Norovirus and medically attended gastroenteritis in U.S. children.
Norovirus and medically attended gastroenteritis in U.S. children.
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诺如病毒和医学参加了美国儿童的胃肠炎。
DOI：
10.1056/nejmsa1206589
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发表时间：
2013-03-21
期刊：
影响因子：
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通讯作者：
Parashar UD
中科院分区：
文献类型：
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作者：
Payne DC;Vinjé J;Szilagyi PG;Edwards KM;Staat MA;Weinberg GA;Hall CB;Chappell J;Bernstein DI;Curns AT;Wikswo M;Shirley SH;Hall AJ;Lopman B;Parashar UD
自引入轮状病毒疫苗以来，轮状病毒相关性急性胃肠炎的病例有所下降，但儿童中诺如病毒相关性急性胃肠炎的负担仍有待评估。我们在医院、急诊科和门诊对5岁以下急性胃肠炎儿童进行了实验室确诊的诺沃克病毒病例的积极监测。2009年和2010年，这些孩子居住在美国三个县中的一个县。对粪便样本进行诺沃克病毒和轮状病毒检测。我们计算了基于人群的诺沃克病毒相关性急性胃肠炎的发病率，并审查了账单记录以确定医疗费用；这些数据被推断为美国5岁以下儿童的人口。2009年和2010年，在因急性胃肠炎就医的幼儿中检出诺沃克病毒的比例为21%(1295人中有278人)，2009年为22%(742人中的165人)，2010年为20%(553人中的113人)(P=0.43)。2009年，4%的健康对照(493人中有19人)也检测到该病毒。在2009年和2010年，12%的儿童急性胃肠炎(1295例中的152例)中发现了轮状病毒。2009年，诺沃克病毒的住院率、急诊室就诊率和门诊就诊率分别为每10,000名5岁以下儿童8.6%、146.7和367.7,2010年为5.8%、134.3%和260.1%，2009年每一次发作的成本估计分别为3,918美元、435美元和151美元。在全国范围内，我们估计，2009年和2010年，美国这个年龄段的儿童因诺沃克病毒感染而平均每年住院、急诊科就诊和门诊就诊的人数分别超过14,000人、281,000人和627,000人，每年的治疗费用超过2.73亿美元。自从引入轮状病毒疫苗以来，诺沃克病毒已成为美国儿童急性胃肠炎的主要医疗原因，每年与近100万次医疗保健就诊有关。(由疾病控制和预防中心资助。)
Cases of rotavirus-associated acute gastroenteritis have declined since the introduction of rotavirus vaccines, but the burden of norovirus-associated acute gastroenteritis in children remains to be assessed. We conducted active surveillance for laboratory-confirmed cases of norovirus among children younger than 5 years of age with acute gastroenteritis in hospitals, emergency departments, and outpatient clinical settings. The children resided in one of three U.S. counties during the years 2009 and 2010. Fecal specimens were tested for norovirus and rotavirus. We calculated population-based rates of norovirus-associated acute gastroenteritis and reviewed billing records to determine medical costs; these data were extrapolated to the U.S. population of children younger than 5 years of age. Norovirus was detected in 21% of young children (278 of 1295) seeking medical attention for acute gastroenteritis in 2009 and 2010, with norovirus detected in 22% (165 of 742) in 2009 and 20% (113 of 553) in 2010 (P = 0.43). The virus was also detected in 4% of healthy controls (19 of 493) in 2009. Rotavirus was identified in 12% of children with acute gastroenteritis (152 of 1295) in 2009 and 2010. The respective rates of hospitalization, emergency department visits, and outpatient visits for the norovirus were 8.6, 146.7, and 367.7 per 10,000 children younger than 5 years of age in 2009 and 5.8, 134.3, and 260.1 per 10,000 in 2010, with an estimated cost per episode of $3,918, $435, and $151, respectively, in 2009. Nationally, we estimate that the average numbers of annual hospitalizations, emergency department visits, and outpatient visits due to norovirus infection in 2009 and 2010 among U.S. children in this age group exceeded 14,000, 281,000, and 627,000, respectively, with more than $273 million in treatment costs each year. Since the introduction of rotavirus vaccines, norovirus has become the leading cause of medically attended acute gastroenteritis in U.S. children and is associated with nearly 1 million health care visits annually. (Funded by the Centers for Disease Control and Prevention.)