基于早期主动筛查的儿童诺如病毒医院感染流行特征研究

Epidemiological characteristics of norovirus healthcare-associated infection in children based on early active screening

摘要:

目的 分析儿童诺如病毒（norovirus，NoV）医院感染分布特点。 方法 采用前瞻性研究方法，基于早期主动筛查分析2019年1月-2021年3月广州市妇女儿童医疗中心住院患儿NoV检测情况，分析患儿NoV医院感染情况，并采用逆转录-聚合酶链反应（RT-PCR）方法进行基因分型。 结果 2 659例次医院感染病例中胃肠道感染421例次，胃肠道医院感染病例中NoV送检188例，送检率44.7%；NoV阳性96例，检出率51.1%。工作人员共发生NoV医院感染24例次，其中保洁人员13例，医护人员11例。NoV医院感染患儿中，男性66例，女性30例；平均年龄（37.6±41.10）月龄，5岁以下占81.3%；秋冬季高发；95.8%为接触方式传播。17例（17.7%）为无症状携带者，79例有症状感染者的临床表现主要为粪便形状改变（69.6%）和呕吐（44.3%）。20.8%涉及医院感染聚集性疫情。NoV医院感染患儿好转70例（72.9%），痊愈26例（27.1%）。44份NoV阳性标本90.9%为GⅡ型。 结论 NoV对儿童胃肠道医院感染有较大影响，可造成聚集性疫情。采取NoV早期主动筛查的方法可早期发现病例，针对流行季节性特征、常见传播方式及无症状感染者可及早采取隔离防控措施。

Abstract:

Objective To analyze the characteristics of norovirus (NoV) healthcare-associated infection (HAI) in children. Methods Based on early active screening analysis, detection result of NoV in hospitalized children in Guangzhou Women and Children's Medical Center from January 2019 to March 2021 was analyzed by prospective study, NoV HAI in children was analyzed, genotyping was performed with reverse transcription-polymerase chain reaction (RT-PCR). Results Among 2 659 cases of HAI, there were 421 cases of gastrointestinal tract infection, 188 cases of gastrointestinal tract infection (44.7%) were conducted NoV detection; 96 cases (51.1%) were positive for NoV. There were 24 cases of NoV HAI among hospital staff, including 13 cleaners and 11 health care workers. Among children with NoV HAI, 66 were males and 30 were females; the average age was (37.6±41.10) months, and 81.3% were under 5 years old; autumn and winter had high incidence; 95.8% were transmitted by contact. 17 cases (17.7%) were asymptomatic carriers, and 79 cases of symptomatic infection were mainly change in stool shape (69.6%) and vomiting (44.3%). 20.8% of cases were related to HAI cluster epidemic. 70 cases (72.9%) of children with NoV HAI got better and 26 cases (27.1%) were cured. 90.9% of 44 NoV positive specimens were type G Ⅱ. Conclusion NoV has a great impact on children's gastrointestinal HAI and can cause cluster epidemic. Early active screening on NoV can detect disease early, isolation and preventive measures can be taken as early as possible according to the seasonal epidemic characteristic, common transmission modes, and asymptomatic infected person.