湖南省2012-2014年发热呼吸道症候群哨点监测结果及分析

目的 通过“发热呼吸道症候群监测”了解湖南省主要呼吸道病毒流行情况及病原谱分布,为发热呼吸道症候群防控及临床诊疗提供科学依据。 方法 2012年1月-2014年12月,从符合发热呼吸道症候群定义的患者身上采集鼻/咽拭子、肺泡灌洗液、痰液样本。采用基于毛细管凝胶电泳的“9+7呼吸道病毒多重PCR检测法”对标本中流感病毒(Flu)、呼吸道腺病毒(AdV)、呼吸道合胞病毒(RSV)、人鼻病毒(hRV)、副流感病毒(PIV)、偏肺病毒(HMPV)、人博卡病毒(hBoV)和人冠状病毒(hCoV)共8种病毒的16个亚型进行核酸检测。使用SPSS17.0统计学软件对个案信息及检测结果进行统计学分析。 结果 2012年1月-2014年12月,从哨点医院采集各类呼吸道标本共961份,其中男性病例标本595份,占61.91%;女性病例标本366份,占38.09%。在961份已检测的标本中,通过PCR检出阳性标本456份,阳性检出率为47.45%。男、女病例标本的阳性检出率差异无统计学意义(P>0.05)。按年龄将病例分为7个年龄组,各年龄组的阳性检出率分别为 1岁以下(52.80%)、1~2岁(66.53%)、2~5岁(49.86%)、6~15岁(25.56%)、16~49岁(11.11%)、50~64岁(17.39%)和65岁以上(19.40%)。在456份病毒阳性的标本中,检出混合感染48例,非混合感染408例。在检出的呼吸道病毒中,AdV、RSV和Flu所占的比例最大(病原谱构成比分别为25.90%、21.31%和17.73%),其次为hRV(14.14%)和PIV(11.75%);HMPV(4.78%)和hBoV(3.98%)检出较少,而hCoV只有两例阳性被检出。男性、女性的病原构成差异无统计学意义(P>0.05)。各年龄段的病原构成差异有统计学意义(P<0.05),其中2岁以下的儿童病例中检出的病毒以RSV(29.36%)和AdV(23.02%)为主,其次为PIV(13.10%)、hRV(11.90%)和Flu(11.11%);2~5岁的儿童病例中,AdV所占比例最大(34.02%),其次为hRV(18.56%)、Flu(18.04%)和RSV(15.46%);6~15岁少儿病例中以Flu(31.43%)和PIV(34.29%)为主,其次为AdV(17.14%)和hRV(14.29%);在16~49岁的病例中,只有Flu检出;在50岁以上老年病例中,病原构成以Flu(68.41%)为主,其余为PIV(10.53%)、HMPV(10.53%)和RSV(10.53%)。监测还发现,Flu、AdV有夏季和冬春季两个流行高峰;RSV有冬春季流行高峰;hRV有秋冬季流行高峰。 结论 所监测的8种呼吸道病毒是引发严重急性呼吸道住院病例的重要病原。5岁以下儿童及65岁以上的老人可能是主要的易感人群。其中,RSV、AdV、 Flu可能是引发儿童病毒性呼吸道感染的主要病原,而Flu则可能是引发成人病毒性呼吸道感染的主要原因。因此,应将这几种病毒作为呼吸道病毒防控的重点,进行更多的监测和更深入的研究。

Sentinel surveillance results of fever respiratory illnesses in Hunan Province, 2012-2014

Objective To investigate the epidemic and profiles of respiratory viruses based on the sentinel surveillance on febrile respiratory illnesses (FRI) in Hunan Province so as to provide scientific evidence for prevention, control and clinical diagnosis and therapy of FRI . Methods We collected nasal/throat swabs, bronchoalveolar lavage fluid and sputum samples from inpatients with FRI from January 2012 to December 2014. The 9+7 multiplex polymerase chain reaction (multiple-PCR) assay for rapid identification of respiratory virus types/subtypes based on capillary gel electrophoresis was used to detect the nucleic acid of 8 viruses including influenza virus (Flu), respiratory adenovirus (AdV), respiratory syncytial virus (RSV), human rhinovirus (hRV), parainfluenza virus (PIV), human metapneumovirus (HMPV), human bocavirus (hBoV) and human coronavirus (hCoV).The case information and test results were analyzed by SPSS17.0 software. Results A total of 961 respiratory tract specimens were collected from inpatients in two sentinel hospitals from January 2012 to December 2014, including 595 specimens (61.91%) from male cases and 366 (38.09%) from female ones. Among the 961 samples detected by PCR, 456 were positive for viral nucleic acid, with the positive detection rate of 47.45%. No statistically significant difference was found in the positive detection rate between males and females(P>0.05). All the inpatients were divided into seven age groups, and the positive detection rates of viral nucleic acid in each age group were as follows 52.80% for group of < 1-year old, 66.53% for 1-2 years old, 49.86% for 2-5 years old, 25.56% for 6-15 years old, 11.11% for 16-49 years old, 17.39% for 50-64 years old and 19.40% for 65- years old. Among the 456 viral nucleic acid positive specimens, 48 indicated mixed infections and 408 indicated single infection. Among the detected respiratory viruses, AdV (25.90%), RSV (21.31%) and Flu (17.73%) accounted for the largest proportion of the profiles, followed by hRV (14.14%), PIV (11.75%), HMPV (4.78%) and hBoV (3.98%). Only two samples were detected to be hCoV nucleic acid positive. Statistically significant difference in the pathogenic profiles of respiratory viruses was not found between the male cases and female ones(P>0.05),but was found among different age groups(P<0.05). Among the inpatients aged ≤ 2 years, Adv (29.36%) and RSV (23.02%) were the dominant detected viruses, followed by PIV (13.10%), hRV (11.90%) and Flu (11.11%). Among the inpatients aged 2-5 years, AdV (34.02%) accounted for the largest proportion of the detected viruses, followed by hRV (18.56%), Flu (18.04%) and RSV (15.46%). Among inpatients aged 6-15 years, Flu (31.43%) and PIV (34.29%) were the main detected viruses, followed by AdV (17.14%) and hRV (14.29%). Among inpatients aged 16-49 years, only Flu was detected. Among inpatients aged ≥50 years, Flu (68.41%) accounted for the largest proportion of the detected viruses, followed by PIV (10.53%), HMPV (10.53%) and RSV (10.53%). There were two epidemic peaks for Flu and AdV, which appeared in summer and winter/spring, while the epidemic peaks of RSV and hRV appeared in winter/spring and in autumn/winter respectively. Conclusions The 8 respiratory viruses under surveillance are the important pathogens causing severe acute respiratory infections in the inpatients. Children aged ≤ 5 years and the elderly aged ≥ 65 years might be the main susceptible populations. RSV, AdV and Flu may be the main pathogens resulting in viral respiratory infections in children, while Flu may be the main pathogen inducing viral respiratory infections in adults. Therefore, it is necessary to conduct further surveillance and more in-depth investigation targeted on the prevention and control of the febrile respiratory illnesses caused by these viruses.