2016年浙江省急性胃肠炎患者诺如病毒的分子流行病学特征分析
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摘要
目的探讨2016年浙江省急性胃肠炎患者中诺如病毒的流行病学和基因特征。方法收集2016年1月至12月共1 308份急性胃肠炎患者的临床流行病学资料和粪便标本,用一步法双重荧光RT-PCR技术检测诺如病毒GⅠ和GⅡ型,用分层抽样抽取阳性标本核酸进行普通RT-PCR扩增,并对扩增产物进行测序分析。结果诺如病毒阳性率为10.55%(138/1 308),其中GⅠ型12例,GⅡ型118例,GⅠ/GⅡ型混合感染8例。诺如病毒在不同年龄组的阳性率随患者年龄上升而下降,以≥60岁组最低;不同性别组间的阳性率差异无统计学意义;诺如病毒感染全年分布,其中12月阳性率达到顶峰,为37.50%。测序结果显示GⅠ的基因亚型主要是GⅠ.6;GⅡ的基因亚型以GⅡ.4与GⅡ.17为主,分别占40.91%(18/44)和34.09%(15/44)。结论诺如病毒是引起2016年浙江省急性胃肠炎的重要病原体,且GⅡ.4和GⅡ.17是主要的基因亚型。
Objective To explore the molecular epidemiological characteristics of norovirus isolated from the patients with acute gastroenteritis in Zhejiang province during 2016. Methods The stool samples and clinical data of 1 308 patients with acute gastroenteritis were collected from January to December in 2016. The type Ⅰ and Ⅱ of norovirus in stool samples were detected by one-step double real-time RT-PCR. Some of the positive specimens were selected by stratified sampling and amplified by conventional RT-PCR,and the PCR products were sequenced for genotype identification and phylogenetic analysis. Results Among the samples studied the positive rate of norovirus was 10.55%(138/1 308) in which 12 cases were GI genotype,118 cases were GⅡ genotype and 8 cases were mixed infection of GⅠ/GⅡ genotypes. The positive rate of norovirus in different age groups decreased with the increased age of patients,and became the lowest in the patient group of more than or equal to 60 years old. There was no significant difference for the positive rates of norovirus in different genders. Norovirus infection was distributed throughout all the year with the peak value of positive rate(37.50%)in December. The sequence analysis demonstrated that GⅡ.4 and GⅡ.17 genotypes were the prevalent strains of GⅡ genotypes with proportions of 40.91%(18/44) and 34.09%(15/44),while GI.6 genotype was the prevalent strain of GI genotypes. Conclusion Norovirus should be the important pathogen causing acute gastroenteritis in Zhejiang province during 2016. GⅡ.4 and GⅡ.17 of norovirus may be the predominant epidemic genotypes.
Objective To explore the molecular epidemiological characteristics of norovirus isolated from the patients with acute gastroenteritis in Zhejiang province during 2016. Methods The stool samples and clinical data of 1 308 patients with acute gastroenteritis were collected from January to December in 2016. The type Ⅰ and Ⅱ of norovirus in stool samples were detected by one-step double real-time RT-PCR. Some of the positive specimens were selected by stratified sampling and amplified by conventional RT-PCR,and the PCR products were sequenced for genotype identification and phylogenetic analysis. Results Among the samples studied the positive rate of norovirus was 10.55%(138/1 308) in which 12 cases were GI genotype,118 cases were GⅡ genotype and 8 cases were mixed infection of GⅠ/GⅡ genotypes. The positive rate of norovirus in different age groups decreased with the increased age of patients,and became the lowest in the patient group of more than or equal to 60 years old. There was no significant difference for the positive rates of norovirus in different genders. Norovirus infection was distributed throughout all the year with the peak value of positive rate(37.50%)in December. The sequence analysis demonstrated that GⅡ.4 and GⅡ.17 genotypes were the prevalent strains of GⅡ genotypes with proportions of 40.91%(18/44) and 34.09%(15/44),while GI.6 genotype was the prevalent strain of GI genotypes. Conclusion Norovirus should be the important pathogen causing acute gastroenteritis in Zhejiang province during 2016. GⅡ.4 and GⅡ.17 of norovirus may be the predominant epidemic genotypes.
引文
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[16]赵丹,苏志磊,张凤,等.青岛市2015年成人散发腹泻病例诺如病毒感染分子流行病学特征[J].中华实验和临床病毒学杂志,2017,31(2):104-107.
[17]Fu JG,Ai J,Qi X,et al.Emergence of two novel norovirus genotype II.4 variants associated with viral gastroenteritis in China[J].Journal of Medical Virology,2013,86(7):1226.
[18]Jung S,Hwang BM,Jung H,et al.Emergence of Norovirus GⅡ.17-associated Outbreak and Sporadic Cases in Korea from 2014 to2015[J].Osong Public Health Res Perspect,2017,8(1):86-90.
[2]de Graaf M,van Beek J,Vennema H,et al.Emergence of a novel GⅡ.17 norovirus-End of the GⅡ.4 era?[J].Euro Surveill,2015,20(26):pii=21178.
[3]Lopman BA,Steele D,Kirkwood CD,et al.The vast and varied global burden of norovirus:prospects for prevention and control[J].PLo S Med,2016,13(4):e1001999.
[4]Majowicz SE,Hall G,Scallan E,et al.A common,symptom-based case definition for gastroenteritis[J].Epidemiol Infect,2008,136(7):886-894.
[5]Chen Y,Li Z,Han D,et al.Viral agents associated with acute diarrhea among outpatient children in southeastern China[J].Pediatr Infect Dis J,2013,32(7):e285-290.
[6]唐震,郑东宇,马恺,等.2013-2014年江苏省食源性疾病中诺如病毒的分子流行病学分析[J].南京医科大学学报(自然科学版),2016,36(10):1213-1217.
[7]Chang H,Zhang L,Ge Y,et al.A Hospital-Based Case-Control Study of Diarrhea in Children in Shanghai[J].Pediatr Infect Dis J,2017,36(11):1057-1063.
[8]余建兴,赖圣杰,王鑫,等.中国27省(市、自治区)2009-2013年门诊腹泻病例诺如病毒流行特征分析[J].中华流行病学杂志,2015,36(3):199-204.
[9]Melhem NM,Zaraket H,Kreidieh K,et al.Clinical and epidemiological characteristics of norovirus gastroenteritis among hospitalized children in Lebanon[J].World J Gastroenterol,2016,22(48):10557-10565.
[10]Saupe AA,Kaehler D,Cebelinski EA,et al.Norovirus Surveillance among Callers to Foodborne Illness Complaint Hotline,Minnesota,USA,2011-2013[J].Emerging Infectious Diseases,2013,19(8):1293-1296.
[11]Chansaenroj J,Tuanthap S,Thanusuwannasak T,et al.Human enteroviruses associated with and without diarrhea in Thailand between2010 and 2016[J].PLo S One,2017,12(7):e0182078.
[12]Bruggink LD,Dunbar NL,Marshall JA.Norovirus genotype diversity in community-based sporadic gastroenteritis incidents:a five-year study[J].J Med Virol,2015,87(6):961-969.
[13]Lucero Y,Vidal R,O'Ryan GM.Norovirus vaccines under development[J].Vaccine,2017.doi:10.1016/j.vaccine.2017.06.043.
[14]Yen C,Wikswo ME,Lopman BA,et al.Impact of an emergent norovirus variant in 2009 on norovirus outbreak activity in the United States[J].Clin Infect Dis,2011,53(6):568-571.
[15]Lindsay L,Wolter J,De Coster I,et al.A decade of norovirus disease risk among older adults in upper-middle and high income countries:a systematic review[J].BMC Infect Dis,2015,15:425.
[16]赵丹,苏志磊,张凤,等.青岛市2015年成人散发腹泻病例诺如病毒感染分子流行病学特征[J].中华实验和临床病毒学杂志,2017,31(2):104-107.
[17]Fu JG,Ai J,Qi X,et al.Emergence of two novel norovirus genotype II.4 variants associated with viral gastroenteritis in China[J].Journal of Medical Virology,2013,86(7):1226.
[18]Jung S,Hwang BM,Jung H,et al.Emergence of Norovirus GⅡ.17-associated Outbreak and Sporadic Cases in Korea from 2014 to2015[J].Osong Public Health Res Perspect,2017,8(1):86-90.