Résumé
Objective@#To analyze the epidemiological characteristics and genetic characteristics of sapovirus (SaV) in a cluster of schools in Changzhou, so as to provide a reference for the treatment of clustered vomiting and diarrhea events in schools.@*Methods@#The epidemiological data and laboratory test data of sapovirus clusters in Changzhou from 2019 to 2022 were collected and analyzed. Partial VP1 genes of SaV positive samples were amplified and sequenced for phylogenetic analysis.@*Results@#A total of 8 cases of clusters of SaV epidemics were reported in Changzhou City from 2019 to 2022, with 118 reported cases. The total attack rate was 1.47%, and the median of the attack number was 15. There were 6 outbreaks in kindergartens and 2 outbreaks in primary schools, which were reported in the epidemic period from September to December. The main clinical manifestations were vomiting (113 cases, 95.76 %), abdominal pain (39 cases, 33.05%), and diarrhea (16 cases, 13.56%). Among the 8 outbreaks, 17 sample strains were successfully sequenced. 5 outbreaks were GII.3 , and the other 3 outbreaks were GI.1, GI .3 and GII.2. GI and GII were the main genotypes in this area, and GII .3 was the predominant strain.@*Conclusion@#SaV is an important pathogen in the clusters of vomiting and diarrhea in schools after the transmission of norovirus. Continuous surveillance of SaV should be carried out to further understand its epidemiological characteristics and genotype distribution, so as to provide scientific basis for the prevention and control of the epidemic in schools.
Résumé
Objective@#To investigate an acute gastroenteritis outbreak caused by Norovirus, and to provide evidence for effective school infectious outbreak prevention and control.@*Methods@#In March 2019, basic information of Huzhou Normal University and related data of cases were collected. Epidemiological characteristics were analyzed. Anal swabs of the 10 cases were collected for laboratory detection. Case definitions, specific detection criteria and procedures were based on the Diagnostic Criteria for Infectious Diarrhea (WS 271-2007) and the Technical Guidelines for the Investigation, Prevention and Control of Outbreaks of Norovirus Infection (2015 edition).@*Results@#During March 15 to March 20, a total of 13 (12 girls and 1 boy) confirmed cases were reported, all of them were from the same class, with the incidence rate being 25.00% (1/4) and 37.50% (12/32) in boys and girls, respectively. No significant sex difference was found ( χ 2=2.05， P >0.05). Anal swab specimens of 10 students were collected from laboratory were positive for Norovirus GII and have an identity of 100%.@*Conclusion@#The gastroenteritis outbreak was deduced to be attributed to GII Norovirus infection, which are likely caused by fecal contamination through person to person contact. It is suggested that schools should strengthen knowledge education on the prevention and control of infectious diseases and improve the protection awareness and ability of teachers and students to protect them.
Résumé
Objective@#To analyze the relationship between the toilet design and sanitary condition of primary and secondary schools in Chengdu and the epidemic situation of Norovirus infection, so as to provide scientific references for school toilet design and Norovirus prevention and control.@*Methods@#A total of 78 cases of norovirus epidemics from 2019 to 2020 were included in this study. These epidemics happened in 78 schools and the causes were indicated as human-to-human transmission. The Chi square and Mann-Whitney U test were used to compare categorical and continuous data respectively. Unconditional binary Logistic regression was used to examine the multivariate associations.@*Results@#Most epidemics happened from October in 2019 to March in 2020(79.49%, 62 cases), in primary schools (71.79%, 56 cases) and in the center area (52.56%, 41 cases). The median of the case number in each epidemic was 10. Overall, 56 schools (71.79%) were equipped with toilets which were flushed independently, and 22 schools (28.21%) were equipped with toilets which were flushed uniformly. There were 27 schools (34.62%) that did not have enough water taps. Logistic regression analysis found that those with toilets flushed uniformly had a stronger epidemic, compared to the schools with toilets flushed independently( OR=5.53, 95%CI=1.63-18.76, P <0.05).@*Conclusion@#In order to prevent intestinal infectious diseases , it is suggested that schools should design or reconstruct independent flushing toilets with adequate faucets.
Résumé
Objective@#To analyze of epidemiological and etiological characteristics of 14 norovirus clusters or outbreak in Nan an District, for comprehensive prevention and control measures for norovirus infections in the region.@*Methods@#Data were collected from the emergency public health event management information system of China Disease Prevention and Control Information System, and were analyzed by using descriptive epidemiological method.@*Results@#In 2018, 14 cases of norovirus infection clusters and outbreaks were reported in Nan an District, accounting for 63.64% of the total number of incidents in the region. A total of 268 cases were reported, with an average incidence of 2.19%; the outbreak occurred mainly in November(n=6); kindergartens reported the most outbreak(n=7), followed by primary schools(n=5); the median duration of the outbreak was 2.80 days; and 14 outbreaks were caused by the GII-type genome of norovirus, with the main transmission routes being human-to-hnuman transmission.@*Conclusion@#The prevalence of norovirus outbreaks tends to be higher in schools, it is necessary to strengthen the monitoring of vomiting and diarrhea symptoms in collective units such as schools, and efforts should be promoted for implementation of all levels of prevention and control measures in school.
Résumé
RESUMEN Objetivo: Describir los resultados de los exámenes de laboratorio realizados en muestras biológicas de pacientes con síndrome de Guillain-Barré (SGB), recibidas en el Instituto Nacional de Salud (INS) entre los años 2018 y 2019. Materiales y métodos: Se realizó un estudio observacional en pacientes con SGB notificados en el sistema de vigilancia epidemiológica. Se obtuvieron muestras biológicas analizadas en el INS para investigar arbovirus, virus respiratorios, enterovirus y enterobacterias, entre otros. Resultados: Se recibió un total de 2051 especímenes clínicos de 906 pacientes con SGB. Tres pacientes dieron positivo al dengue y tres pacientes al Zika. En 19 pacientes, el cultivo en heces fue positivo para Campylobacter jejuni. El análisis filogenético de diez cepas de Campylobacter jejuni las clasificó como genotipo ST2993, reportado previamente en China y asociado a un brote de SGB. En 2018, hubo 12 muestras que habían dado positivo al PCR para enterovirus en el líquido cefalorraquídeo, pero ninguna pudo corroborarse con el cultivo respectivo ni con secuenciamiento de genoma completo. Un paciente dio positivo por virus de la influenza A, dos por virus de la influenza B, dos por adenovirus, cinco por virus respiratorio sincicial, y diez por rinovirus. Conclusión: Se han encontrado diversos agentes patógenos en especímenes de pacientes con SGB, sin embargo, la presencia de Campylobacter jejuni genotipo ST2993, un patógeno relacionado a brotes de SGB en varios continentes, sería el probable agente causal. Es necesario confirmar esta hipótesis con estudios analíticos y determinar la cadena de transmisión de este agente para implementar las medidas de prevención y control.
ABSTRACT Objective: To describe the results of laboratory tests performed on biological samples from patients with Guillain-Barré syndrome (GBS) submitted to the Instituto Nacional de Salud (INS) between 2018 and 2019. Materials and methods: We conducted an observational study on patients with GBS, by using data from the epidemiological surveillance system. Biological samples, previously analyzed at the INS, were obtained to study arboviruses, respiratory viruses, enteroviruses and enterobacteria, among others. Results: A total of 2,051 specimens were obtained from 906 patients with GBS. Three patients tested positive for dengue and three for Zika. In 19 patients, the stool culture was positive for Campylobacter jejuni. Phylogenetic analysis of 10 Campylobacter jejuni strains classified them as genotype ST2993, which was previously reported in China and associated to a GBS outbreak. Twelve cerebrospinal fluid samples tested positive for enterovirus by PCR in 2018, but none could be verified by culture or complete genome sequencing during the study. One patient was positive for influenza A, two for influenza B, two for adenovirus, five for respiratory syncytial virus, and ten for rinovirus. Conclusion: Several pathogens were found in samples from patients with GBS. However, we found that the genotype ST2993 of Campylobacter jejuni was the most likely causal agent, a pathogen that is related to GBS outbreaks in different continents. It is necessary to confirm this hypothesis with additional analytical studies and it is important to describe the transmission mechanism of C. jejuni genotype ST2993 in order to implement prevention and control measures.
Sujets)
Humains , Mâle , Femelle , Patients , Virus , Épidémies de maladies , Syndrome de Guillain-Barré , Campylobacter jejuni , Enterovirus , Surveillance épidémiologique , LaboratoiresRésumé
Objective@#To investigate factors associated with awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region，to provide evidence for Norovirus outbreaks prevention and control.@*Methods@#A total of 320 primary and middle school staffs from 48 schools in 3 cities in the pearl river delta region were selected by multistage quota random sampling method and were interviewed face to face with questionnaire about knowledge of Norovirus and prevention and control of Norovirus outbreaks.@*Results@#The awareness rate of Norovirus knowledge and prevention and control of Norovirus outbreaks among primary middle school and the total school staffs in the pearl river delta region were 35.37%,57.63% and 48.42%,respectively. The results of univariate analysis showed that the awareness rate of prevention and control of Norovirus outbreaks was significantly affected by duties, the total awareness rate among teachers(OR =0.22，95%CI=0.09-0.55),cooks(OR=0.09，95%CI=0.04-0.23)and cleaners(OR=0.02，95%CI=0.00-0.07)were far lower than school doctors(P<0.05).@*Conclusion@#The awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region was needed to be improved. Valid implements, such as operation procedure, to build up prevention and control capability should be carried out that focus on specific job responsibilities.
Résumé
Objective@#To investigate the duration of Norovirus (NoV) shedding among infected school children during a NoV outbreak in a kindergarten,and to provide scientitic basis for epidemic prevention and control.@*Methods@#Specimens and epidemiological data were collected from suspected cases, and specimens were detected using real-time RT-PCR to determine whether or not infecting with NoV. Specimens were collected every 3-7 days from NoV-infected children until specimens became negative for NoV.@*Results@#A total of 14 suspected cases were reported, and 12 of them were infected with NoV. The average duration of NoV shedding was (26.58±17.94)d. The specimens among 9 from 12 Nov-infected cases were positive at 7 days, 8 NoV-intected cased remained positive at 14 days and 7 Non-infected cased at least 21 days.@*Conclusion@#Since NoV shedding duration among NoV-infected children tends to longer than their isolation time during outbreaks, reinforcement of hygiene practices among these school children is especially necessary to reduce the risk of virus secondary transmissions after their return to school.
Résumé
Objective@#To analyze the epidemiological characteristics and influencing factors of norovirus aggregation in primary and secondary schools in Haidian District of Beijing from 2015 to 2018,and to provide scientific basis for the prevention and control of school aggregation epidemic situation.@*Methods@#An epidemiological method was used to analyze the epidemic characteristics of norovirus aggregation in the primary and secondary schools in Haidian District of Beijing from January 2015 to December 2018. Multivariate Logistic was used to analyze the influencing factors of norovirus aggregation.@*Results@#A total of 74 cases of norovirus aggregation in primary and secondary schools in Haidian District of Beijing from 2015 to 2018 were reported, involving 52 primary and secondary schools. Totally 1 291 suspected cases and a median of 12.5 cases of single epidemic were reported. Winter and spring were high incidence season. There was significant difference in the incidence rate of epidemic situation in primary and secondary schools(χ2=98.82, P<0.01). There was significant difference in the incidence rate between men and women(χ2=55.56, P<0.01). A total of 648 samples and 486 positive samples were collected, with a positive rate of 75.00%, mainly GⅡ virus, accounting for 87.45%. Multivariate Logistic regression showed that the scale of school(>2 000，1 000~2 000), student’s hand hygiene habit,requirement for medical care after the outbreak is the influence factor of the outbreak(OR=3.78，2.95，8.25，2.88).@*Conclusion@#Poor hand hygiene habits are the most important risk factors for the outbreak, so schools and parents should cultivate children to develop good hygiene habits of washing hands before and after meals, and timely isolation of cases found in schools is also an important measure to prevent and control the epidemic.
Résumé
Objective@#This study aims to estimate the economic burden of disease of outbreak of norovirus gastroenteritis in the Pearl River Delta Region, and provide scientific evidence for the government’s decision-making and control measures.@*Methods@#Using a unified questionnaire, a survey was conducted to the schools and students’ families which had suffered an outbreak of norovirus gastroenteritis in the Pearl River Delta Region from October 2017 to April 2018.@*Results@#The survey found that the mean total economic burden of sick students was 720.41(95%UI=640.45-804.63)RMB. The mean economic burden of sick students who were inpatient, outpatient and self-treatment were 1 712.75(95%UI=328.50-34 00.00), 213.70(95%UI=191.83-236.33) and 58.97(95%UI=43.00-77.69)RMB, respectively. The mean economic burden of transport, extra tutoring and cost of lost labor were 53.63(95%UI=43.98-63.58), 558.49(95%UI=381.40-774.01) and 695.62(95UI=630.25-767.29)RMB. The mean total economic burden of health students was 382.62(95%UI=343.29-424.45)RMB. The mean total economic burden of school was 49 264.53(95%UI=22 363.38-79 976.25)RMB. The total economic burden of disease increases as the level of outbreak increases. The larger the epidemic level, the proportion of sick students’ financial burden gradually decreased, 56.58%,23.27% and 10.93%.@*Conclusion@#The high economic burden of disease of norovirus gastroenteritis in the Pearl River Delta Region, respectively, indicating that relevant departments should strengthen the prevention, control and education in order to mitigate the disease economic burden.
Résumé
Objective@#To analyze the epidemiological and etiological characteristics of aggregation epidemics of infectious diarrhea induced by norovirus, and to provide the scientific basis for the prevention and control.@*Methods@#A descriptive epidemiological analysis of aggregation epidemics events occurred during 2016-2018 in Longhua District of Shenzhen was carried out, with subtypes identified by real-time fluorescence quantitative PCR, Region B and Region C fragment sequence determination.@*Results@#There were 34 aggregation epidemic events,including 448 cases, the mean attack rate was 18.26%(448/2 454). The median duration of aggregation epidemic was 3 days. The peak season appeared in autumn and winter, and the peak of epidemic emerged from December 2016 to April 2017. About 91.18% (31/34) of the epidemics occurred in schools and child care centers, and among children aged 3-6 years (78.79%, 353/448). The clinical symptoms were mainly nausea and vomiting (95.77%, 408/426) in children and adolescents but diarrhea in adult group (95.45%, 21/22). The differences between vomiting and diarrhea were both statistically significant in the two age groups (χ2=98.89，99.61，P<0.01). 29 cases were transmitted through interpersonal network, of which 21 cases were found to have unregulated treatment of vomit on campus. The detection rate of biological samples was 49.15% (203/413), all of which were G Ⅱ norovirus. The genotype was mainly GⅡ.P16-G Ⅱ.2(n=49)from November 2016 to April 2017.@*Conclusion@#Norovirus can cause large-scale outbreaks in child care centers and schools easily. Early standardized patient isolation and proper management of vomit and diarrhea are the key steps in prevention and control measures.
Résumé
Objective@#To investigate the epidemiological characteristics of norovirus clustering and outbreaks in schools and kindergartens in China, so as to provide references for prevention and control of outbreaks.@*Methods@#A descriptive epidemiological method was used to analyze outbreaks of Norovirus in schools and kindergartens in China during 2014-2018 , the indicators which was analyzed and compared including attack rate, duration of the outbreak, reporting interval.@*Results@#A total of 832 Norovirus outbreaks were reported by schools and kindergartens in China from 2014 to 2018. The total number of outbreaks showed an upward trend with an average annual growth rate of 58%. The number of reported cases was 40 445 but there was no death. Norovirus outbreaks mainly occurred in primary schools (42%), followed by kindergartens and middle schools (both 24%), university (6%) and 77 outbreaks (4%) were reported in universities and other schools. The peak seasons were March to May, November and December each year. Jiangsu Province and Guangdong Province (both 22%) reported the largest number of outbreaks. The main transmission of norovirus outbreaks was through direct person contact (72%), foodborne (4%) and waterborne (3%) caused fewer outbreaks than direct person contact. The duration of the epidemic was positively correlated with the reporting interval (r=0.63, P<0.05) and the number of cases per outbreak (r=0.51, P<0.05).@*Conclusion@#Disinfection treatment of vomitus should be standardized in schools and kindergartens. Timely detection, reporting, disposal of the epidemic can effectively control the spread of norovirus outbreaks.
Résumé
Objective To explore the relationship between hs - CRP and the etiology of children with hand- foot - and - mouth disease(HFMD). Methods A total of 1156 laboratory - confirmed children diagnosed with HFMD by pathogenic detection(detection methods include EV71 - CA16 IgM antibody detection and universal real -time fluorescent quantitative RT - PCR detection of enterovirus nucleic acid EV71/ CA16/ EV) in the Children′s Hospital of Hangzhou were involved in the research from September 2014 to July 2016. The hs - CRP levels in the early days(≤5 days) were recorded,and all data were analyzed with SPSS16. 0. Results Of all the 1156 cases,there were 642 cases with hs - CRP level more than 10mg/ dL,of whom 37 cases were infected by EV71(5. 8％ ),552 cases were infected by EV(86. 0％ ),53 cases were infected by CA16(8. 2％ ). In 514 cases with hs - CRP level less than 10mg/ dL,of whom 298 cases were infected by EV71(58. 0％ ),152 cases were infected by EV(29. 6％ ),64 cases were infected by CA16(12.4％). Of cases with hs - CRP >10mg/ dL,EV universal type got a significantly higher rate,with statistically significant difference(P < 0. 05). Of cases with hs - CRP < 10mg/ dL,EV71 got a significantly higher rate,with statistically significant difference(P < 0. 05). Conclusion The higher the hs - CRP level of the HFMD,the higher infection rate of EV. The lower the hs - CRP level of the HFMD,the higher infection rate of EV71.
Résumé
Objective To study the clinical features of neonates with enteroviral infection.Method We collected all neonates with enteroviral infection confirmed pathologically in the Department of Neonatology in the Children's Hospital of Fudan University from March 2009 to July 2016 retrospectively.The clinical data of the patients (clinical manifestation,first laboratory examinations,imaging findings,treatment procedures and outcomes) were retrieved to summarize the clinical features of neonatal enterovirus infection and to analyze the factors affecting the prognosis of neonatal enterovirus infection.Result A total of 81 neonates with enterovirus infection were included in the study.Among them,55 were full-term infants and 26 were premature infants,and the birth weight was (3 029±728)g.The median age of hospital admission was 5 (1,16) d,and multiple systemic manifestations were common in the course of the disease.Among them,19.8％(16/81)died.The factors for death are preterm birth,decreased hemoglobin,platelet count or serum albumin levels,abnormal coagulation,elevated blood lactate levels and acidosis.A scoring system was established based on high-risk factors.A score of ≥ 4 could reliably predict adverse outcomes,with a specificity of 92.3％ and a sensitivity of 93.8％.Conclusion Enteroviral infection in neonates can be highlt critical multiple system involvement.Neonates enterovirus infections with high risk factors(premature delivery,hemoglobin/ platelet/ albumin hypoplasia,coagulation dysfunction,lactic acid increase and acidosis) had higher mortality rate.There is a need to identify these neonates for intensive care and better treatment is warranted to improve the prognosis of these patients early.
Résumé
Objective@#To understand the epidemiological and etiological characteristics of enterovirus (EV)-associated diseases among children in Beijing from 2010 to 2016.@*Methods@#This was a repeated cross-sectional study. The throat swabs were collected from children with probable EV-associated diseases at the Children' s Hospital Affiliated to Capital Institute of Pediatrics from 2010 to 2016. The samples were sent for pan-EV, enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) detection by real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR) . The viral types of non-EV-A71 and non-CV-A16 EV-positive samples were identified using modified RT-PCR and sequencing with CV-A6, EV-A/B group and 5 'UTR universal primers. The constituent ratios of the prevalence of different EV types in different age and gender groups were compared.@*Results@#Of the 2 703 throat swabs, 1 992 (73.7%) samples were positive for EV, including EV-A71 (19.1%, 516/2 703), CV-A16 (24.3%, 658/2 703), CV-A6 (22.2%, 600/2 703), CV-A10 (4.5%, 122/2 703) and other types of EV (3.5%, 95/2 703). There was 1 case of EV-A71 and CV-A16 co-infection. The positive detection rate of EV-A group (excluding EV-A71, CV-A16, CV-A6 and CV-A10) increased from 11.3% (7/62) to 95.2% (59/62) after using the modified VP1-specific primers and PCR amplification conditions. During the period between 2010 and 2012, CV-A16 and EV-A71 predominated in EV-positive samples. However, CV-A6 accounted for 60.7% (68/112) in 2013, much higher than CV-A16 (23.2%, 26/112) and EV-A71 (12.5%, 14/112). In 2014, EVs were mainly of CV-A16 and EV-A71, but CV-A6 was the predominant type in 2015 (68.2%, 232/340) and in 2016 (38.6%, 151/391). The epidemic season of EVs was mostly from April to August, but CV-A6 showed a small epidemic peak from October to November. The male-to-female ratio of EV-positive patients was 1.50∶1, and EV-associated diseases mostly occurred in children under 5 years of age. Younger children were more susceptible to CV-A6 than to EV-A71 and CV-A16.@*Conclusions@#From 2010 to 2016, there was a significant change in the spectrum of EVs in children with EV-associated diseases in Beijing. Since 2013, non-EV-A71 and non-CV-A16 increased, and CV-A6 gradually became one of the major pathogens of EV-associated diseases. The modified PCR primers and amplification conditions can effectively improve the reliability of test results.
Résumé
Objective To study the peripheral blood helper T cell 17 (Th17)/ regulatory T cell (Treg) balance and levels of related immune cytokines in children with enterovirus encephalitis. Methods One hundred and two children with enterovirus encephalitis from January 2014 to January 2017 were selected as enterovirus encephalitis group, and 100 healthy children who received physical examination during the same period were selected as healthy control group. The peripheral blood expressions of Th17 and Treg were detected by flow cytometry, and the Th17/Treg was calculated. The serum levels of interleukin (IL)-6, IL-17, IL-23, IL-4, IL-10 and transforming growth factor (TGF)-β were detected by enzyme-linked immunosorbent assay. Results The peripheral blood expression of Th17 and Th17/Treg in enterovirus encephalitis group were significantly higher than those in healthy control group (0.032 ± 0.006 vs. 0.024 ± 0.004 and 3.04 ± 0.61 vs. 1.99 ± 0.37), the peripheral blood expression of Treg was significantly lower than that in healthy control group (0.011 ± 0.002 vs. 0.013 ± 0.002), and there were statistical differences (P＜0.05). The serum levels of IL-6, IL-17 and IL-23 in enterovirus encephalitis group were significantly higher than those in healthy control group, the serum levels of IL-4, IL-10 and TGF-β were significantly lower than those in healthy control group, and there were statistical differences (P＜0.05). Conclusions The peripheral blood expression of Th17 is high, and the peripheral blood expression of Treg is low in children with enterovirus encephalitis. There is imbalance of Th17/Treg. The IL-17, IL-23, IL-4, IL-4, IL-10, TGF-β and other Th17 and Treg related immune cytokines may be involved in the pathogenesis of enterovirus encephalitis.
Résumé
ABSTRACT The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.(AU)
RESUMEN El brote de enterovirus D68 (EV-D68) registrado en el 2014 en los Estados Unidos suscitó preocupación acerca de la introducción del virus en el Caribe. El objetivo de este estudio fue aportar pruebas rápidas, mediante la adopción de un enfoque filogénico relativamente sencillo, de que durante ese brote ingresaron en el Caribe cepas del EV-D68. Entre octubre del 2014 y mayo del 2015, el laboratorio regional de referencia ubicado en el Organismo de Salud Pública del Caribe (Puerto España, Trinidad y Tabago) detectó cuatro casos de EV-D68 provenientes de dos países (Bermudas y Dominica) mediante el análisis molecular de muestras respiratorias. Todos los casos correspondían a niños que acudieron al hospital con dificultad respiratoria moderada. No se detectó ningún caso de parálisis flácida aguda. El análisis filogénico de las cepas encontradas en el Caribe demostró una semejanza superior al 99 % con la cepa responsable del brote del 2014 en los Estados Unidos, lo que demuestra la introducción y la circulación del virus en la región.(AU)
Sujets)
Humains , Nouveau-né , Nourrisson , Enfant d'âge préscolaire , Infections à entérovirus/prévention et contrôle , Infections à entérovirus/épidémiologie , Bermudes/épidémiologie , Caraïbe/épidémiologie , Dominique/épidémiologie , Entérovirus humain D/isolement et purificationRésumé
Enterovirus 71 (EV71) infection can cause hand,foot and mouth disease,due to its neurotropic nature,severe cases can affect the central nervous system and emerge neurogenic pulmonary edema (NPE),respiratory and circulatory failure,and even lead to death.The advances in the pathogenesis of severe HFMD neurogenic pulmonary edema after EV71 infection in recent years are described.
Résumé
O gênero Enterovirus (EV) é o agente etiológico mais frequente e responsável pela ocorrência de meningite viral no mundo. O objetivo deste trabalho foi de avaliar resultados da implantação do ensaio de PCR em tempo real (RT-qPCR) para a detecção de EV. Foram selecionadas 616amostras de líquido cefalorraquidiano (LCR) de pacientes com meningite, recebidas para realizar período de 1998-2013. Os RNAs foram extraídos diretamente do LCR pelo método QIAamp®, e o ensaio TaqMan® foi aplicado. A avaliação foi feita comparando-se resultados de RT-qPCR com os obtidos pelo método de isolamento em cultura de células.Das 616 amostras analisadas, 94 (15,2 %) foram positivas para EV no ensaio de RT-qPCR; e na cultura celular EV foi isolado de 58 (9,4 %) amostras. Valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram de 89,70 %, 92,40 %, 55,30 % e 98,90 %,respectivamente. O RT-qPCR foi ligeiramente superior à cultura viral para a detecção de EV no LCR. O RT-qPCR TaqMan® é um ensaio rápido e sensível, facilmente exeqüível e com potencial para melhorar o diagnóstico da meningite viral na rotina do laboratório de saúde pública noEstado de São Paulo.
The genus Enterovirus (EV) is the most frequent etiological agent responsible for the occurrence of viral meningitis in the world. The objective of this work was to evaluate the results of the implantation of the real-time PCR assay (RT-qPCR) for the detection of EV. We selected 616 samples of cerebrospinal fluid (CSF) from patients with meningitis, received for the period 1998-2013. The RNAs were extracted directly from the CSF by the QIAamp® method, and the TaqMan® assay was applied. The results of the RT-qPCR test were compared with those obtained by the cell culture isolation method. Of the 616 samples analyzed, 94 (15.2%) were positive for EV in the RT-qPCR assay; And cell culture EV was isolated from 58 (9.4%) samples. Sensitivity, specificity, positive predictive value and negative predictive values were 89.70%, 92.40%, 55.30% and 98.90%, respectively. The RT-qPCR was slightly superior to the viral culture for the detection of EV in the CSF. RT-qPCR TaqMan® is a rapid and sensitive, easily feasible and potential test to improve the diagnosis of viral meningitis in the routine of the public health laboratory in the State of São Paulo.
Sujets)
Enterovirus , Méningite/diagnostic , Réaction de polymérisation en chaîneRésumé
O gênero Enterovirus (EV) é o agente etiológico mais frequente e responsável pela ocorrência de meningite viral no mundo. O objetivo deste trabalho foi de avaliar resultados da implantação do ensaio de PCR em tempo real (RT-qPCR) para a detecção de EV. Foram selecionadas 616 amostras de líquido cefalorraquidiano (LCR) de pacientes com meningite, recebidas para realizar diagnóstico laboratorial no período de 1998-2013. Os RNAs foram extraídos diretamente do LCR pelo método QIAamp®, e o ensaio TaqMan® foi aplicado. A avaliação foi feita comparando-se resultados de RT-qPCR com os obtidos pelo método de isolamento em cultura de células. Das 616 amostras analisadas, 94 (15,2 %) foram positivas para EV no ensaio de RT-qPCR; e na cultura celular EV foi isolado de 58 (9,4 %) amostras. Valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram de 89,70 %, 92,40 %, 55,30 % e 98,90 %, respectivamente. O RT-qPCR foi ligeiramente superior à cultura viral para a detecção de EV no LCR. O RT-qPCR TaqMan® é um ensaio rápido e sensível, facilmente exeqüível e com potencial para melhorar o diagnóstico da meningite viral na rotina do laboratório de saúde pública no Estado de São Paulo.
Enterovirus (EV) genus is the most frequent etiological agent causing viral meningitis worldwide. This study aimed at evaluating the performance of real-time reverse transcription-PCR (RT-qPCR) assay for detecting EV. A total of 616 cerebrospinal fluid (CSF) samples from patients with meningitis were selected, among those received at EV diagnosis laboratory from 1998 to 2013. RNAs were directly extracted from CSF by using QIAamp® Viral RNA Mini Kit, and TaqMan® RT-qPCR assay was applied. Evaluation was made by comparing the RT-qPCR results with those found in the cell culture for viral isolation method. Of 616 analyzed samples, 94 (15.20%) were positive for EV RNA on the RT-qPCR assay; and in the cell culture EV was isolated from 58 (9.40 %) samples. The assay showed sensitivity, specificity, positive predictive value and negative predictive value of 89.70 %, 92.40 %, 55.30 % and 98.90 %, respectively. In the present study, the RT-qPCR assay was slightly superior when compared to the viral culture technique for detecting EV from CSF samples. The TaqMan® RT-qPCR assay shows to be a fast and sensitive assay, easy to perform, and it shows a potential to improve the viral meningitis diagnosis in the public health laboratory in São Paulo State.
Sujets)
Humains , Méningite virale/diagnostic , Réaction de polymérisation en chaine en temps réel , Infections à entérovirus/diagnosticRésumé
Objective To analyze the etiological and epidemiological characteristics of hand, foot and mouth disease (HFMD) in Yangpu District of Shanghai from 2009 to 2013, providing evidence for its prevention and control. Methods HFMD surveillance and report were done using the National Disease Supervision Information Management System. Descriptive epidemiological method was used to analyze the 2009-2013 epidemiologic characters and etiological characters (partial patients) of HFMD in Yangpu District, Shanghai. Nucleic acid of enterovirus (EV) genome was detected by real-time PCR in some patients. Results A total of 4 974 cases of HFMD were reported during 2009-2013 in Yangpu District, Shanghai, with the average annual incidence rate of 755.3 per million, with no death cases and 9 (0.18%) severe cases. The peak incidence was observed in the period of April to July. The epidemic peak had an increasing tendency and could be delayed. The incidence rates of HFMD were increased at an annual basis(Ptrend<0.05) in all communities and were significantly different between different communities (P<0.05). Most of the cases were less than 5-year-old scattered and childcare children. The main epidemic strains were EV71 and Cox A16 in 2010, and other enterovirus and Cox A16 in 2011-2013. The proportions of other enterovirus strains were increased, with overlapping phenomenon found in the pathogenic spectrum curves before and after the epidemic peak. Conclusion The 2009-2013 epidemiology of HFMD in Yangpu District of Shanghai had prominent seasonal, regional and population characteristics. Epidemic superiority strains vary annually and influence the epidemic trend and severity.