Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective, population-based study in Nicaragua.
Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective, population-based study in Nicaragua.
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DOI：
10.1097/inf.0000000000000427
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发表时间：
2014-11
期刊：
影响因子：
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通讯作者：
Paniagua M
中科院分区：
文献类型：
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作者：
Becker-Dreps S;Bucardo F;Vilchez S;Zambrana LE;Liu L;Weber DJ;Peña R;Barclay L;Vinjé J;Hudgens MG;Nordgren J;Svensson L;Morgan DR;Espinoza F;Paniagua M
尼加拉瓜是第一个使用五价轮状病毒疫苗（RV5）进行常规免疫的发展中国家。在接种rv5疫苗的人群中，了解儿童腹泻的感染病因是指导腹泻治疗和预防工作的必要条件。我们通过家访跟踪了尼加拉瓜León地区5岁以下儿童腹泻事件的人群样本。获得了关于RV5历史和社会人口统计学的信息。在腹泻期间和健康儿童中收集粪便样本，对病毒、细菌和寄生虫进行实验室分析。计算各肠道病原菌的检出率和发病率。该队列中的826名儿童在607.5儿童年的暴露时间内经历了677次腹泻发作（每个儿童年1.1次）。在收集的337例腹泻粪便中，61.1%检出至少一种肠道病原体。腹泻便中最常见的肠道病原体为诺如病毒（20.4%）、萨波病毒（16.6%）、肠致病性大肠埃希菌（EPEC, 11.3%）、溶组织内阿米巴（8.3%）、兰第鞭毛虫（8.0%）和产肠毒素大肠埃希菌（ETEC, 7.7%），轮状病毒在腹泻便中检出5.3%。在健康儿童粪便中常检出EPEC和ETEC。在腹泻儿童中，诺瓦克病毒更常见于年龄较小的儿童（< 2岁），而兰氏螺旋体更常见于年龄较大的儿童（2-4岁）。轮状病毒检测的平均年龄为34.6个月。在引入RV5后的中美洲社区，在腹泻儿童中不常见轮状病毒。应考虑诺如病毒和萨波病毒的预防和适当管理，以进一步减轻腹泻疾病的负担。
Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. We followed a population-based sample of children less than 5 years in León, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial, and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least one enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (EPEC, 11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%), and enterotoxigenic E.coli (ETEC, 7.7%), with rotavirus detected among 5.3% of diarrheal stools. EPEC and ETEC were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (< 2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. In this Central American community following RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.