2015年冬至2016年春儿童急性呼吸道感染病毒监测及分析

目的 调查2015年冬至2016年春在郑州大学第三附属医院儿科门诊急性呼吸道感染（ARI）患儿病毒病原学情况。方法 收集483例ARI患儿鼻咽部分泌物,采用多重媒介探针熔解曲线分析技术检测流感病毒A、B型,呼吸道合胞病毒A、B型,副流感病毒1~4型,鼻病毒,腺病毒,人偏肺病毒,冠状病毒,人博卡病毒和肠病毒。结果 病毒阳性检出率29.19%（141/483）,前4位依次为流感病毒8.49%、副流感病毒5.38%、呼吸道合胞病毒3.93%、鼻病毒2.90%,双重感染1.86%。29 d至6月龄婴儿病毒总检出率高于3~5岁及 6岁组,组间比较差异有统计学意义（2=7.068,P=0.008;2=6.810,P=0.009）,乙型流感病毒在1~2岁检出率最高,冠状病毒在29 d至6月龄者检出率最高,男性与女性病毒总检出率差异无统计学意义。呼吸道合胞病毒A型在急性下呼吸道感染阳性率为8.96%,与急性上呼吸道感染比较差异有统计学意义（2=9.042,P=0.003）;鼻病毒春季阳性率高于冬季,乙型流感病毒阳性率冬季高于春季,差异有统计学意义（2=4.999,P=0.025;2=6.876,P=0.009）,其他呼吸道病毒在冬、春季阳性率差异无统计学意义。结论 儿童ARI病毒阳性率与年龄、季节、感染状况有关,在调查期间流感病毒、副流感病毒、呼吸道合胞病毒和鼻病毒是儿童ARI的主要病毒病原。     

江苏省常熟市一起聚集性儿童上呼吸道感染疫情的病原学调查

目的 分析2021年9月江苏省常熟市某幼儿园一起急性上呼吸道感染聚集性疫情发生的原因。方法 收集2021年9月江苏省常熟市某幼儿园急性上呼吸道感染患儿的临床信息,采集患儿咽拭子样本。采用实时荧光定量PCR对样本进行18种呼吸道病原体筛查。利用巢式PCR法对高检出率的鼻病毒进行分型片段扩增及测序。使用MEGA 7.0软件对测序结果进行序列比对,并构建系统进化树。结果 此次聚集性急性上呼吸道感染疫情主要临床症状为流涕、咽痛。共采集患儿咽拭子样本51份,其中男童24份、女童27份。18种呼吸道病原体筛查结果显示,检出率为80.39%(41/51),其中单一病毒检出率为64.71%(33/51),混合病毒检出率为15.69%(8/51)。检出的单一病毒中鼻病毒占比最高,为42.43%(14/33)。其他病毒占比依次为细小病毒B19占18.18%(6/33),博卡病毒为15.15%(5/33),冠状病毒229E为6.06%(2/33),人偏肺病毒、乙型流感病毒、腺病毒、呼吸道合胞病毒、冠状病毒OC43和NL63均为3.03%(1/33)。7例鼻病毒与其他病毒混合感染。对21份鼻病毒阳性样本进行V...     

北京地区急性呼吸道感染病例中副流感病毒感染的流行特征研究

目的 了解北京地区急性呼吸道感染病例中副流感病毒感染现况,探索其流行特征。方法 选择2011-2014年期间就诊于哨点医院的急性呼吸道感染病例,采集其咽拭子、深咳痰液等呼吸道样本,采用多重实时荧光PCR法检测副流感病毒1型、2型、3型、4型及其他常见呼吸道病毒,包括腺病毒、偏肺病毒、冠状病毒、流感病毒、呼吸道合胞病毒、鼻病毒、博卡病毒、肠道病毒,检测结果采用SPSS 17.0软件进行统计分析。结果 3978例病例中共检测到217例副流感病毒阳性病例,阳性检出率为5.46%;其他呼吸道病毒检测阳性率最高为流感病毒,为12.27%(488/3978);副流感病毒中3型阳性检出率最高,为2.21%, 2型阳性检出率最低,为0.83%;5岁以下儿童组阳性检出率最高,为7.75%,其次为60岁以上老龄组,6～15岁青年组阳性检出率最低;2011-2013年副流感病毒1型、3型阳性检出率呈逐年下降趋势,2014年有所升高;副流感病毒2型阳性检出率在2011年和2013年间明显高于2012年和2014年,呈隔年流行态势;4年中副流感病毒4型呈散发;6-8月副流感病毒的阳性检出率明显高于其他月份;急性上呼吸道感染与急性下呼吸道感染病例中副流感病毒阳性率差异无统计学意义。结论 2011-2014年北京地区副流感病毒感染主要为3型和1型;婴幼儿是副流感病毒感染的主要人群。不同年份、月份副流感病毒流行强度及流行型别差异有统计学意义。     

Evaluation of the AdvanSure™ real-time RT-PCR compared with culture and Seeplex RV15 for simultaneous detection of respiratory viruses

Recently, AdvanSure™ kit based on multiplex real-time PCR was developed for simultaneous detection of 14 respiratory viruses (RVs). We compared the performance of AdvanSure with those of Seeplex® RV 15 ACE and culture by determining their sensitivities and specificities against a composite reference standard. Four hundred thirty-seven respiratory samples were tested by modified shell vial culture method, RV 15 ACE, and AdvanSure. One hundred fourteen samples (26.2%) out of 437 samples were positive by culture, while additional 91 (20.8%) were positive by AdvanSure or RV15. One hundred twelve of 114 culture-positive samples were positive by AdvanSure except 2 samples (1 adenovirus, 1 respiratory syncytial virus [RSV]). Overall, the sensitivities of culture, RV15, and AdvanSure were 74.5%, 89.8%, and 95.1%, respectively. Sensitivities of culture, RV15, and AdvanSure for each virus tested were as follows: 91/100/96% for influenza A, 60/0/100% for influenza B, 63/95/97% for RSV, 69/81/89% for adenovirus, and 87/93/93% for parainfluenza virus. For viruses not covered by culture, sensitivities of RV15 and AdvanSure were as follows: 77/88% for rhinovirus, 100/100% for coronavirus OC43, 40/100% for coronavirus 229E/NL63, 13/100% for metapneumovirus, and 44/100% for bocavirus. The overall specificities of culture, RV15, and AdvanSure were 100/98.9/99.5%, respectively. Of 45 coinfected specimens, AdvanSure detected 41 specimens (91.1%) as coinfected, while RV15 detected 27 specimens (60.0%) as coinfected. AdvanSure assay demonstrated exquisite performance for the detection of RVs and will be a valuable tool for the management of RV infection.     

成人发热呼吸道症候群病毒病原学调查分析

目的 了解该地区成人发热呼吸道症候群病毒病原谱的构成.方法 利用巢式聚合酶链反应对发热呼吸道症候群成人患者痰标本进行流感病毒(Flu-A、B、C型)、呼吸道合胞病毒(RSV-A、B型)、腺病毒(ADV)、副流感病毒(PIV-1、2、3、4型)、冠状病毒(HCoV)、偏肺病毒(MPV)及博卡病毒(BoV)检测.结果 共收集确诊患者标本610例,病毒感染阳性率为8.5%(52/610);不同病毒检出率由高到低依次为Flu 5.57%(34/610)、RSV 1.48%(9/610)、ADV 1.15%(7/610)、PIV 0.49%(3/610)及HCoV 0.16%(1/610);检出2例混合感染,分别为Flu-A/ADV和PIV-1/HCoV.病毒感染患者以60岁以上老年人为主[71.15%(37/52)],其次是40～60岁人群[23.08%(12/52)].病毒感染好发于7～ 9月(P＜0.05);男性、女性病毒感染阳性率差异无统计学意义(P>0.05).结论 该地区成人发热呼吸道病毒感染病例的病原体以Flu和RSV为主.     

GeXP多重RT-PCR技术在呼吸道病毒检测中的应用

目的 应用GeXP多重基因表达遗传分析系统多重RT-PCR技术检测急性呼吸道感染儿童呼吸道样本中的呼吸道病毒并探讨其在儿童呼吸道感染病毒检测中的价值。方法 回顾性检测2010年7月～2012年6月期间因疑似急性呼吸道感染就诊的1 800名儿科患者的呼吸道样本,应用GeXP多重基因表达遗传分析系统多重RT-PCR技术对呼吸道合胞病毒、鼻病毒等多种呼吸道病毒进行检测。采用SPSS 13.0统计软件进行统计学分析。结果 GeXP多重RT-PCR方法检测到样本中的10种呼吸道病毒。样本中共有67.33%(1 212/1 800)的样本至少有一种病毒检测结果为阳性。这1 212份病毒阳性标本中,人类鼻病毒(HRV)阳性最多,为375份,阳性率20.83%; 其次为呼吸道合胞病毒(RSV)249份,阳性率13.83%; 其他依次为人类腺病毒(HADV)、人类副流感病毒3(HPIV-3)、人类博卡病毒(HBoV)、甲型流感(InfA)、人类副流感病毒4(HPIV-4)、流感C(InfC)、人类偏肺病毒(hMPV)和乙型流感病毒(Inf B); 阳性率分别为8.89%,6.5%,5.3%,5.3%,3.3%,1.5%,1.11%和0.67%。不同性别间患儿呼吸道病毒阳性率差异无统计学意义(P>0.05)。研究中观察到13.5%(243/1 800)的病例同时感染两种或两种以上的病毒,其中两种病毒的混合感染为210例(11.67%),3种病毒混合感染为33例(1.83%)。呼吸道病毒的感染率存在季节差异,RSV大多在春季和冬季流行,HBoV,hMPV,InfA,Inf B和 HPIV-3大多是在春季流行,而HADV和HPIV-4主要在夏季流行,Inf C大多是在秋季流行。结论 GeXP分析系统多重RT-PCR方法是一个快速、高通量、高灵敏度且特异度强的检测分析方法,可用于急性呼吸道感染临床分子诊断和流行病学研究。     

Decline of Influenza and Respiratory Viruses With COVID-19 Public Health Measures: Alberta,Canada

ObjectiveTo determine the incidence of influenza and noninfluenza respiratory viruses (NIRVs) pre-/post-implementation of public health measures aimed to decrease coronavirus disease 2019 (COVID-19) transmission using population-based surveillance data. We hypothesized that such measures could reduce the burden of respiratory viruses (RVs) transmitting via the same routes.Patients and MethodsAn interrupted time-series analysis of RV surveillance data in Alberta, Canada, from May 2017 to July 2020 was conducted. The burden of influenza and NIRVs before and after intervention initiation at week 11 was compared. The analysis was adjusted for seasonality, overdispersion, and autocorrelation.ResultsDuring the study period, an average of 708 and 4056 weekly respiratory multiplex molecular panels were conducted pre-/post-intervention, respectively. We found significant reductions in test positivity rates in the postintervention period for influenza (-94.3%; 95% CI, -93.8 to 97.4%; P<.001) and all NIRVs (-76.5%; 95% CI, -77.3 to -75.8%; P<.001) in the crude model, and -86.2% (95% CI, -91.5 to -77.4%: P<.001) and -75% (95% CI, -79.7 to -69.3%; P<.001), respectively, in the adjusted models. Subanalyses for individual viruses showed significant decreases in respiratory syncytial virus, human metapneumovirus, enterovirus/rhinovirus, and parainfluenza. For non–severe acute respiratory coronavirus 2 human coronaviruses, the decline was not statistically significant after adjustment (-22.3%; 95% CI, -49.3 to +19%, P=.246).ConclusionThe implementation of COVID-19 public health measures likely resulted in reduced transmission of common RVs. Although drastic lockdowns are unlikely to be required given widespread COVID-19 vaccination, targeted implementation of such measures can lower RV disease burden. Studies to evaluate relative contributions of individual interventions are warranted.     

婴幼儿呼吸道合胞病毒和人鼻病毒急性下呼吸道感染临床特征及随访研究

目的：比较婴幼儿呼吸道合胞病毒（RSV）和人鼻病毒（HRV）急性下呼吸道感染的临床特征,探讨婴幼儿期RSV急性下呼吸道感染患儿后期哮喘和反复喘息的发生与HRV感染患儿是否存在差异。方法采用 RT-PCR 或 PCR 方法检测住院患儿咽拭子或鼻咽吸取物中常见的呼吸道感染病毒,选取单一RSV和HRV感染病例,回顾性比较两组患者的临床特征并进行随访。结果 RSV感染组纳入病例80例, HRV感染组纳入32例。两组患儿的临床特征相似,但RSV感染组患儿年龄偏小（P＝0.004）,有喘息表现者明显多于 HRV 感染组（P＝0.000）。在与哮喘和反复喘息发生的关系上,两组间的差异无统计学意义（P值均为1.000）。结论婴幼儿RSV和HRV急性下呼吸道感染的临床特征相似,但在平均年龄、临床喘息的发生率等方面存在统计学差异。未发现婴幼儿期 RSV 感染患儿后期哮喘和反复喘息的发生与HRV感染患儿间存在差异。     

杭州地区2009甲型H1N1流感重症患儿中人类偏肺病毒感染状况研究

目的了解杭州地区2009甲型H1N1流感（以下简称甲流）重症患儿中人类偏肺病毒（hMPV）的感染状况。方法采集2009年11月至2010年1月确诊为甲流重症患儿的呼吸道样本79份,用传统逆转录聚合酶链反应（RT-PCR）、荧光定量RT-PCR方法检测hMPV及其他呼吸道病毒。选择hMPV阳性样本PCR扩增产物进行核苷酸测序,将所测序列与GenBank比对分析,并绘制基因进化树。结果79份甲流病毒阳性样本中,hMPV及其它呼吸道病毒阳性率20．25％（16,79）,hMPV阳性PCR扩增产物4份,占甲流重症病例的5．06％（4,79）。其中3份hMPV阳性PCR扩增产物核苷酸序列相似性为99．1％～99．5％,与广东省流行株GD．165,泰国株155N及B1代表株高度相似,并且被GenBank收录。结论杭州地区确诊感染的2009甲型H1N1流感重症病例中存在与hMPV共同感染状况,且hMPV均为B1基因型。     

2015-2019年上海市急性呼吸道感染病例人冠状病毒感染情况分析

  目的   了解上海市急性呼吸道感染病例中人冠状病毒（HCoV）的分布特征,深入了解HCoV的流行规律,为其防控提供科学依据。   方法   收集2015 — 2019年上海市急性呼吸道感染监测标本3 531份,利用多重PCR技术进行常见呼吸道病原体的检测。   结果   在3 531份标本中,病毒总检出率为39.73%（1 403/3 531）。 其中,HCoV检出率为3.14%（111/3 531）。 HCoV在急性呼吸道感染病例中的总检出率仅次于流感病毒和人鼻病毒/肠道病毒,流行亚型以HCoV-OC43、HCoV-NL63为主,不同HCoV亚型在人群中呈隔年交替流行的趋势。 混合感染发生率高达36.93%（41/111）,混合感染病例中的重症比例较高。   结论   HCoV是上海市急性呼吸道感染的重要病原,应加强急性呼吸道感染病例病原学监测,重点关注HCoV与其他病原的混合感染。     

Antiviral therapy for respiratory viral infections in immunocompromised patients

Introduction: Respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, coronavirus, human metapneumovirus, and rhinovirus) represent the most common causes of respiratory viral infections in immunocompromised patients. Also, these infections may be more severe in immunocompromised patients than in the general population. Early diagnosis and treatment of viral infections continue to be of paramount importance in immunocompromised patients; because once viral replication and invasive infections are evident, prognosis can be grave.

Areas covered: The purpose of this review is to provide an overview of the main antiviral agents used for the treatment of respiratory viral infections in immunocompromised patients and review of the new agents in the pipeline.

Expert commentary: Over the past decade, important diagnostic advances, specifically, the use of rapid molecular testing has helped close the gap between clinical scenarios and pathogen identification and enhanced early diagnosis of viral infections and understanding of the role of prolonged shedding and viral loads. Advancements in novel antiviral therapeutics with high resistance thresholds and effective immunization for preventable infections in immunocompromised patients are needed.     

22种呼吸道病原体核酸多重联检试剂盒检测效能评估

目的 通过对1种新型呼吸道病原体核酸多重联检试剂盒检测效能评价,为新型冠状病毒(SARS-CoV-2)、流行性感冒(流感)病毒等叠加流行的大规模检测提供适宜技术方法.方法 收集北京地区急性呼吸道感染病例阳性标本252份,采用4种核酸检测试剂盒(3种核酸多重检测试剂盒A、B、C及1种SARS-CoV-2检测试剂盒D)分别...     

珠海地区353例儿童喘息性疾病病毒病原学分析

目的 探讨儿童喘息性疾病的病毒病原学特征,提高临床诊治水平.方法 收集本院儿科2018年6月至2019年5月353例喘息患儿的咽拭子,应用多重PCR技术对病毒进行检测,并分析临床资料.结果 病毒检测阳性124例(35.13％),呼吸道合胞病毒(RSV)77例(21.81％)、副流感病毒(PIV)14例(3.97％)、博...     

2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较

目的 了解老年人呼吸道感染住院患者呼吸道合胞病毒(RSV)感染的流行病学特征,比较RSV感染与流感病毒感染的临床严重性差异,探索影响老年人呼吸道感染住院期间死亡的危险因素。方法 收集2016年1月1日至2020年12月31日贵阳市2家医院收治的60岁以上老年人呼吸道感染住院患者的临床和病原学检测资料。比较RSV感染与流感病毒感染老年人在人口学特征、基础性疾病、临床表现,以及住院时间和住院期间死亡等临床结局上存在的差异,并采用多因素logistic回归模型探索影响老年人呼吸道感染住院期间死亡的危险因素。结果 5 131例60岁以上呼吸道感染住院患者中,RSV检测阳性率为2%,流感病毒检测阳性率为10%。77%(80/104)的RSV感染和63%(312/497)的流感病毒感染集中在每年的11月至次年2月,发病具有明显季节性。与流感病毒感染老年人比较,RSV感染的中位发病年龄(73岁vs. 74岁,P=0.997),ICU收治比例(7%vs. 6%,P=0.822)和住院期间死亡率(6%vs. 3%,P=0.233)差异无统计学意义。但RSV感染的老年人中位住院天数延长(14 d vs. ...     

北京市海淀区新型冠状病毒肺炎患者及其家庭成员呼吸道病原谱研究

目的 分析北京市海淀区新型冠状病毒肺炎(COVID-19)患者及其家庭成员中常见呼吸道病原体的流行情况,比较混合感染患者与只感染新型冠状病毒(SARS-CoV-2)患者的疾病严重程度差异.方法 使用多重荧光定量PCR方法对2020年1-6月北京市海淀区疾病预防控制中心检测的所有COVID-19患者及其家庭成员同期采集的...     

Clinical characteristics and outcomes of patients with 2009 influenza A(H1N1) virus infection with respiratory failure requiring mechanical ventilation

Purpose

The purpose of the study was to describe the clinical characteristics and outcomes of critically ill patients with 2009 influenza A(H1N1).

Methods

An observational study of patients with confirmed or probable 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation was performed.

Results

We studied 96 patients (mean age, 45 [14] years [mean, SD]; 44% female). Shock and acute respiratory distress syndrome were diagnosed during the first 72 hours of admission in 43% and 72% of patients, respectively. Noninvasive positive pressure ventilation was used in 45% of the patients, but failed in 77% of them. Bacterial pneumonia was diagnosed in 33% of cases, 8% during the first week (due to community-acquired microorganisms) and 25% after the first week (due to gram-negative bacilli and resistant gram-positive cocci). Intensive care unit mortality was 50%. Nonsurvivors differed from survivors in the prevalence of cardiovascular, respiratory, and hematologic failure on admission and late pneumonia. Reported causes of death were refractory hypoxia, multiorgan failure, and shock (50%, 38%, and 12% of all causes of death, respectively).

Conclusions

Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia.     

深圳地区儿童呼吸道感染人类偏肺病毒检出及鉴定

目的 应用呼吸道感染常见病毒快速筛查技术检测人类偏肺病毒(human metapneumovirus,hMPV),并对检出的hMPV进行分子生物学鉴定.方法 采用Luminex 100多功能悬浮点阵检测技术和多重PCR技术同时筛查检测呼吸道合胞病毒、流感病毒、人类偏肺病毒等7种病毒、11个亚型.人类偏肺病毒的鉴定采用hMPV核蛋白基因特异性片段PCR扩增、核酸测序,并进行进化树分析.结果 47份临床标本共筛查出病毒19株,检出率40.2%(19/47),其中呼吸道合胞病毒8份、占检出病毒的42.1%(8/19),流感病毒7份(占36.8%),副流感病毒、鼻病毒、柯萨奇病毒、人类偏肺病毒各1份(占5.3%).检出的这例人类偏肺病毒为深圳地区首例,经hMPV核蛋白基因特异性片段核酸序列分析,其与hMPV日本株、北京株、泰国株的同源性＞98%.进化树分析表明深圳株的病毒核蛋白基因与北京株、日本株、泰国株等在同一基因进化簇中.结论 人类偏肺病毒可能是儿童呼吸道感染的主要病毒之一,应引起临床的重视.多功能悬浮点阵和多重PCR技术对病毒感染件疾病的快速筛查具有实用价值,尤其在解决流行病病原学分析方面具有重要意义.     

Performance of a rapid multi-analyte 2-photon excitation assay in children with acute respiratory infection

The purpose of this study is to evaluate the diagnostic performance of the novel 2-photon excitation-based mariPOC© Assay (ArcDia Laboratories, Turku, Finland) for antigen detection of respiratory viruses versus real-time polymerase chain reaction (PCR). The mariPOC Assay and 2 multiplex real-time PCR techniques were performed on nasopharyngeal samples from pediatric patients with suspicion of acute respiratory infection admitted to a children's hospital in Spain during October 2011 to January 2013. A total of 233 samples were studied. Sensitivities and specificities (95% confidence interval) of the mariPOC Assay were for respiratory syncytial virus (RSV), 78.4% (69.7–85.6) and 99.2% (96.3–100.0); influenza virus (IFV) A, 66.7% (26.2–94.0) and 99.6% (97.9–100.0); IFV-B, 63.6% (33.6–87.2) and 100.0% (98.7–100.0); human metapneumovirus (hMPV), 60.0% (34.5–81.9) and 100.0% (98.6–100.0); adenovirus (ADV), 12.5% (0.6–48.0) and 100.0% (98.7–100.0), respectively. The mariPOC Assay is a highly specific method for simultaneous detection of 8 respiratory viruses but has sensitivities that range from moderately high for RSV to moderate for IFV and hMPV and low for ADV.