Viral agents of gastroenteritis. Public health importance and outbreak management.
Viral agents of gastroenteritis. Public health importance and outbreak management.
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胃肠炎的病毒剂。
DOI：
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发表时间：
1990
影响因子：
33.7
通讯作者：
S. Monroe
中科院分区：
文献类型：
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作者：
LeBaron Cw;Furutan Np;Lewin Jf;Allen;Gouvea;C. Moe;S. Monroe
每年，传染性胃肠炎导致美国超过 210,000 名儿童住院，全世界有 4-1000 万儿童死亡。自 20 世纪 70 年代中期以来，人们对造成这一公共卫生负担的病毒因子的认识急剧增加。轮状病毒是导致儿童腹泻的最常见原因，几乎感染美国所有 4 岁以下的儿童，并导致 0.75% 的 2 岁以下儿童潜在致命脱水。最近发现的其他病原体包括肠道腺病毒、杯状病毒、星状病毒和诺沃克家族病原体。这些病毒的结论性诊断需要对粪便标本进行电子显微镜检查，这种实验室技术只有包括疾病预防控制中心在内的少数大型中心具备。提交给 CDC 进行病毒病理学检测的疫情爆发粪便样本应在 10 名患者患病后的前 48 小时内大量收集，同时粪便仍为液体，并应储存在 4°C 下（不可冷冻）。急性期和恢复期血清样本应在患病第一周和此后三周内从同一个人以及相同数量的对照中采集。病毒性胃肠炎暴发的控制措施应侧重于消除持续存在的常见感染源（例如，患病的食品处理者或供水系统的污染），并中断人与人之间的传播，这种传播可能会在消除共同感染源后在人群中持续爆发。由于环境卫生的改善可能不会伴随着病毒引起的地方性腹泻的减少，因此免疫接种可能在未来的控制中发挥重要作用；轮状病毒疫苗试验正在进行中。考虑到疫苗的开发和使用，疾病预防控制中心最近开始对胃肠炎病毒进行全国监测。涉及轮状病毒或其他腹泻病毒病原体检测的医疗机构可以参与。
Each year, infectious gastroenteritis causes greater than 210,000 children in the United States to be hospitalized and 4-10 million children to die worldwide. Since the mid-1970s, knowledge has increased dramatically concerning the viral agents that are responsible for much of this public health burden. Rotavirus, the most common cause of diarrhea among children, infects virtually every child in the United States by the age of 4 years and causes potentially lethal dehydration in 0.75% of children less than 2 years of age. Other recently identified pathogens include the enteric adenoviruses, calicivirus, astrovirus, and the Norwalk family of agents. Conclusive diagnosis of these viruses requires electron microscopic examination of stool specimens, a laboratory technique that is available only at a few large centers, including CDC. Stool samples from an outbreak that are submitted to CDC for detection of viral pathology should be collected in bulk from 10 ill persons during their first 48 hours of illness, while feces are still liquid, and should be stored at 4 C (not frozen). Acute- and convalescent-phase serum samples should be collected from the same persons, plus from an equal number of controls, during the first week of illness and 3 weeks thereafter. Control measures for outbreaks of viral gastroenteritis should focus on the removal of an ongoing common source of infection (e.g., an ill food handler or the contamination of a water supply) and on the interruption of person-to-person transmission that can perpetuate an outbreak in a population after the common source has been removed. Because improvements in environmental hygiene may not be accompanied by reductions of endemic diarrhea caused by viruses, immunization may play an important role in future control; vaccine trials for rotavirus are in progress. In anticipation of vaccine development and use, CDC recently began national surveillance for the viral agents of gastroenteritis. Health-care facilities involved in the detection of rotavirus or the other viral agents of diarrhea can participate.