佛山市学龄前儿童肺炎链球菌的传播模式及影响因素

  目的  掌握学龄前儿童肺炎链球菌的传播模式及其影响因素，为揭示传播模式和控制传播提供重要的科学依据。  方法  采用分层整群抽样法，抽取佛山市顺德区7所幼儿园2 031名健康儿童，进行鼻拭子采样并分离鉴定肺炎链球菌。儿童肺炎链球菌携带的聚集性分析采用随机效应模型，运用分子型别的同源性分析揭示传播模式，肺炎链球菌携带的影响因素采用χ2检验与随机效应logistic回归分析模型相结合方法。  结果  儿童鼻腔肺炎链球菌携带率为21.8%。随机效应模型分析提示，儿童肺炎链球菌携带存在班级聚集性(Z=4.34, P < 0.001)；7所幼儿园菌株班级内同源率分别为60.9%、79.2%、76.0%、80.0%、82.8%、75.9%和33.3%；班级间同源率分别为90.6%、91.7%、88.0%、82.9%、63.8%、93.1%和76.2%。影响因素分析表明，非佛山市户籍(OR=1.36, 95% CI: 1.04~1.79, P=0.027)、农村地区(OR=1.60, 95% CI: 1.09~2.35, P=0.017)、鼻腔携带卡他莫拉杆菌(OR=1.91, 95% CI: 1.49~2.45, P < 0.001)是肺炎链球菌携带的危险因素；年级升高(OR=0.66, 95% CI: 0.52~0.83, P < 0.001)、鼻腔携带金黄色葡萄球菌(OR=0.41, 95% CI: 0.31~0.55, P < 0.001)是肺炎链球菌携带的保护因素。  结论  儿童肺炎链球菌存在较高的班级内和班级间传播风险，年级、户籍、地区以及鼻腔其他细菌携带情况是学龄前儿童肺炎链球菌携带的重要影响因素。

Transmission modes and influencing factors of Streptococcus pneumoniae among preschool children in Foshan

  Objective  To urderstand the transmission mode and influencing factors of Streptococcus pneumoniae (S. pneumoniae) in preschool children, and to provide an important scientific basis for revealing the transmission pattern and controlling the transmission.  Methods  Stratified cluster sampling method was used to select 2 031 healthy children from seven kindergartens in Shunde District, Foshan City. Nasal swabs were taken and tested for S. pneumoniae. The random-effect model was used to explore the clustering of S. pneumoniae carriage in children, and homology analysis of molecular types was used to reveal the transmission mode. Both χ2 test and random-effect logistic regression were used to analyze the effects of multiple influencing factors.  Results  The nasal carriage rate of S. pneumoniae in children was 21.8%. Random-effect model indicated that there was a class-level clustering effect of S. pneumoniae carriage in children (Z=4.34, P < 0.001). The within-class homology rates of strains in seven kindergartens were 60.9%, 79.2%, 76.0%, 80.0%, 82.8%, 75.9% and 33.3%, respectively. The between-class homology rates were 90.6%, 91.7%, 88.0%, 82.9%, 63.8%, 93.1% and 76.2%, respectively. The analysis of influencing factors showed that non-household registration (OR=1.36, 95% CI: 1.04-1.79, P=0.027), rural area (OR=1.60, 95% CI: 1.09-2.35, P=0.017) and nasal carrying Moraxella catarrhalis (OR=1.91, 95% CI: 1.49-2.45, P < 0.001) were risk factors for S. pneumoniae carriage, while grade (OR=0.66, 95% CI: 0.52-0.83, P < 0.001) and nasal Staphylococcus aureus carriage (OR=0.41, 95% CI: 0.31-0.55, P < 0.001) were protective factors.  Conclusions  There is a high risk of S. pneumoniae transmission among children within and between classes. Grade, household registration, area and nasal carriage of other bacteria are important influencing factors for S. pneumoniae carriage in preschool children.