Risk factors in dengue shock syndrome: a prospective epidemiologic study in Rayong, Thailand. I. The 1980 outbreak.
Risk factors in dengue shock syndrome: a prospective epidemiologic study in Rayong, Thailand. I. The 1980 outbreak.
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登革热休克综合征的危险因素：泰国罗勇府的一项前瞻性流行病学研究。
DOI：
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发表时间：
1984
影响因子：
5
通讯作者：
S. Halstead
中科院分区：
文献类型：
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作者：
N. Sangkawibha;S. Rojanasuphot;S. Ahandrik;Sukho Viriyapongse;S. Jatanasen;V. Salitul;B. Phanthumachinda;S. Halstead
1980年1月，泰国罗勇市区和邻近的郊区村庄被选为登革热流行病学的长期研究对象。从学校和家庭中随机抽取的3185名儿童中，估计了四种登革热血清型中和抗体的人群流行率。为了估计每种登革热病毒血清型感染的发生率（登革热血清转换），1981年1月对一年级儿童进行了重新放血（队列研究）。对入院儿童进行登革热病毒分离和配对血清抗体反应的研究。1980年发生了登革热流行。对1009例1-10岁以下儿童流行前血清进行菌斑减少中和试验，结果显示3.3%对登革热1型免疫，13.2%对登革热2型免疫，6.4%对登革热3型免疫，5.8%对登革热4型免疫。对流行前和流行后队列血液样本的检查显示，251名血清阴性儿童的登革热感染发生率为39.4%（15.1%登革1型、11.1%登革2型、2.0%登革3型、4.8%登革4型和6.4%两种或两种以上登革病毒）。在研究地区的52935名居民中，有22例病毒学和临床确诊的登革热休克综合征，患者为15岁或以下的儿童。22例休克综合征患者均有二型抗体反应。22例患者中有8例在休克发作前已纳入随机血清学样本；其中5人对登革热1型免疫，2人对登革热3型免疫，1人对登革热4型免疫，没有人对登革热2型免疫。尽管1980年1型登革热感染率很高，但从登革休克综合征病例中只发现了2型登革热病毒，包括两名具有病前血清标本的1型登革热免疫儿童。尽管登革热1型抗体在流行前的流行率是所有类型中最低的，但具有这种免疫背景的儿童对休克病例的贡献不成比例。罗勇县登革休克综合征的危险因素按降序排列为登革2型继发感染，其次是登革1型、登革3型或登革4型原发性感染。
In January 1980, the municipal area of Rayong, Thailand, and contiguous suburban villages were chosen for a long-term study on dengue epidemiology. From 3,185 children randomly sampled in schools and households, the population prevalence of neutralizing antibody to the four dengue serotypes was estimated. To estimate the incidence of infection with each dengue virus serotype (dengue seroconversions), first grade children were re-bled in January 1981 (cohort study). Children admitted to hospital were studied for dengue virus isolation and antibody responses in paired sera. An epidemic of dengue occurred in 1980. Plaque reduction neutralization tests of 1,009 pre-epidemic sera from children aged less than 1-10 years of age determined that 3.3% were immune to dengue 1, 13.2% to dengue 2, 6.4% to dengue 3, and 5.8% to dengue 4. Examination of pre- and post-epidemic cohort blood samples revealed that the incidence of dengue infection in 251 seronegative children was 39.4% (15.1% dengue 1, 11.1% dengue 2, 2.0% dengue 3, 4.8% dengue 4, and 6.4% two or more dengue viruses). Among the 52,935 residents of the study area, there were 22 cases of virologically and clinically confirmed dengue shock syndrome, in children 15 years or younger. All 22 shock syndrome cases had secondary type antibody responses. Eight of 22 had been included in the random serologic sample prior to onset of shock; five had been immune to dengue 1, two to dengue 3, one to dengue 4, and none to dengue 2. Despite the high rate of dengue 1 infections in 1980, only dengue 2 viruses were recovered from dengue shock syndrome cases, including two dengue 1 immune children with pre-illness serum specimens. Although the pre-epidemic prevalence of antibodies to dengue 1 was the lowest to any type, children with this immunologic background contributed disproportionately to shock cases. In descending order of magnitude, risk factors for dengue shock syndrome in Rayong were secondary infections with dengue 2 which followed primary infections with dengue 1, dengue 3, or dengue 4.