Enterovirus D68 Reemerges Globally as a Severe Pathogen Targeting Children.
Enterovirus D68 Reemerges Globally as a Severe Pathogen Targeting Children.
复制标题
肠道病毒 D68 在全球重新出现，成为针对儿童的严重病原体。
DOI：
10.1097/pcc.0000000000000961
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Randolph,AdrienneG
中科院分区：
文献类型：
--
作者：
Randolph,AdrienneG
各国必须关注热带地区贫困儿童的困境，因为解决他们的问题就是解决我们的问题。二十年后，史无前例的大规模移民、快速的航空运输、气候变化和全球迫在眉睫的感染威胁，使得冷漠成为一种过时的反应 (2)。我们许多人都赞同 Guerrant 博士 (1) 的观点，这一点可以从多伦多世界大会上对全球健康问题的关注以及全球健康领域小儿急性肺损伤和脓毒症研究小组的形成得到证明。与贫困和获得健康有关的问题是普遍存在的，那些最无力支付费用的人承受着最沉重的费用，即使在美国也是如此 (3)。2013 年，儿科急性肺损伤和脓毒症调查员网络组建了一个由 39 个美国 PICU 组成的小组，准备在一种新型流感或新出现的病毒病原体（称为“儿科重症监护流感和新兴病毒”）爆发期间收集临床数据。严重病原体 (PICFlu-ESP)”亚组。跨机构设立了单一机构审查委员会 (IRB)，39 个机构中有 24 个机构同意依赖该机构。基于网络的数据收集表格以模块化方式开发，有助于根据病原体和临床特征进行快速修改。该计划是将数据发送给政府合作者，以提供疫情爆发的实时跟踪，就像 2009 年大流行期间所做的那样 (7)。如果政府机构宣布国家进入紧急状态，IRB 会批准放弃同意进行数据收集。尽管前景乐观，但 EV-D68 的爆发暴露了 PICFlu-ESP 亚组监测模型中的一些缺陷。由于放弃同意，因此根据当前 IRB 批准的方案不会收集患者样本，除非用于临床目的。系统病毒检测和储存呼吸道样本以供进一步评估是确认病原体和评估遗传漂变的先决条件。资金也是一个问题；支持数据收集的付款合同需要时间，并且必须提前完成，以捕获在几个月内迅速上升和下降的病原体。即使场地合同到位，政府资金也需要到位并迅速释放。鉴于无法预测疫情何时发生，更佳的方法可能是在哨点儿科重症监护室进行持续的病毒监测。在此之前，像 Rao 等人 (8) 那样定期进行病毒多重检测和储存呼吸道样本的 PICU 可提供宝贵的资源。
States must pay attention to the plight of poor children in the tropics because the solutions to their problems are the solutions to ours. Two decades later, unprecedented mass migrations, rapid air transit, climate change and the looming threat of infections globally, renders indifference an antiquated response (2). That many of us endorse sentiments by Dr. Guerrant (1) is evidenced by the attention to global health issues at the World Congress in Toronto and the formation of a Pediatric Acute Lung Injury and Sepsis Investigators subgroup in global health. Problems related to poverty and access to health are universal, those that are least able to pay are subjected to the most oppressive fees, even in the United States (3).Division, in 2013, the Pediatric Acute Lung Injury and Sepsis Investigator’s network developed a group of 39 US PICUs poised to collect clinical data during an outbreak of a novel influenza or emerging viral pathogen called the “Pediatric Intensive Care Influenza and Emerging Severe Pathogens (PICFlu-ESP)” subgroup. A single institutional review board (IRB) was set up across institutions, and 24 of 39 sites agreed to rely on it. Webbased data collection forms were developed in a modular fashion, facilitating rapid modifications based on pathogen and clinical characteristics. The plan was for data to be sent to government collaborators to provide real-time tracking of the outbreak like was done during the 2009 pandemic (7). Waiver of consent was approved by the IRBs for data collection in the event that a national emergency was declared by a government agency. Although promising, the EV-D68 outbreak revealed some gaps in the PICFlu-ESP subgroup’s surveillance model. Because consent is waived, samples from patients are not collected under the current IRB approved protocol unless they are for clinical purposes. Systematic viral testing and banking of respiratory samples for further evaluation is a prerequisite for confirming the pathogen and evaluating genetic drift. Funding was also an issue; contracts for payment to support data collection take time and must be done in advance to capture a rapidly emerging pathogen that rises and falls within months. Even if site contracts were in place, government funds would need to be available and quickly released. Given the inability to predict when outbreaks will occur, a more optimal approach may be to perform ongoing viral surveillance in sentinel PICUs. Until then, PICUs like that of Rao et al (8) that routinely perform viral multiplex testing and bank respiratory samples provide a valuable resource.