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目的 监测我国城市儿童诺如病毒和轮状病毒腹泻的临床流行特征.方法 2008年7月至2009年9月,我们在上海、杭州、广州、重庆和天津门诊急性腹泻儿童中进行一项前瞻性的流行病学调查,随机收集急性非细菌性痢疾样腹泻患儿粪便标本,用胶体金试剂盒检测A组轮状病毒,轮状病毒阴性标本进一步用一步法实时定量荧光RT-PCR方法检测诺如病毒G Ⅰ和GⅡ基因组.描述性分析诺如病毒和轮状病毒的检出率、季节流行规律和易感儿童年龄特征.结果 连续1年期间,共收集到标本5091份,轮状病毒检测阳性标本数为1563份,占30.7%,各地轮状病毒检出率分别为上海29.5%(268/916)、杭州36.1%(334/926)、广州26.3%(254/968)、重庆34.1%(359/1054)和天津28.2%(348/1233).诺如病毒在3528份轮状病毒阴性标本中检出数为1049份(29.7%),各地检出率分别为上海21.2%(136/642)、杭州31.3%(185/592)、广州24.2%(173/714)、重庆31.8%(221/695)、天津37.7%(334/885).估计诺如病毒在所有样本中检出率至少为20.6%(1049/5092).1049份诺如病毒株中,GⅡ基因型1036份(98.7%),G Ⅰ基因型16份(1.5%),3份标本同时检测到G Ⅰ和GⅡ型.1049例诺如病毒腹泻儿童年龄在1个月～14岁,年龄中位数10(13.9±16.9)个月,91.8%患儿≤2岁.1563例轮状病毒腹泻儿童年龄在1个月～11.3岁,92.5%患儿≤2岁,年龄中位数10(12.9±13.7)个月.年龄中位数比较差异有统计学意义(P<0.05).轮状病毒流行高峰发生在秋冬季10月至次年2月份,而诺如病毒在北方天津地区流行高峰出现在冬春季(11月至次年4月),诺如病毒在上海、杭州和重庆自4月份开始活跃,流行高峰常在夏秋季7至10月份,而在广州地区除春季散发外其他季节都有较为显著的流行.结论 轮状病毒和诺如病毒是我国婴幼儿腹泻主要的病毒病原.全国轮状病毒高峰季节基本一致,但是诺如病毒流行季节因地区而异,北方冷季呈现流行高峰,东部和西南部地区主要在夏秋季最流行,南方夏秋季和冬季都可出现较强的流行.

Objective To survey the clinical epidemiological features of norovirus and rotavirus diarrhea among children living in 5 cities . Method A prospective epidemiological investigation was conducted among outpatient children with acute diarrhea between August 2008 and July 2009 in Shanghai, Hangzhou, Guangzhou, Chongqing and Tianjin. The stool samples were randomly collected from children with non-dysentery diarrhea. Croup A rotavirus antigen was tested by the kit that applies colloidal gold method in all specimens. G Ⅰ and GⅡ genogroups of norovirus were detected by one-step real-time reverse-transcription polymerase chain reaction (RT-PCR). The detection rates, seasonality and susceptible age of both viruses-associated diarrhea were analyzed. Result During the one-year period, 5091 fecal samples were obtained, of which 1563 (30.7%) were rotavirus-positive. The detection rates of rotavirus were 29.5% (268/916) in Shanghai, 36.1% (334/926) in Hangzhou, 26.3% (254/968) in Guangzhou, 34.1% (359/1054) in Chongqing and 28. 2% (348/1233) in Tianjin, respectively. Among the remaining 3528 rotavirus-negative samples, 1049 (29. 7% )were identified to be norovirus-positive. The detection rates of norovims were 21. 2% (136/642) in Shanghai, 31. 3% (185/592) in Hangzhou, 24. 2% (173/714) in Guangzhou, 31. 8% (221/695) in Chongqing and 37. 7% (334/885)in Tianjin,respectively. It is estimated that the infection rate of norovirus among outpatients with acute diarrhea is at least more than 20. 6% (1049/ 5092). Of 1049 norovirus strains, 1036 (98. 7% ) were G Ⅱ genogroup and 16 (1. 5% ) were G Ⅰ genogroup, 3 were mixed with G Ⅰ and G Ⅱ genogroups. The 1049 children with norovirus diarrhea aged between 1 month and 14 years with the median age of 10 months (mean: 13. 9 ± 16. 9 months) and 91. 8% were 2 years old or younger. The 1563 children with rotavirus diarrhea aged between 1 month and 11. 3 years with the median age of 10 months (mean; 12. 9 ± 13. 7 months) and 92. 5% were 2 years old or younger. The median ages between norovirus-infected children and rotavirus-infected children were significantly different (P < 0. 05). The peak seasons of rotavirus diarrhea spanned autumn and winter (from October to February). The peak seasons of norovirus diarrhea presented in the winter and spring (from November to April) in Tianjin. Norovirus became active in April and usually predominantly prevalent in the summer and autumn (from July to October) in Shanghai, Hangzhou and Chongqing. However, norovirus was sporadically prevalent in the spring and detected more commonly in the other seasons in Guangzhou. Conclusion Both rotavirus and norovirus are the major causitive agents for childhood diarrhea The seasonality of rotavirus diarrhea was similar among the 5 cities. Nevertheless, the seasonality of norovirus diarrhea was diverse in the different areas. In Tianjin located in the north of China, norovirus was quite prevalent in the cold season. In the east (Shanghai and Hangzhou) and south-west (Chongqing) , norovirus prevailed dominantly in the summer and autumn. In the south (Guangzhou) , the activity of norovirus was more obvious in the summer, autumn and winter.