infection, more detailed studies are needed collecting data from human, animal and environmental sources and using both culture and genomic tools.     

Multiple enteropathogenic viruses in a gastroenteritis outbreak in a military exercise of the Portuguese Army

BackgroundGastroenteritis is one of the most common infectious diseases in the military populations and can diminish operational effectiveness and impede force readiness.ObjectivesThe present study investigates the cause and the source of an acute gastroenteritis outbreak that occurred during a military exercise of the Portuguese Army, in February 2013.Study DesignA retrospective investigation was performed and stool samples, food items and water were screened for common foodborne bacteria and viruses, namely Norovirus GI, Norovirus GII, Astrovirus, Rotavirus, Adenovirus and Sapovirus.ResultsFrom the total of 160 soldiers that participated in the military exercise 20 developed gastroenteritis (attack rate of 12.5%). Symptoms were predominantly vomiting (n = 17, 85%) and diarrhoea (n = 9, 45%). The first cases occurred 24–48 h after drinking water from the creek, the plausible origin of the outbreak. The epidemic peak was registered 2 days after and the last cases 6 days after, upon returning to base. No pathogenic bacteria were found in stools however virological analysis revealed the presence of multiple enteropathogenic viruses, namely Norovirus GI (GI.3), Norovirus GII (GII.4 New Orleans 2009), Astrovirus and Sapovirus, as single or co-infections. Food and water samples were not tested for the presence of viruses due to exhaustion of samples on bacteriological analysis.ConclusionsTo the best of our knowledge this is the first report of a viral gastroenteritis outbreak among military personnel in the Portuguese Army.     

2017年山东省三个城市食源性腹泻中胃肠炎病毒的病原谱特征分析

目的分析山东省三个城市食源性腹泻病例中胃肠炎病毒病原谱的分布和流行特征。方法于2017年1—12月,以山东省济南、烟台和临沂市的6家哨点医院为研究现场,收集1397例食源性腹泻病例的粪便标本,同时获取其基本信息和临床症状。采用双重荧光定量RT PCR分别检测如病毒基因Ⅰ组(NoV GⅠ)和Ⅱ组(NoV GⅡ)、札如病毒(SaV)和人星状病毒(HAstV),采用单重荧光定量RT PCR检测轮状病毒A组(RVA),采用荧光定量PCR检测肠道腺病毒(EAdV),对病毒的特异性片段进行测序、分型。比较不同特征病例胃肠炎病毒阳性率以及阳性和阴性病例间临床症状的差异。结果年龄M(P25,P75)为23(1,42)岁;以男性为主,占57.48%(803例);≤5岁儿童居多,占36.36%(508例)。胃肠炎病毒阳性率为33.93%(474例),济南、临沂和烟台市分别为32.03%(147/459)、41.54%(189/455)和28.57%(138/483)(P<0.001);NoV GⅡ组的阳性率最高,为16.54%(231例),5月(24.75%,50/202)和6月(19.59%,38/194)出现高峰,以GⅡ.P16/GⅡ.2型(48.28%,56/116)为主。阳性病例中,44.51%(211/474)出现呕吐症状,高于阴性病例(34.13%,315/923),差异有统计学意义(P<0.001)。结论山东省食源性腹泻病例中男性、5岁以下儿童居多;NoV GⅡ流行强度较高,发病高峰为春夏季,病毒性胃肠炎临床症状不典型。     

卢龙县一起人杯状病毒引起急性胃肠炎暴发的流行病学调查

目的调查河北省卢龙县急性胃肠炎暴发的流行情况，分析发病原因。方法应用流行病学调查方法对卢龙县发生一起暴发性急性胃肠炎进行调查，采用ELISA和RT-PCR方法进行人杯状病毒检测，并对PCR产物克隆测序，进行遗传进化分析。结果在调查的736人中，发病134例，罹患率为18．20％，1例死亡。发病年龄范围在1-77岁，以青壮年发病较多。6月25～30日为发病高峰。6份粪便标本中，ELISA方法检出3份杯状病毒阳性，RT-PCR方法确认1例，并鉴定为诺如病毒GI/2基因型。结论证实由杯状病毒引起急性胃肠炎暴发。     

一起诺如病毒Ⅰ型Ⅱ型混合感染急性胃肠炎暴发疫情调查分析

目的 对湖州市某中学发生的一起以腹泻、呕吐为特征的暴发疫情进行调查和分析,查找病因、分析危险因素.方法 采用现场流行病学调查方法,结合临床表现及实验室检测结果进行调查与综合分析.结果该校共发生急性胃肠炎病例578例,罹患率为23.58%;临床表现主要为腹泻、呕吐、腹痛、恶心,少见发热,大多症状较轻,病程1～3 d;各班均有发病,无明显聚集性;共采集患者粪便标本15份,采用RT-PCR方法检出诺如病毒阳性标本11份,其中Ⅱ型6份,Ⅰ型阳性3份,Ⅰ型、Ⅱ型混合阳性2份(同一学生,两次采样).病例对照研究显示,饮用未加热桶装水是此次发病的危险因素(OR=2.46,95% CI=1.19～5.23),且饮水量与发病存在剂量反应关系(X2=24.18,P<0.01).通过采取隔离治疗传染源、改桶装水为供应开水、卫生消杀及健康教育等综合措施后,疫情迅速得到控制.结论 本次疫情是由诺如病毒引起的急性胃肠炎暴发,可疑的传播途径为饮用未加热的桶装水与日常接触.     

Impact of rotavirus vaccination on rotavirus and all-cause gastroenteritis in peri-urban Kenyan children

A monovalent rotavirus vaccine (RV1) was introduced into the National Immunization Program in Kenya in July 2014. We examined the impact of the vaccine on hospitalization for all-cause acute gastroenteritis (AGE) and rotavirus-specific AGE and strain distribution at a large referral hospital which serves a predominantly peri-urban population in Central Kenya. Data on rotavirus AGE and strain distribution were derived from ongoing hospital-based AGE surveillance. Hospital administrative data were used to compare trends in all-cause AGE. Pre-vaccine (July 2009–June 2014) and post-vaccine (July 2014–June 2016) periods were compared for changes in hospitalization for all-cause AGE and rotavirus AGE and strain distribution. Following the vaccine introduction, the proportion of children aged <5 years hospitalized for rotavirus declined by 30% (95% CI: 19–45%) in the first year and 64% (95% CI: 49–77%) in the second year. Reductions in rotavirus positivity were most pronounced among the vaccine-eligible group (<12 months) in the first year post-vaccination at 42% (95% CI: 28–56%). Greater reductions of 67% (95% CI: 51–79%) were seen in the second year in the 12–23 months age group. Similarly, hospitalizations for all-cause AGE among children <5 years of age decreased by 31% (95% CI: 24–40%) in the first year and 58% (95% CI: 49–67%) in the second year of vaccine introduction. Seasonal peaks of rotavirus and all-cause AGE were reduced substantially. There was an increased detection of G2P[4], G3P[6] and G3P[8], which coincided temporally with the timing of the vaccine introduction. Thus, introducing the rotavirus vaccine into the routine immunization program in Kenya has resulted in a notable decline in rotavirus and all-cause AGE hospitalizations in Central Kenya. This provides early evidence for public health policy makers in Kenya to support the sustained use of the rotavirus vaccine in routine immunizations.     

Lost workdays and healthcare use before and after hospital visits due to rotavirus and other gastroenteritis among young children in Norway

BackgroundCost-effectiveness of rotavirus vaccination is affected by assumptions used in health economic evaluations. To inform such evaluations, we assessed healthcare use before and after hospitalisations due to rotavirus and other acute gastroenteritis (AGE) among children <5 years of age in Norway and estimated daycare and work absenteeism.MethodsWe conducted post-discharge interviews with caregivers of 282 children hospitalised with AGE at two hospitals in Norway during April 2014–February 2017. We collected data on healthcare use and absenteeism from daycare and work. We examined healthcare seeking and absenteeism patterns for RV-specific and other gastroenteritis.ResultsCaregivers of 485 (37%) of 1 298 hospitalised children were invited to participate, and 282 (58%) completed the questionnaire. Among these, 106 (38%) were rotavirus-positive, 119 (42%) were rotavirus-negative, and for 57 (20%) children no rotavirus testing was performed. Overall, 97% of children had been in contact with a healthcare provider before hospital admission and 28% had contacted a healthcare provider after discharge. Children that attended daycare were absent from daycare for a mean of 6.3 days (median 5 days). Caregivers of these children reported work absenteeism in 74% of cases. The mean duration of work absenteeism among caregivers was 5.9 days (median 5 days) both for RV-positive and RV-negative cases.ConclusionIn Norway, work absenteeism and healthcare use before and after hospitalisation due to rotavirus and non-rotavirus gastroenteritis are considerable and impose an economic burden on the healthcare system and society.     

半夏泻心汤加味治疗急性胃肠炎96例的效果分析

目的：探讨在急性胃肠炎患者应用半夏泻心汤加味的治疗效果,给临床治疗提供理论依据。方法：选取2013年10月－2015年10月医院收治96例急性胃肠炎患者作为研究对象,按照患者入院的先后顺序将患者平均分成两组,观察者和对照组均48例,对照组应用左氧氟沙星注射液进行治疗,观察者应用半夏泻心汤加味治疗,分析比较两组患者的治疗效果、治疗后患者的生活质量评分以及治疗过程中的不良反应发生情况。结果：观察者的有效率明显高于对照组,组间差异明显,具有统计学意义（P＜0．05）;观察组患者的不良反应发生率为2．08％,对照组的不良反应发生率为16．67％,观察者的不良反应发生率明显低于对照组,组间差异明显,具有统计学意义（P＜0．05）;经过治疗后,观察者的生活质量评分明显高于对照组,组间差异明显,具有统计学意义（P＜0．05）。结论：半夏泻心汤加味治疗急性胃肠炎疗效明显,不良反应小,值得临床推广使用。     

南京某小学一起诺如病毒胃肠炎暴发疫情调查

目的分析急性胃肠炎疫情暴发的原因及危险因素。 方法回顾性病例对照研究分析2017年4月26日至 2017年5月5日南京市某小学出现的111例胃肠炎患者。其中男性64例,女性47例;年龄7～36岁,平均年龄(10.84±4.00)岁。通过病例对照研究探索可疑传播因素,选择一、三、五年级病例55例,按1∶1在同班级选择同性别无症状健康人群55例为对照,分析疫情发生的危险因素。采用荧光定量RT-PCR方法对人体、环境及食物标本进行诺如病毒核酸检测。 结果本次疫情共111例病例,其中学生108例(95.7%),教师3例(2.6%)。实验室共检出诺如病毒GⅡ型核酸阳性11份(12.6%),其中9份为学生肛拭子样(56%),1份为学生粪便样(100%),1份为三(1)班门把手涂擦样(3.33%)。病例对照研究结果显示：靠近患者呕吐物1米是危险因素(OR＝3.90,P<0.05),说明直接或间接接触呕吐物或气溶胶是疫情发生的主要危险因素。其他因素暂未发现与该起暴发有统计学意义上的关联。 结论该起感染性腹泻聚集性疫情由诺如病毒引起,密切接触与暴露于患者的呕吐物是最主要的危险因素。     

一起诺如病毒引起的急性胃肠炎暴发疫情调查

摘要:目的　了解诺如病毒引起的急性胃肠炎暴发的原因和流行特征,为制定防控措施提供科学依据。方法　采用现场流行病学调查、病例对照研究以及现场卫生学调查方法,探索引起本次疫情暴发的危险因素。结果　本次疫情历时8 d,共患病92例,罹患率4.5%。经Logistic回归分析提示是由学生乘坐公交车接触诺如病毒病人引起的学校诺如病毒胃肠炎暴发疫情。结论　加强病情监测和报告,是学校诺如病毒疫情防控的主要对策。