Prevalence and determinants of Campylobacter infection among under five children with acute watery diarrhea in Mwanza,North Tanzania

Background

Campylobacteriosis, a zoonotic bacterial disease observed world-wide, is becoming the most commonly recognized cause of bacterial gastroenteritis in humans. This study was done to determine the prevalence and determinants of Campylobacter infection among under-fives with acute watery diarrhea in Mwanza City, Tanzania.

Method

This cross-sectional hospital-based study was conducted at Bugando Medical Centre (BMC) and Sekou Toure Hospital in Mwanza City. All inpatients and outpatients under-fives who met the inclusion criteria from October 2012 to April 2013 were enrolled in the study. Demographic and clinical data were obtained using standardized data collection tools. Stool samples were collected for gram staining and culture for Campylobacter spp. on Preston selective agar media. In addition, blood slides for malaria and HIV tests were done to all patients.

Results

A total of 300 children were enrolled with a median age of 12 [interquartile range, 8–19] months. Of these, 169 (56.5%) were from BMC and 131 (43.7%) from Sekou-Toure hospital. One hundred and seventy (56.7%) of the participating children were male. Of 300 under-fives with acute watery diarrhea, 29 patients (9.7%) were found to have Campylobacter infection. A significant higher number of children with Campylobacter infection were found in Sekou Toure hospital compared to BMC [16.0% (21/29) versus 4.7% (8/29), p = 0.002)]. Age above 2 years was independently found to predict campylobacter infection (OR: 2.9, 95% CI 1.1-7.7, p = 0.0037). Of 30 patients with a positive blood slide for Plasmodium falciparum, 20.0% were also positive for Campylobacter infection (OR: 3.9, 95% CI 1.2-10.1, p = 0.021).

Conclusion

Campylobacter infection shows a comparatively low prevalence in under-fives with acute watery diarrhea in Mwanza city and is independently associated with positive slides for malaria and an age above 2 years. Further studies are needed to type the most prevalent Campylobacter species and to determine their antibiotic susceptibility pattern.     

Early impact of rotavirus vaccination in children less than five years of age in Mozambique

BackgroundMozambique introduced rotavirus vaccine (Rotarix, GSK Biologicals) in the National Immunization Program in September 2015 with the objective of reducing the burden of total diarrheal disease and specifically severe rotavirus disease. This study aimed to evaluate the early impact of rotavirus vaccine in reducing all-cause diarrhea and rotavirus-specific hospitalizations.MethodsWe analysed stool specimens collected from children under five years old, between January 2014 and June 2017 within the National Surveillance for Acute Diarrhea. We compared annual changes in rotavirus positivity, median age of children hospitalized for rotavirus and the number of all-cause for diarrheal hospitalizations. Rotavirus detection was performed using enzyme immunoassay.ResultsDuring this period, 1296 samples were collected and analyzed. Rotavirus positivity before vaccine introduction was 40.2% (39/97) in 2014 and 38.3% (225/588) in 2015, then after vaccine introduction reduced to 12.2% and 13.5% in 2016 and 2017, respectively. The median age of children hospitalized for rotavirus was 9 and 11 months in 2014 and 2015 and 10 months in 2016 and 2017. Rotavirus hospitalizations exhibited a seasonal peak prior to vaccine introduction, between June and September in 2014 and 2015, coinciding with winter period in Mozambique. After vaccine introduction, the peak was delayed until August to December in 2016 and was substantially diminished. There was a reduction in all-cause acute diarrhea hospitalizations in children aged 0–11 months after vaccine introduction.ConclusionWe observed a reduction in rotavirus positivity and in the number of all-cause diarrhea hospitalizations after vaccine introduction. The data suggest rotavirus vaccine is having a positive impact on the control of rotavirus diarrheal disease in Mozambique.     

2010年婴幼儿腹泻轮状病毒监测分析

目的了解乌鲁木齐地区婴幼儿轮状病毒(RV)腹泻流行情况。方法 2010年1~12月,采集门诊或住院≤5岁婴幼儿腹泻样本503份,用胶体金法和ELISA检测RV抗原,阳性样本用逆转录-聚合酶链反应(RT-PCR)进行G、P基因型分型。结果 503份腹泻样本,RV阳性率为24.25%(122/503)。RV感染对象主要为35月以内婴幼儿(95.08%)。对102份RV阳性样本进行G/P分型,G3型是主要优势株,占46.08%,其次为G1型(34.31%)、G9型(11.76%)和G2型(2.94%),混合G型感染占4.90%;P基因型以P[8]为主导,占67.65%,其次为P型混合感染(19.61%)、P[4](6.86%)和P[6](4.90%),1例(0.98%)未能分型。最常见的G/P组合为G3P[8](35.29%)和G1P[8](27.45%)。结论 RV是乌鲁木齐地区婴幼儿腹泻的主要病原,2010年G3P[8]和G1P[8]为主要流行基因型。     

Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis

IntroductionEmerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk age-group for respiratory infections, remain unclear. We conducted a systematic review and meta-analysis of epidemiological and clinical characteristics of COVID-19 infection in children under five years.MethodFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses , we searched several electronic databases (Pubmed, EMBASE, Web of Science, and Scopus) with no language restriction for published epidemiological studies and case-reports reporting laboratory-confirmed COVID-19 infection in children under five years until June 4, 2020. We assessed pooled prevalence for key demographics and clinical characteristics using Freeman-Tukey double arcsine random-effects model for studies except case-reports. We evaluated risk of bias separately for case-reports and other studies.ResultsWe identified 1,964 articles, of which, 65 articles were eligible for systematic review that represented 1,214 children younger than five years with laboratory-confirmed COVID-19 infection. The pooled estimates showed that 50% young COVID-19 cases were infants (95% CI: 36% ? 63%, 27 studies); 53% were male (95% CI: 41% ? 65%, 24 studies); 43% were asymptomatic (95% CI: 15% ? 73%, 9 studies) and 7% (95% CI: 0% ? 30%, 5 studies) had severe disease that required intensive-care-unit admission. Of 139 newborns from COVID-19 infected mothers, five (3.6%) were COVID-19 positive. There was only one death recorded.DiscussionThis systematic review reports the largest number of children younger than five years with COVID-19 infection till date. Our meta-analysis shows nearly half of young COVID-19 cases were asymptomatic and half were infants, highlighting the need for ongoing surveillance to better understand the epidemiology, clinical pattern, and transmission of COVID-19 to develop effective preventive strategies against COVID-19 disease in young paediatric population.     

明光市 5 岁以下住院儿童腹泻轮状病毒感染监测分析简

目的了解和掌握明光市5岁以下住院儿童腹泻轮状病毒感染情况。方法收集明光市人民医院2012年5~11月5岁以下住院儿童腹泻粪便标本,采用酶联免疫法检测A组轮状病毒,阳性者反转录-聚合酶链反应进行G/P分型鉴定。结果 A组轮状病毒感染率35.33%,A组轮状病毒P分型以P4为主,G分型以G2为主。结论轮状病毒感染是明光市5岁以下住院儿童腹泻的重要病因。     

Diarrhea among hospitalized children under five: A call for inclusion of rotavirus vaccine to the national immunization program in Indonesia

ContextRotavirus diarrhea is a common disease worldwide which mostly affects children under five years old. Rotavirus infection causes severe diarrhea and leads to substantial health care costs. In Indonesia the rotavirus vaccine has been available since 2011, however it has not been included into the National Immunization Program. This study aims to describe the proportion of rotavirus in children under 5 in Indonesia, the clinical characteristics of rotavirus infections, and the rotavirus strains circulating in the country during 2010–2015.MethodsChildren under five years of age with acute watery diarrhea were prospectively identified and enrolled through the active diarrhea surveillance system in 5 sites in four provinces in Indonesia during 2010–2015. The rotavirus specimens were tested using Enzyme Immunoassay. Bivariate logistic regression tests were performed to compare rotavirus positive and negative results with respect to the collected demographic and clinical variables.ResultsFrom January 2010 to December 2015, the average annual rotavirus prevalence among children hospitalized with acute watery diarrhea in four provinces in Indonesia was 47.5%. Rotavirus diarrhea occurred mostly in children under 2 years of age. Of all age groups, children aged 6–11 and 12–23 months had the highest prevalence of rotavirus diarrhea in all years (54.2% and 50.6%, respectively). This study found that the most prevalent of G and P genotypes were G1P8 in 2010 (63.2%), 2011 (64.1%) and 2012 (74.6%) and G3P8 in 2013 (49.7%), 2014 (82.5%) and 2015 (84.4%)ConclusionsThis study demonstrates that rotavirus is a major cause of diarrhea in hospitalized children in Indonesia. These findings highlight the need for inclusion of the rotavirus vaccine to the National Immunization Program in Indonesia.     

北京地区腹泻儿童轮状病毒感染近况及3种检测试剂盒的比较

目的:了解北京地区腹泻患儿轮状病毒的感染情况,并比较3种试剂盒对轮状病毒的检出率。方法:对2004～2007年北京儿童医院门诊腹泻患儿43960份粪便标本进行轮状病毒抗原检测,分析发病季节、患儿年龄、性别与病毒检出率的关系;采用3种不同试剂盒(万泰、Coris和Asia-lion)对83份腹泻患儿的粪便标本同时进行轮状病毒抗原检测,并进行对比分析。结果:①轮状病毒检出率以秋冬季最高,其次为春季,夏季最低。同2005年和2006年相比,2007年检出率呈下降趋势。②662名不同年龄段患儿的检出率有显著性差异,其中以6~24月患儿检出率最高。③以两种试剂盒检测结果一致为标准,万泰、Coris和Asia-lion试剂盒检测轮状病毒的敏感性分别为93.3%(14/15)、100.0%(15/15)和86.7%(13/15);特异性分别为92.6%(63/68)、98.5%(67/68)和92.6%(63/68)。结论:北京地区儿童轮状病毒腹泻的发生率近3年呈下降趋势,高峰期仍在秋冬季节,但春季也有较高的发生率。2岁以下儿童轮状病毒感染率高。3种试剂盒均能对轮状病毒进行快速检测,准确性均较高。     

河北省卢龙县2010-2020年哨点监测5岁以下儿童病毒性腹泻病原学特征分析

目的 分析河北省哨点监测<5岁儿童病毒性腹泻病原学特征,为儿童病毒性腹泻科学防控提供参考依据。方法 收集2010-2020年河北省卢龙县哨点监测医院<5岁腹泻住院病例粪便标本。采用ELISA法检测轮状病毒抗原,轮状病毒分型采用半巢式两轮RT-PCR方法。杯状病毒检测及分型、星状病毒和肠道腺病毒检测均采用实时荧光定量PCR方法。采用SPSS 20.0软件对数据进行统计学分析。结果 共检测2 925例粪便标本,病原总体阳性率为65.61%（1 919/2 925）。轮状病毒、杯状病毒、肠道腺病毒和星状病毒阳性率分别为42.80%（1 252/2 925）、22.12%（647/2 925）、6.19%（181/2 925）、3.56%（104/2 925）。2010-2017年病毒性腹泻主要以轮状病毒感染为主（59.30%,1 017/1 715）,2018-2020年以杯状病毒感染为主（53.43%,109/204）。轮状病毒阳性率峰值出现在冬季,以12~17月龄婴幼儿最高（52.96%,483/912）。轮状病毒阳性标本,G/P分型以G9P［8］型为主（58.31%,730/1 252）,其次为G3P［8］型（8.15%,102/1 252）。杯状病毒以诺如病毒Ⅱ组为主,2011-2016年和2018年优势基因型分别为GⅡ.4［P31］型和GⅡ.3［P12］型。结论 轮状病毒和杯状病毒是2010-2020年河北省卢龙县<5岁儿童病毒性腹泻的优势病原体,冬季为主要流行季节。     

攀枝花地区0～5岁儿童轮状病毒腹泻的分子流行病学研究

目的探讨攀枝花地区2009年10～12月婴幼儿轮状病毒腹泻的分子流行病学特征及临床特点。方法采用胶体金免疫层析法、逆转录-聚合酶链法(RT-PCR)对收集的婴幼儿腹泻标本270份进行轮状病毒检测及A组轮状病毒常见的G、P基因分型研究。结果 270份腹泻标本轮状病毒阳性率为38.6%;6月～2岁年龄组的阳性率为45.4%(89/196),2～5岁年龄组的阳性率为20.3%(15/74),两组对比差异有统计学意义(P﹤0.005);104例被检测的A组轮状病毒腹泻粪便标本中G分型以G2为主,P分型以P4为主。结论轮状病毒是攀枝花地区婴幼儿腹泻的主要病原,G2型和P4型为2009年的优势毒株。该病毒引起的小儿腹泻主要发生在秋冬季,6月～2岁婴幼儿是轮状病毒的易感人群。     

罗定市10岁以下儿童肺炎支原体感染的调查分析

目的:了解罗定市10岁以下儿童肺炎支原体(MP)感染情况。方法:对2001年7月～2004年6月在该院就诊的呼吸道感染患儿采用低效价颗粒凝集测抗体实验测定血清中MpIgM滴度。结果:1127例患儿中检出阳性病例235例,阳性检出率20.85%,其中0岁～组MP阳性率为7.37%,1岁～组为21.24%,6～10岁组为35.69%;冬春季(12～2月)为MP感染的高峰期。结论:MP是引起10岁以下儿童(特别是学龄儿童)感染的主要病原体之一,早期诊断十分重要。     

Cost-effectiveness of rotavirus vaccination in children under five years of age in 195 countries: A meta-regression analysis

BackgroundRotavirus caused an estimated 151,714 deaths from diarrhea among children under 5 in 2019. To reduce mortality, countries are considering adding rotavirus vaccination to their routine immunization program. Cost-effectiveness analyses (CEAs) to inform these decisions are not available in every setting, and where they are, results are sensitive to modeling assumptions, especially about vaccine efficacy. We used advances in meta-regression methods and estimates of vaccine efficacy by location to estimate incremental cost-effectiveness ratios (ICERs) for rotavirus vaccination in 195 countries.MethodsBeginning with Tufts University CEA and Global Health CEA registries we used 515 ICERs from 68 articles published through 2017, extracted 938 additional one-way sensitivity analyses, and excluded 33 ICERs for a sample of 1,418. We used a five-stage, mixed-effects, Bayesian metaregression framework to predict ICERs, and logistic regression model to predict the probability that the vaccine was cost-saving. For both models, covariates were vaccine characteristics including efficacy, study methods, and country-specific rotavirus disability-adjusted life-years (DALYs) and gross domestic product (GDP) per capita. All results are reported in 2017 United States dollars.ResultsVaccine efficacy, vaccine cost, GDP per capita and rotavirus DALYs were important drivers of variability in ICERs. Globally, the median ICER was $2,289 (95% uncertainty interval (UI): $147–$38,993) and ranged from $85 per DALY averted (95% UI: $13–$302) in Central African Republic to $70,599 per DALY averted (95% UI: $11,030–$263,858) in the United States. Among countries eligible for support from Gavi, The Vaccine Alliance, the mean ICER was $255 per DALY averted (95% UI: $39–$918), and among countries eligible for the PAHO revolving fund, the mean ICER was $2,464 per DALY averted (95% UI: $382–$3,118).ConclusionOur findings incorporate recent evidence that vaccine efficacy differs across locations, and support expansion of rotavirus vaccination programs, particularly in countries eligible for support from Gavi, The Vaccine Alliance.     

嘉兴地区5岁以下儿童轮状病毒腹泻的疾病负担

目的:了解嘉兴地区5岁以下儿童轮状病毒腹泻疾病负担情况。方法:采用系统抽样法,抽取2018—2019年嘉兴市秀洲区各乡镇/街道报告的300例5岁以下轮状病毒腹泻病例作为调查对象。采用自行设计的调查表,获取调查对象基本情况和治疗情况,以及生病期间亲属陪护情况和生命质量等情况,综合评估疾病负担。结果:300例患儿的调查问卷...     

四川省农村5岁以下儿童腹泻患病状况及影响因素研究

目的 了解四川省农村5岁以下儿童腹泻患病状况及其影响因素,为儿童腹泻病的防治提供建议.方法 利用第四次国家卫生服务调查西部扩点调查四川省的资料,描述性分析四川省农村5岁以下儿童腹泻患病状况,并采用Logis-tic回归模型探讨儿童腹泻患病的影响因素.结果 四川省农村5岁以下儿童腹泻两周患病率为10.1％.儿童腹泻两周患病率随着年龄的上升而下降,患病高峰在0～2岁.影响儿童腹泻的主要因素为年龄、父母是否均长期在外务工、家庭是否使用安全饮用水.结论 四川省农村儿童腹泻防治工作的重点对象为0～2岁儿童和留守儿童,并且儿童腹泻的防治应从提倡合理喂养、改善用水卫生、保持良好的卫生习惯等方面入手.     

云南省5岁以下儿童死亡监测情况分析

5岁以下儿童死亡监测工作是实施《中国妇女发展纲要》和《中国儿童发展纲要》的需要 ,也是各级卫生行政部门和医疗保健机构的重要职责之一。通过对近几年来 5岁以下儿童死亡监测结果的简要回顾总结 ,分析了所取得的经验和存在的问题 ,并提出了一些改善 5岁以下儿童死亡监测工作的建设性意见     

宁夏五县农村7岁及以下儿童腹泻两周患病情况及影响因素分析

目的 了解宁夏回族自治区五县农村7岁及以下儿童腹泻的患病现状及其影响因素,为采取相应的干预措施和优化卫生资源配置提供科学依据。方法 数据来源于宁夏卫生厅与哈佛/牛津大学研究团队合作开展的“创新支付制度,提高卫生效益”试点项目对宁夏五县(海原、盐池、同心、彭阳、西吉)“农村居民家庭卫生健康询问调查”2009、2011、2012年和2015年调查的10 318名儿童的资料,应用SPSS 23.0软件通过单因素分析和非条件二分类 Logistic回归对儿童腹泻影响因素进行筛选。结果 宁夏五县农村7岁及以下儿童腹泻两周患病率为5.4%(558/10 318),单因素分析结果显示不同年龄、民族以及是否计划免疫儿童的腹泻患病率不同,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示回族儿童(OR=1.351,95%CI:1.090~1.671),儿童年龄小(0~＜2岁,OR=10.515,95%CI:7.308~15.129; 2~＜4岁,OR=3.319,95%CI:2.285~4.821)和家庭年收入水平低(OR=1.555,95%CI:1.229~1.966)可能是该地区儿童腹泻的危险因素。结论 宁夏五县农村地区7岁及以下儿童两周腹泻患病率较高,民族、年龄、家庭年收入水平是宁夏农村地区儿童腹泻的主要影响因素。     

福建省第2次5岁以下儿童维生素A缺乏症调查

目的:了解福建省5岁以下儿童维生素A缺乏现状,以对今后防治措施提供依据。方法:根据福建省地理位置、经济状况采取整群分层抽样方法,共分3个层,每层抽取2~4个县市,共有福州等9个县市。对儿童进行常规体检、病史询问和血清维生素A检测。结果:本次5岁以下儿童5 973例,亚临床维生素A缺乏患病率为3.2%;亚临床维生素A可疑缺乏患病率为23.0%;没有发现有临床表现的维生素A缺乏。显示福建省5岁以下儿童维生素A水平在不同县市、不同年龄存在差异。结论:增加与多食胡萝卜、肝脏等维生素A含量高的食物,才是预防维生素A缺乏的根本方法。婴儿早期开始服用鱼肝油,是预防和治疗维生素A缺乏的最有效、最迅速、最经济的手段。     

住院儿童下呼吸道非典型病原体感染5年流行病学分析

【目的】 对昆明地区5年间急性下呼吸道感染(acute lower respiratory infection, ALRI)进行流行病学分析,为该病的预防提供理论依据。对住院儿童进行三种常见非典型病原体感染临床流行病学回顾性分析。 【方法】 应用间接免疫荧光法(IFA)对2003—2007年12 083例本院收治的ALRI住院患儿,进行肺炎支原体(M-pneumoniae, MP)、嗜肺军团菌1型(L-pneumoniae, LP1)、肺炎衣原体(chlamydia pneumoniae, CPn)血清IgM抗体联合检测,根据研究结果对5年间病原谱、病原流行概况、阳性患儿病原年龄分布特点进行临床流行病学资料汇总分析。 【结果】 5年间ALRI儿童非典型病原体感染总阳性率30.1%。MP、Lp1、CPn阳性率分别为17.3%、11.3%、1.4%。MP感染率秋、冬季最高, 2003年夏秋季、2007年秋冬季出现MP流行趋势;Lp1夏、秋季感染率高于春、冬季; CPn全年均可发病,呈散发。MP是1岁以上ALRI儿童的重要病原;Lp1、CPn随年龄增长呈上升趋势,是年长儿ALRI 的主要病原。 【结论】 昆明地区儿童非典型病原体感染病原以MP、Lp1感染为主;感染率存在季节差异。随年龄增长非典型病原体感染率增高。     

消旋卡多曲治疗小儿急性腹泻疗效观察

目的观察消旋忙多曲治疗小儿急性腹泻的疗效与安全性。方法选取120例小儿急性腹泻的患儿,随机分为两组,对照组使用思密达、金双歧及补液等对症治疗。观察组在对照组的基础上加用消旋卡多曲,观察两组的临床疗效和不良反应。结果观察组有效率为92％,明显高于对照组（72％）。结论消旋卡多曲能较快减少腹泻的次数,迅速纠正脱水,明显缩短腹泻病程,用药后无明显不良反应,安全性高。     

2005～2009年沈阳市大东区5岁以下儿童死亡分析

目的:掌握并了解沈阳市大东区5岁以下儿童死亡情况,制定干预措施,努力降低沈阳市大东区5岁以下儿童死亡率。方法:对2005～2009年沈阳市大东区辖区内5岁以下儿童死亡监测资料进行分析。结果:2009年与2005年相比,5岁以下儿童死亡率没有大的波动,基本保持平稳态势;5年间先天异常、早产低出生体重逐年增加,已成为5岁以下儿童主要死因。结论:做好围产保健,加强产前筛查,降低出生缺陷,防早产是降低5岁以下儿童死亡的有力措施。