目的 了解深圳市2017-2021年儿童重症下呼吸道病毒感染的病原谱变化,探讨流行病学特点,为预防呼吸道病毒感染提供依据.方法 收集2017年1月—2021年12月深圳市儿童医院儿童重症监护病房(Pediatric intensive care unit,PICU)住院的重症病毒性肺炎患儿资料.以2019年12月新型冠状病毒暴发为界点,分为新冠疫情暴发前及新冠疫情期.采用χ2检验或Fisher确切概率法分析两时期病原谱特点.结果 共712例重症病毒性肺炎患儿,男性469例,女性243例,年龄1.25(0.50,3.83)岁.<3岁495例,<6岁626例.入PICU前病程3.0(2.0,5.0)d.49例为院内获得性感染,54例因重症病毒肺炎反复入住PICU.检出病毒依次是流感病毒(Influenza A and B viruses,IVA/B)223例(IVA 160例,IVB70例)、呼吸道合胞病毒(Respiratory syncytial virus,RSV)215例、鼻病毒(Human rhinovirus,HRV)125例、腺病毒(Adenovirus,ADV)91例、人副流感病毒(Human Parainfluenza viruses,HPIV)53例、博卡病毒(Human bocavi-rus,HBoV)34例、巨细胞病毒(Cytomegalovirus,CMV)26例、人偏肺病毒(Human metapneumovirus,HMPV)17例、冠状病毒(Human coronavirus,HCoV)7例.1种病毒感染634例;多重病毒感染78例.居前三位病毒,按年龄:<1岁为RSV、IVA/B、HRV,1～<3岁为IVA/B、RSV、ADV,3～<6岁及6～<10岁为IVA/B、HRV、ADV,10～<14岁为HRV、IVA/B、CMV;按月份:3-5月及6-8月是RSV、IVA/B、ADV,9-11月是RSV、HRV、IVA/B,12-2月是IVA/B、RSV、HRV;新冠疫情前为IVA/B、RSV、ADV,新冠疫情期间为HRV、RSV、HPIV.结论 PICU重症下呼吸道病毒感染病毒谱在新冠疫情期间发生了变化.不同年龄段儿童在不同月份病毒谱存在差异.
Epidemiological analysis of severe lower respiratory tract viral infections in children in Shenzhen,2017-2021
Objective To analyze the changes in the pathogen spectrum of severe lower respiratory tract viral infections in children before and during the outbreak of the COVID-19 pandemic,and to explore the epidemiological characteristics to provide a basis for preventing respiratory viral infections.Methods We conducted a retrospective analysis of clinical data from patients with severe viral pneumonia admitted to the pediatric intensive care unit(PICU)of Shenzhen Children's Hospital from January 2017 to December 2021.Taking the outbreak of the COVID-19 pandemic as the cut-off point,it is separated into the period before the outbreak of the COVID-19 pandemic and the period during the pandemic.Virus spectrum and clinical data between the two groups were analyzed using the chi-square test or Fisher's exact probability method.Results A total of 712 cases of severe viral pneumonia were reported,including 469 males and 243 females,with a median age of 1.25(0.50,3.83)years.Among them,495 cases were under 3 years old,and 626 cases were under 6 years old.The median duration of illness before admission to the PICU was 3.00(2.00,5.00)days.Hospital-acquired infections were seen in 6.88%of the children.Firty-four children had been hospitalized≥2 times due to repeated infections.The detected viruses were influenza viruses(IVA and IVB)in 223 cases(160 IVA and 70 IVB),respiratory syncytial virus(RSV)in 215 cases,human rhinovirus(HRV)in 125 cases,adenovirus(ADV)in 91 cases,human parainfluenza viruses(HPIV)in 53 cases,human bocavirus(HBoV)in 34 cases,cytomegalovirus(CMV)in 26 cases,human metapneumovirus(HMPV)in 17 cases,and human coronavirus(HCoV)in 7 cases.A total of 634 cases were infected with a single virus,while 78 cases were infected with multiple viruses.The top three viruses,sorted by age,were as follows:<1 year:RSV,IVA/B,and HRV;1-<3 years:IVA/B,RSV,and ADV;3-<6 years and 6-<10 years:IVA/B,HRV,and ADV;10-<14 years:HRV,IVA/B,and CMV;sorted by time distribution:March-May and June-August:RSV,IVA/B,and ADV;September-November:RSV,HRV,and IVA/B;December-February:IVA/B,RSV,and HRV.Before the COVID-19 epidemic,the top three viruses were IVA/B,RSV,and ADV,while during the COVID-19 epidemic were HRV,RSV,and HPIV.Conclusions During the COVID-19 pandemic,the viral spectrum of severe lower respiratory tract viral infections in the PICU changed.Before the pandemic,IVA/B,RSV,and ADV were prevalent,while during the pandemic,HRV,RSV,and HPIV were more prevalent.The viral spectrum varies among children of different age groups and in different months.
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