COVID-19流行期间上海单中心儿童肺炎支原体和 沙眼衣原体感染流行病学研究

doi:10.3969/j.issn.1673-5501.2022.04.005

摘要/Abstract

摘要： 背景：新型冠状病毒肺炎（COVID-19）疫情发生以来中国政府采取了一系列防控措施，在有效遏制COVID-19疫情蔓延的同时对其他常见呼吸道病原的流行产生了影响。目的：分析COVID-19流行期间儿童急性呼吸道感染（ARTI）肺炎支原体（Mp）和沙眼衣原体（CT）的流行病学特征。设计：观察性研究。方法：2019年2月1日至2021年5月31日于复旦大学附属儿科医院（我院）诊断为ARTI并行Mp、CT和9种常见呼吸道病毒检测的数据，分为单一病原体感染（仅检出Mp或CT）和混合感染（Mp+CT，Mp或CT+9种常见呼吸道病毒中任意1种及以上，Mp+CT+9种常见呼吸道病毒中任意1种及以上）。呼吸道样本（鼻咽部抽吸物/肺泡灌洗液）采集和检测均在我院完成。①COVID-19疫情前（简称疫情前）：2019年2月1日至2020年1月31日，不主动实施COVID-19疫情防控措施；②COVID-19疫情中（简称疫情中）：2020年2月1日至2020年5月31日，COVID-19疫情大流行全国范围内严格实施非药物干预措施（NPI），学校停课；③COVID-19疫情后（简称疫情后）：2020年6月1日至2021年5月31日，COVID-19疫情防控常态化阶段，NPI措施有所放松，学校重新复课，社会复工复产。对纳入的病原体样本，根据当次诊断ARTI时患儿年龄分为≤28 d、~12月、~3岁、~6岁和≥7岁。主要结局指标：COVID-19流行期间Mp、CT流行病学。结果：10 358份因ARTI行呼吸道病原体检测的样本纳入本文分析，其中疫情前、中和后分别为6 080份、754份和3 524份，疫情后较前病原体送检率下降42.04%［（6 080-3 524）/6 080×100%］。男6 138例，女4 220例。Mp总检出率12.39%，疫情前、中、后呈陡然下降趋势，疫情后较前Mp检出率下降96.29%，差异有统计学意义（P<0.001）。CT总检出率为1.45%，疫情前、中、后呈上升趋势，疫情后较前阶段检出率上升65.49%，差异有统计学意义（P=0.003）。单纯Mp或CT检出率10.84%，疫情后较前Mp检出率下降96.05%、CT检出率上升119.70%，差异均有统计学意义。混合感染检出率2.89%，疫情后较前Mp混合感染检出率下降97.32%，差异有统计学意义，Mp+CT混合感染和CT混合感染检出率差异均无统计学意义。疫情前Mp呈明显的夏季检出率高的特征，疫情后季节检出特征消失。CT检出率全年分布均匀。疫情前、中、后Mp和CT送检率以及CT检出率12月龄后随着年龄的增加均呈下降趋势，而疫情前、中、后Mp检出率随年龄增加分别呈现明显上升、上升和略有上升趋势。疫情前、中、后≤28 d至~12月龄组CT检出率随着年龄的增加呈明显上升趋势。结论：COVID-19疫情期间采取的一系列防控措施，不仅遏制了新型冠状病毒的传播，同时影响了非典型呼吸道病原体的流行病学，Mp检出率明显降低，且消弥了Mp检出高峰季，而CT的检出率出现上升。

关键词: 急性呼吸道感染, 肺炎支原体, 沙眼衣原体, 流行病学

Abstract:

BackgroundSoon after the emergence of community transmission of COVID19, the Chinese government has introduced a series of nonpharmaceutical interventions (NPI) to eliminate COVID19 and these NPIS have already affected the prevalence of other common respiratory pathogens.
ObjectiveThis study aimed to analyze the epidemiological characteristics of mycoplasma pneumoniae (Mp) and chlamydia trachomatis (CT) of acute respiratory infections （ARTI） in children during the COVID19 pandemic.
DesignObservational study.
MethodsRespiratory specimens for the detection of Mp, CT and other 9 common respiratory viruses were collected from children with ARTI at Children's Hospital of Fudan University from February 2019 to May 2021. The detection data were divided into the group of single pathogen infection (only Mp and CT were detected) and coinfection (Mp+CT, Mp or CT +any one or more of 9 common respiratory viruses and Mp+CT+ one or more of 9 common respiratory viruses). Respiratory specimens (nasopharyngeal aspirates/bronchoalveolar lavage fluid) were collected and tested in our hospital. a. Three satages were compared including "preCOVID19" period: from February 1, 2019 to January 31, 2020, without actively implemented nationwide NPI; b."COVID19"period, from February 1, 2020 to May 31, 2020, when strict nationwide NPI were implemented and schools were closed; c."postCOVID19"period, from June 1, 2020 to May 31, 2021, when nationwide NPI were relaxed, schools were reopened and social work was resumed. All the enrolled samples were divided into 5 age groups: ≤28 days, ~12 months, ~3 years, ~6 years and ≥7 years according to the age at the time of ARTI diagnosis.
Main outcome measuresThe epidemiological changes of Mp and CT during the COVID19 pandemic.
ResultsA total of 10 358 specimens tested for respiratory pathogens were enrolled in this analysis, including 6 080 in the preCOVID19 period, 754 in the COVID19 period and 3 524 in the postCOVID19 period. The total number decreased by 42.04% ［(6 080-3524)/6 080］during postCOVID19 when compared to preCOVID19. Among all the enrolled patients, 6 138 were male and 4 220 were female. The overall detection rate of Mp was 12.39%, the observed prevalence declined sharply and was decreased by 96.29% ( P<0.001) with a significant difference. The overall detection rate of CT was 1.45%. The detection rate showed an increasing trend and was increased by 65.49% (P=0.003). The detection rate of single Mp and CT infection was 10.84%. Compare to the pre-COVID-19 period, the detection rate of Mp was decreased by 96.05% and the detection rate of CT was increased by 119.70% in the post-COVID-19 period, with a significant difference. The overall coinfection rate was 2.89%. The coinfection rate of Mp was decreased by 97.32% (P<0.001), while no significant difference was observed in the coinfection rate of MP+CT and CT. Mp peaked in summer during the pre-COVID-19 period, whereas the annual peak was interrupted after the NPI were adopted. CT was detected throughout the whole study period. The examination rates were sharply decreased with the increase of age in the group of older than 12 months in both three periods, while the detection rate of Mp showed a great increase in the pre-COVID-19 period, an increase in the COVID-19 period and a slight increase in the post-COVID-19 period. The increase in the detection rate of CT was observed in the age of ≤28 days and -12 months in all three periods, while the examination rate and detection rate of CT showed a sharply decrease in children older than 12 months with the increase of age in the whole study period.
ConclusionThe public health interventions aiming to eliminate COVID-19 have great impact on the prevalence of the atypical pathogens. The detection rate of Mp was significantly reduced, and the seasonality of Mp was disappeared, while the detection rate of CT was significantly increased.

Key wordsAcute respiratory tract infections;Mycoplasma pneumoniae;Chlamydia trachomatis;Epidemiology

Key words: Acute respiratory tract infections, Mycoplasma pneumoniae, Chlamydia trachomatis, Epidemiology

徐梦华柳鹏程卢丽娟苏犁云曹凌峰徐锦. COVID-19流行期间上海单中心儿童肺炎支原体和沙眼衣原体感染流行病学研究[J]. 中国循证儿科杂志, 2022, 17(4): 290-295.

XU Menghua, LIU Pengcheng, LU Lijuan, SU Liyun, CAO Lingfeng, XU Jin. Epidemiological study of mycoplasma pneumoniae and chlamydia trachomatis infection in a single center in Shanghai during the COVID-19 pandemic[J]. Chinese Journal of Evidence-Based Pediatrics, 2022, 17(4): 290-295.

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