中国轮状病毒感染性腹泻免疫预防进展

轮状病毒(Rotavirus,RV)是导致全球婴幼儿病毒性腹泻主要的病原,疫苗接种是预防婴幼儿RV感染最有效的措施之一。本文对RV感染性腹泻的病原学、流行病学、疫苗的免疫预防等研究进展予以综述,重点介绍了全球正在使用的3种RV疫苗的安全性、效力、免疫程序以及世界卫生组织的立场和其他国家的应用经验,结合中国免疫规划实施现状提出了RV疫苗的免疫预防的思考和建议。     

轮状病毒性胃肠炎

引起胃肠道感染最常见的病毒有轮状病毒(Ｒｏｔａｖｉｒｕｓ)、诺沃克样病毒 (Ｎｏｒｗａｌｋ -ｌｉｋｅｖｉｒｕｓ)、腺病毒 (Ａｄｅｎｏｖｉｒｕｓ)、萼状病毒 (Ｃａｌｉｃｉｖｉｒｕｓ)、星状病毒 (Ａｓｔｒｏｖｉｒｕｓ)和托拉病毒 (Ｔｏｒｏｖｉｒｕｓ)等 ,均可引起急性胃肠炎 ,都有明显的腹泻 ,腹泻病人中由 75 %以上的是被前述病毒引起的。临床上当呕吐显著 ,潜伏期长于 1 4ｈ则疑为病毒引起。整个病程不少于 72ｈ[1] 。流行性的病毒为萼状病毒、轮状病毒、星状病毒、腺病毒等。急性散发性和地方性儿童和成人腹泻的病原是 :轮状病毒…     

轮状病毒性胃肠炎

轮状病毒是病毒性胃肠炎的另一个主要病原体。1973年Bishop等首次提出轮状病毒是婴儿胃肠炎的重要病因,并在十二指肠的肠上皮细胞内找到病毒颗粒。它是人畜共患的一种疾病,虽然交叉感染不常见,但可发生。Hodes等(1978)用电镜发现小牛的大便中含有轮状病毒。人的轮状病毒成功的引起小牛、羊羔,猪和猴有症状或无症状的感染。     

轮状病毒胃肠炎患儿与非感染性腹泻患儿血清微量元素水平变化对照研究

目的通过对轮状病毒胃肠炎患儿及非感染性腹泻患儿锌、铁、铜、钙、镁及铅等微量元素水平的对照研究,了解轮状病毒感染对人体微量元素的变化的影响。方法随机选取47名轮状病毒肠炎的患儿及56名非感染性腹泻的患儿分别测定研究对象的锌、铁、铜、钙、镁及铅等微量元素水平。结果轮状病毒胃肠炎患儿的锌、钙、镁这三种微量元素水平均低于非感染性腹泻患儿,轮状病毒患儿血铅水平则高于非感染性腹泻患儿,差异具有显著性（P〈0.05）,而铜、铁元素含量无显著性差异（p>0.05）结论：轮状病毒肠炎患儿比非感染性腹泻患儿更易于发生微量元素失衡,在轮状病毒肠炎的患儿的治疗过程中应该加强血清微量元素水平的监测。     

婴幼儿轮状病毒感染性腹泻监测分析

目的:了解乌鲁木齐地区婴幼儿轮状病毒感染性腹泻感染情况。方法:2006年1~12月采集门诊或住院≤5岁婴幼儿腹泻标本248例,利用酶联免疫法(ELISA)检测轮状病毒抗原。结果:248例腹泻标本,检出轮状病毒133例,阳性率为53.6%。轮状病毒感染对象主要为24月以内婴幼儿,占94.7%,发病高峰在8~9月。结论:轮状病毒是乌鲁木齐地区婴幼儿腹泻的主要病原体,监测轮状病毒感染情况意义重大。     

小儿轮状病毒感染性腹泻实验室筛查

轮状病毒(Rotavirus RV)是婴幼儿急性腹泻的重要病原体之一，为了解本地区RV感染的流行概况，我们于2003年8月～2004年7月，对来我院就医的腹泻患儿，应用ELISA法，对腹泻患儿粪便进行了RV抗原检测观察，结果报告如下。     

轮状病毒感染性腹泻的调查分析

<正>近年来,轮状病毒(RV)感染性腹泻,已成为我国急性传染病中发病数最多,流行面最广,影响群众生活生产最普遍的一组疾病。RV腹泻是导致儿童营养不良,生长发育障碍和成人劳动力大量损失的重要因素,直接危害着人们的身体健康和国民经济的可持续发展。本文对我区RV腹泻进行调查分析如下:     

轮状病毒性腹泻

近年来,无论在发达国家还是在发展中国家,轮状病毒已成为引起少儿腹泻的重要病原。此外,轮状病毒性腹泻临床症状较重,2岁以下患儿往往需要住院治疗。     

轮状病毒性腹泻

病毒性胃肠炎是由多种病毒感染引起的急性小肠炎症。主要临床表现有发热、恶心呕吐、腹泻、排稀便或水样便,病程短、病死率低。本病见于世界各地,有时呈暴发流行。迄今为止,已证明与急性腹泻相关的病毒有轮状病毒、诺瓦克病毒、肠腺病毒、星状病毒及冠状病毒等。临床常见的主要     

轮状病毒感染性腹泻的调查分析

近年来，轮状病毒（RV）感染性腹泻，已成为我国急性传染病中发病数最多，流行面最广，影响群众生活生产最普遍的一组疾病。RV腹泻是导致儿童营养不良，生长发育障碍和成人劳动力大量损失的重要因素，直接危害着人们的身体健康和国民经济的可持续发展。本文对我区RV腹泻进行调查分析如下：     

Rotavirus and severe childhood diarrhea

Studies published between 1986 and 1999 indicated that rotavirus causes approximately 22% (range 17%-28%) of childhood diarrhea hospitalizations. From 2000 to 2004, this proportion increased to 39% (range 29%-45%). Application of this proportion to the recent World Health Organization estimates of diarrhea-related childhood deaths gave an estimated 611,000 (range 454,000-705,000) rotavirus-related deaths.     

腹泻患儿轮状病毒感染分析

目的了解腹泻患儿轮状病毒感染的季节性、年龄段和实验室检查特点。方法对医院2008-2009年7237例腹泻患儿粪便进行常规检查和轮状病毒检测。结果 7237份腹泻粪便共检出轮状病毒1754株,检出率为24.24%;高发期为11、12月份,最高检出率达48.22%;高发年龄为6月龄~2岁,检出率为33.91%,占64.02%;轮状病毒阳性粪便常规镜检,阴性结果占44.64%,脂肪球检出率为36.94%,14.99%的标本检出少量白细胞。结论轮状病毒是引起患儿腹泻的主要病原体之一,及时检测粪便轮状病毒,可以为临床早期诊断和对症治疗提供依据。     

Rotavirus and non-bacterial infantile gastroenteritis in Kuwait

The role of rotavirus in non-bacterial gastroenteritis in Kuwait was investigated. Employing electronmicroscopy (EM) and enzyme-linked-immuno-sorbent-assay (ELISA) techniques, the virus was detected in the stools of 42 of 274 (15.3%) infants with the disease. A statistically significant association (P less than 0.05) was found between virus excretion and age since 37 of 42 (88.1%) of rotavirus positive cases were aged 2-12 months. 57.1% of all rotaviruses detected were among specimens collected during the first 3 days since onset of clinical symptoms. In addition a highly significant relationship (P less than 0.01) was found between virus excretion and seasonal variation since highest virus excretion rates (76.1%) were detected in specimens collected during the autumn and early winter months, and coincided with the annual gastroenteritis season in Kuwait. Diarrhoea and vomiting were the most frequently encountered clinical symptoms being present in 92.9% and 76.2% of all rotavirus positive patients, respectively.     

2006年婴幼儿腹泻轮状病毒监测分析

目的监测乌鲁木齐地区婴幼儿腹泻轮状病毒（RV）感染情况和流行特点。方法 2006年1月至12月,采集门诊或住院≤5岁婴幼儿腹泻样本248例,用酶免法（ELISA）筛查RV,用RT-PCR方法对RV阳性毒株进行G基因型分型。采用SPSS13.0统计软件,数据处理用χ2检验。P〈0.05表示统计学差异有统计学意义。结果 248例腹泻样本,检出RV 133例,阳性率为53.6%。RV感染对象主要为24月以内婴幼儿,占94.7%,发病高峰在8~9月份。对125份RV阳性毒株进行G基因型分型,结果显示：G1型（46.4%）为最流行毒株,其次为G3型（17.6%）、G9型（7.2%）和G2型（4.0%）,混合感染占14.4%,不能分型占10.4%。结论轮状病毒是乌鲁木齐地区婴幼儿腹泻的主要病原,2006年G1和G3型为主要流行基因型。     

感染性腹泻的实验室诊断

感染性腹泻是由于食品和饮水受细菌、病毒和寄生虫污染所致。常见的病原体有 :(1 )细菌 :霍乱弧菌、沙门菌、志贺痢疾杆菌、致病性大肠杆菌、弯曲菌等 ,属于革兰阴性菌 ;金黄色葡萄球菌属于革兰阳性菌 ,李斯特菌为革兰阳性的短小杆菌 ;(2 )病毒 :甲、戊型肝炎病毒和轮状病毒等 ;(3 )寄生虫 :溶组织阿米巴、蓝氏贾弟鞭毛虫等。粪便检查是最主要的实验室检查方法 ,包括粪便常规、免疫学检查和细菌培养及药敏试验。若为细菌感染 ,对可疑食物、患者呕吐物及粪便作细菌培养 ,能分离出同一致病菌。血常规见白细胞升高 ,多提示细菌性感染 ,血红蛋白…     

A diagnostic quandary: Rotavirus vaccine associated diarrhea

The patient is an otherwise healthy two-month-old boy who received the recommended vaccinations for his age group, which included the rotavirus pentavalent vaccine (RV5; RotaTeq) at his two-month well child visit. Three days later, he developed prolonged non-bloody diarrhea and was found to have persistently positive rotavirus antigen in his stool. Subsequent workup revealed mild defects in his functional T-cell immunocompetence. Genetic testing was obtained through the Invitae panel and was negative for hereditary forms of primary immunodeficiencies. The rotavirus antigen was found to have cleared from his stool around four months after receiving the RV5. Unfortunately, the source of the rotavirus infection was unable to be determined. The caregivers had misconceptions about the vaccine and the child’s immune system function which led to refusal of any further vaccinations. Healthcare providers should strive to develop honest and respectful relationships with parents to have thoughtful dialogues regarding vaccine safety and efficacy.     

Weather variability and paediatric infectious gastroenteritis

Investigations of the relationship between weather variability and infectious gastroenteritis (IG) are becoming increasingly important in light of international interest in the potential health effects of climate change. However, few studies have examined the impact on children, despite the fact that children are considered particularly vulnerable to climate change. We acquired data about cases of IG in children aged <15 years and about weather variability in Fukuoka, Japan from 2000 to 2008 and used time-series analyses to assess how weather variability affected IG cases, adjusting for confounding factors. The temperature-IG relationship had an inverted V shape, with fewer cases at temperatures lower and higher than ~13°C. Every 1°C increase in temperature below the threshold (13°C) was associated with a 23·2% [95% confidence interval (CI) 16·6-30·2] increase, while every 1°C increase in temperature above the threshold (13°C) was associated with an 11·8% (95% CI 6·6-17·3) decrease in incidence. The increase in cases per 1% drop in relative humidity was 3·9% (95% CI 2·8-5·0). The percentage increase of IG cases was greatest in the 0-4 years age group and tended to decrease with increasing age. We found a progressive reduction in weather-related IG cases in children aged >4 years. Our results suggest that public health interventions aimed at controlling weather-related IG may be most effective when focused on young children.     

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。     

Acute infectious diarrhea in children

Infantile acute gastroenteritis is still a frequent problem particularly in younger children, with high mortality rate in developing countries and high impact on health costs in industrialized countries. The increased knowledge on its pathophysiology has led to the definition of two distinct mechanisms of diarrhea: the secretory and the osmotic pathway. Investigation on the host-microorganism interaction revealed a complex scenario with sophisticated mechanisms developed by microorganisms during evolution to overcome the host defense system. The latter includes immune and non immune coordinated components, with a major role played by the GALT (gut associated lymphoreticular tissue). Knowledge of epidemiology and of the natural history of intestinal infections has led to rational diagnostic approach with substantial cut of medical costs. Novel therapeutic strategies have been made available with the use of probiotics and of passive immunotherapy together with a dramatic reduction of antibiotic treatment. HIV pandemy raises major problems which need rapid responses.