ILLNESS AND MICROBIAL EXPERIENCES OF NURSERY CHILDREN AT JUNIOR VILLAGE
ILLNESS AND MICROBIAL EXPERIENCES OF NURSERY CHILDREN AT JUNIOR VILLAGE
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DOI：
10.1093/oxfordjournals.aje.a120219
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发表时间：
1961-01-01
影响因子：
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通讯作者：
FLOYD, TM
中科院分区：
文献类型：
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作者：
BELL, JA;COLE, RM;FLOYD, TM
对479名6 ~ 35个月的正常儿童进行了为期3年的疾病和感染自然发生的研究。平均每周有53名儿童接受观察，其中8人要么入院，要么出院。本报告描述了研究安排、疾病和感染的一般流行病学及其相互关系，而其他报告则详细介绍了特定感染的经验。在研究的早期，观察的强度增加了，但此后保持相当稳定，由全职医务人员每天两次对所有儿童进行直肠温度测量，观察疾病。所有患儿在入院时及此后的常规时间间隔内采集血清学研究标本。所有患儿在入院时、发病时和每周至少一次常规采集咽喉和肛门标本进行病毒和细菌研究。在研究的后半部分，当观察最密集时，每月收集约4000个实验室样本并进行病毒和细菌测试。除了107例风疹和102例水痘外，根据发热100.6[度]F确定了偏离正常健康的情况，并根据发热的高度和持续时间以及相关临床表现的发生情况将其分为可疑发热（A）和确定疾病（B或C）。平均每周明确疾病（BC）发作率为21.5%。它每周变化很大，季节略有不同，但几乎是统一的年龄，性别和种族。然而，明确疾病（B）的发病率，即，无相关临床表现的明确发热在研究早期随着观察强度的增加而增加，而明确疾病（C）的发生率在整个研究期间保持相对恒定。明确疾病的发病率，无论是B和C，随着居住在托儿所的时间，可能表明提高免疫力的感染。通过实验室分离，共发现1718例和2307例儿童感染，分别有55种病毒和54种细菌血清型。不同性别的感染率相似，但不同年龄和种族的感染率略有不同。腺病毒和肠道细菌感染率在非常年轻的显着高。一般来说，每个孩子平均每2到4周就有一次新的细菌或病毒感染，毫无疑问，许多未被识别的感染也会发生。急性发热性疾病（BC）与腺病毒1型、3型和5型、流感粘病毒A2型和副流感病毒1型和3型感染之间存在显著相关性（分别为血吸附2型和1型）、脊髓灰质炎病毒2型、科萨基B病毒3型、宋内志贺氏菌1期和A群β-溶血性链球菌4型和12型以及1型、2型、5和23。我们发现这些关联是通过使用未分化的、明确的疾病而不是临床实体的质量，带有一些任意的终点，并且没有使用尚未完成的抗体研究，这些抗体研究最终将有助于确定病原体首次分离的时间是否指示首次感染的时间。这些关联的性质表明了病原学关系;然而，疾病与其他特定感染之间缺乏关联并不一定意味着这些病原体缺乏致病性或在其他情况下不会诱发疾病。
A 3-year study of the natural occurrence of illness and infection was carried out among 479 normal children 6 to 35 months of age who lived under somewhat crowded conditions in a welfare institution. In an average week, 53 children were under observation and 8 of these were either admitted or discharged. This report describes the study arrangement, the general epidemiology of illness and infections and their interrelationships, while other reports detail experiences with specific infections. During the early part of the study, the intensity of observations was increased but thereafter it remained fairly constant and illnesses were observed by a full-time medical staff who took rectal temperatures twice daily on all children. Specimens for serologic study were collected from all children on admission and at routine intervals thereafter. Throat and anal specimens for viral and bacterial study were collected from all children on admission, at onset of illness and routinely at least once a week. During the latter part of the study when observations were most intense some 4000 laboratory specimens per month were collected and tested for viruses and bacteria. Aside from 107 cases of rubeola and 102 cases of varicella, departures from normal health were identified on the basis of fever 100.6[degree]F and were classified as questionable fevers (A) and definite illnesses (B or C) depending upon the height and persistence of fever and occurrence of associated clinical manifestations. The mean weekly definite illness (BC) attack rate was 21.5%. It varied considerably from week to week and varied slightly by season but was nearly uniform by age, sex and race. However, the rates for definite illnesses (B), i.e., definite fevers without associated clinical findings, increased during the early part of the study as intensity of observation increased whereas the rates for definite illness (C) remained relatively constant throughout the study. The attack rates for definite illnesses, both B and C, decreased with duration of residence in the nursery, probably indicating increased immunity to infection. By laboratory isolation a total of 1718 and 2307 child-infections were found with 55 virus and 54 bacterial serotypes, respectively. The infection rates were similar by sex, but differed slightly by age and race for different infections. Adenovirus and enteric bacterial infection rates were notably high in the very young. In general, each child averaged a new bacterial or virus infection every 2 to 4 weeks and many unrecognized infections undoubtedly occurred. There was a significant association between acute febrile illness (BC) and infections with adenovirus types 1, 3 and 5, myxovirus influenza A2 and para-influenza types 1 and 3 (hemadsorption types 2 and 1, respectively), poliovirus type 2, Coxsackie B virus type 3, Shigella sonnei phase 1, and group A beta-hemolytic streptococci types 4 and 12 and one or more of types 1, 2, 5 and 23. We found these associations by using the mass of undifferentiated, definite illness rather than clinical entities, with somewhat arbitrary end points, and without using the as yet incomplete antibody studies which eventually will help determine whether the time when an agent was first isolated indicates the time of first infection. These associations were of such a nature as to indicate an etiologic relationship; however, lack of association between illness and other specific infections does not necessarily imply that these agents lacked pathogenicity or that they could not induce illness under other circumstances.