利水健脾解毒汤灌肠联合酪酸梭菌活菌散治疗婴幼儿轮状病毒肠炎疗效观察

目的探讨利水健脾解毒汤灌肠联合酪酸梭菌活菌散口服治疗婴幼儿轮状病毒肠炎的临床疗效。方法将82例的患轮状病毒肠炎婴幼儿随机分为治疗组42例与对照组40例,两组患儿均给予常规治疗,治疗组给予利水健脾解毒汤灌肠及酪酸梭菌活菌散口服,对照组静滴利巴韦林,观察患儿治疗一疗程(3 d)临床疗效和轮状病毒转阴率。结果治疗组总有效率为90.47%,轮状病毒转阴率为71.43%,对照组分别为52.50%、32.50%。治疗组总有效率及轮状病毒转阴率均显著高于对照组(P0.01),2组患儿均未出现不良反应。结论利水健脾解毒汤灌肠及酪酸梭菌活菌散口服治疗婴幼儿轮状毒肠炎疗效显著,安全性高,是治疗婴幼儿轮状病毒肠炎的有效方法。     

妈咪爱联合利巴韦林、思密达治疗婴幼儿轮状病毒肠炎的观察

目的观察妈咪爱联合利巴韦林、思密达治疗婴幼儿轮状病毒性肠炎的疗效。方法将轮状病毒性肠炎患儿58例按就诊先后顺序随机分为对照组29例,用利巴韦林、思密达治疗。治疗组29例,在对照组治疗的基础上加用妈咪爱治疗;利巴韦林用法：10mg/（kg·d）,分3次口服;思密达用法：1岁以下,1g/次,1岁以上,1．5g/次,3次／d;妈咪爱用法：1岁以下,0．5g／次,1岁以上,1g,／次,2次／d。结果治疗组的治愈率和总有效率分别为75．86％和96．55％,对照组的治愈率和总有效率分别为48．28％和75．86％,组间比较,其差异有显著性（P〈0．05）。结论妈咪爱联合利巴韦林、思密达治疗婴幼儿轮状病毒性肠炎疗效显著。     

布拉酵母菌散联合蒙脱石散对轮状病毒肠炎患儿细胞免疫功能的影响及疗效观察

目的探讨布拉酵母菌散联合蒙脱石散对轮状病毒肠炎患儿细胞免疫功能的影响及疗效。方法76例婴幼儿轮状病毒肠炎随机分为观察组和对照组。两组患儿均予以补液、抗病毒、纠正水电解质及酸碱平衡紊乱等常规治疗。观察组患儿加用布拉酵母菌散剂和蒙脱石散治疗,对照组患儿予以单纯的蒙脱石散治疗。观察两组患儿治疗后临床疗效及不良反应,并比较两组患者治疗后1个月T淋巴细胞亚群的变化。结果治疗72h后,观察组患儿的临床总有效率为94．74％,明显高于对照组的78．95％（χ2=4．15,P〈0．05）,两组患儿治疗中未发现明显药物不良反应。治疗后1个月,观察组患儿CD4＋及CD4＋／CD8＋比值较治疗前明显上升,CD8＋较治疗前明显下降（P〈0．05）。而对照组患儿治疗前后CD4＋、CD8＋、CD4＋／CD8＋比值无明显变化（P〉0．05）。结论布拉酵母菌散联合蒙脱石散治疗婴幼儿轮状病毒肠炎具有较好的疗效,安全性较好,与增强患儿的细胞免疫功能密切相关。     

布拉氏酵母菌散对轮状病毒肠炎患儿血清白介素-6和肿瘤坏死因子-α水平的影响及疗效观察

目的探讨布拉氏酵母菌散对轮状病毒肠炎患儿血清白介素16（IL-6）和肿瘤坏死因子-α（TNF-α）水平的影响及疗效观察。方法选取轮状病毒肠炎患儿84例,随机分为两组（观察组42例和对照组42例）。两组患儿均予以调整饮食、静脉及口服补液、抗病毒及纠正水电解质及酸碱平衡紊乱等常规治疗。观察组患儿加用布拉氏酵母菌散剂治疗,其中〈12个月,0．125g／次,1次／d;≥12个月,0．25g／次,2Oc／a。对照组患儿除不予以布拉氏酵母菌散剂治疗,余治疗药物基本同观察组。治疗3d后,观察两组患儿治疗前后血清细胞因子IL-6和TNF-α水平,并探讨其疗效及不良反应情况。结果治疗3d后,两组患儿血清IL-6和TNF-α水平均比治疗前明显下降（P〈0．05或P〈0．01）,且观察组较对照组下降更明显（P〈0．05）;同时观察组患儿的临床总有效率（95．24％）明显好于对照组（78．57％）（X2=5．13,P〈0．05）,两组患儿治疗期间无明显的药物不良反应发生。结论布拉氏酵母菌散治疗轮状病毒肠炎患儿疗效及安全性均较好,能降低血清细胞因子IL-6和TNF-α表达水平,抑制炎症及免疫反应过程。     

口服轮状病毒活疫苗安全性和免疫原性观察

为了观察口服轮状病毒活疫苗在儿童服用后的安全性和免疫原性效果。于惠州市选择63名6月龄~3岁的儿童为观察对象。所用疫苗由兰州生物制品研究所生产,服苗前和服苗后4~5周采末梢血,以中和试验检测抗轮状病毒(G1、G2、G3、G4)型抗体及疫苗株(LLR型)的抗体水平。63名儿童服苗前、后采集的血清样本双份配对均有效者为37人。37人服苗后各型抗体阳转率为47.06%~72.72%;≥4倍增长率为43.40%~66.04%;各型中和抗体免疫前后平均增长2.67~3.01倍。63名服苗儿童中的不良反应为低热3例(24.67%)、中热1例(1.59%)、无高热反应。观察结果表明,轮状病毒具有良好的免疫原性和安全性。     

宝乐安（酪酸梭菌散剂）治疗婴幼儿轮状病毒性肠炎96例疗效观察

目的观察和评价宝乐安（酪酸梭菌CGMCC0313.1散剂）治疗小儿轮状病毒性肠炎的临床疗效。方法将184例轮状病毒性肠炎患儿随机分为观察组和对照组,观察组96例,宝乐安联合炎琥宁进行治疗,对照组88例,单独应用炎琥宁治疗,观察疗效和不良反应。结果观察组总有效率为86.46%,对照组总有效为62.50%,差异有显著性（P〈0.01）。结论宝乐安联合抗病毒药物炎琥宁治疗小儿轮状病毒性肠炎疗效显著,且未见不良反应,值得临床推广应用。     

口服轮状病毒疫苗RotaTeq对不同人种轮状病毒胃肠炎免疫原性的meta分析

评价口服轮状病毒减毒活疫苗RotaTeq对全球儿童轮状病毒胃肠炎免疫原性,为疫苗的使用提供循证参考。检索2006-2021年公开发表的有关口服轮状病毒减毒活疫苗（Oral Live Attenuated Rotavirus Vaccine,ORV）RotaTeq(RV5)的文献,根据纳入排除标准筛选,共纳入了8 015名研究对象,其中疫苗组纳入研究对象4 062名,对照组纳入研究对象3 953名,使用RevMan5.3软件进行数据分析。共纳入6篇文献,对照组相比疫苗组血清IgA抗体、SNA-G1抗体、SNA-G2抗体、SNA-G3抗体、SNA-G4抗体、SNA-P1A[8]抗体的抗体阳转率分别升高了73%(95%CI:65%～81%)、35%(95%CI:19%～50%)、11%(95%CI:6%～16%)、12%(95%CI:5%～19%)、30%(95%CI:21%～38%)、23%(95%CI:8%～38%);与对照组相比,黄色人种疫苗组血清IgA抗体、SNA-G1抗体、SNA-G2抗体、SNA-G3抗体、SNA-G4抗体、SNA-P1A[8]抗体的抗体阳转率分别升高了75%(9...     

腹泻患儿粪便A群轮状病毒抗原检测的结果分析

目的:了解本地区腹泻婴幼儿的A群轮状病毒感染情况及其流行特点。方法:采用胶体金法对我院2009年10月-2010年9月2104例有腹泻和肠炎特征的婴幼儿粪便进行A群轮状病毒抗原检测。结果:在2104例受检者中,A群轮状病毒感染的总阳性率是24.71%,其中男性感染率24.17%,女性为25.40%。不同年龄组间以1-2岁婴幼儿感染率最高,为32.13%,0-1岁为20.72%,2-5岁为12.03%。感染的季节特征是秋末冬初季(10-12月)阳性率最高,为42.82%,春末夏初季(4-6月)最低,为8.81%。结论:由A群轮状病毒感染引发的急性腹泻主要发生在1-2岁的婴幼儿,各个季节均有发生,以秋末冬初季为高发。     

四联活菌片联合干扰素治疗婴幼儿轮状病毒性肠炎疗效观察

目的:对四联活菌片联合干扰素治疗婴幼儿轮状病毒性肠炎的疗效进行观察.方法:轮状病毒流行期住院的急性腹泻病人共150例,病程3 d以内,经电镜及酶联免疫吸附试验检测为轮状病毒90例,随机分为二组,治疗组(n=48)服用普乐拜乐片及肌注基因工程a-1 b干扰素,对照组(n=42)利巴伟林肌注或静点,二组在纠正脱水、酸中毒等治疗方案相同,且均不用抗生素、止泻药.结果:治疗组在退热时间,止泻时间,脱水纠正时间,住院时间与对照组相比差异有非常显著性(P＜0.01).结论:四联活菌剂普乐拜尔片联合干扰素治疗婴幼儿轮状病毒性肠炎疗效肯定,无副作用,值得临床推广.     

婴幼儿轮状病毒性肠炎病原检测和治疗

目的了解辽河油田地区秋冬季3岁以下腹泻儿童轮状病毒感染率,观察口服抗轮状病毒免疫球蛋白(抗-HPV IgY)对轮状病毒感染性肠炎的疗效。方法酶联免疫吸附(ELISA)法检测患儿大便轮状病毒抗原阳性者,比较抗．HPV IgY治疗组和常规药物治疗组2组的有效率。结果粪便中轮状病毒抗原检出率为71％,抗-HRV IgY治疗组的3d有效率为82．3％,常规药物治疗组为32．5％。结论轮状病毒感染是婴幼儿秋季腹泻的主要致病微生物,口服抗轮状病毒免疫球蛋白疗效高于常规药物治疗组。     

腹泻患儿粪便A群轮状病毒抗原检测的结果分析

目的：了解本地区腹泻婴幼儿的A群轮状病毒感染情况及其流行特点。方法：采用胶体金法对我院2009年10月-2010年9月2104例有腹泻和肠炎特征的婴幼儿粪便进行A群轮状病毒抗原检测。结果：在2104例受检者中,A群轮状病毒感染的总阳性率是24．71％,其中男性感染率24．17％,女性为25．40％。不同年龄组间以1—2岁婴幼儿感染率最高,为32．13％,0-1岁为20．72％,2-5岁为12．03％。感染的季节特征是秋末冬初季（10—12月）阳性率最高,为42．82％,春末夏初季（4．6月）最低,为8．81％。结论：由A群轮状病毒感染引发的急性腹泻主要发生在1-2岁的婴幼儿,各个季节均有发生,以秋末冬初季为高发。     

Detection and characterization of rotavirus G and P types from children participating in a rotavirus vaccine trial in Belém, Brazil

This study sought the characterization of rotaviruses in a trial with a tetravalent rhesus-human rotavirus vaccine in Belém, Brazil in children who received three doses of vaccine or placebo in the 1st, 3rd and 5th months of life. Rotavirus electropherotypes, subgroups, G serotypes, G, [P] and [P], G genotypes were determined in 93.3%, 95.9%, 93.3%, 73.3%, 95.5% and 92.2% of isolates, respectively. Serotypes G1, G2 and G4 were detected in 58.9%, 30% and 4.4% of the cases, respectively. Rotavirus genotype G5 was detected for the first time in Northern region in 4.4% of the infections. Rotavirus genotypes P[8], P[4], P[6] and P[8 + 6] were detected in 54.5%, 26.7%, 12.2%, and 2.2% of the cases, respectively. The predominant genotypes were P[8], G1 and P[4], G2 with 53% and 26.6% of the infections, respectively. Unusual strains accounted for 20.5% including P[4], G1, P[6], G1, P[6], G4, P[6], G5, P[8], G2, P[8], G5. Mixed infections involving P[8 + 6], G2 and P[8 + 6], G1 were also noted. The neonatal P[6] strains associated with diarrhea were detected among children aged 9-24 months. To our knowledge, this study represents the first in Brazil to analyse, on molecular basis, rotavirus genotypes from children participating in a rotavirus vaccine trial. These results are of potential importance regarding future rotavirus vaccination strategies in Brazil.     

Detection of human rotavirus in hospitalized diarrheic children in central India

During the present study, group A human rotaviruses were detected among diarrheic children using polyacrylamide gel electrophoresis (PAGE) technique, with a typical RNA migration pattern of 4:2:3:2, suggestive of group A rotavirus. During the study, a total of 46 fecal samples collected from hospitalized children with acute diarrhea as well as children inhabiting nearby animal farms with history of presence of animal rotaviruses on the farms were processed for detection of human rotavirus. Out of 33 diarrheic children, 12 showed presence of rotavirus infection (36.36%), however, none of the children from animal farm areas showed presence of rotavirus. Female children were more susceptible to rotavirus infection (46.15%) than males (30%). Majority of the cases of rotavirus gastroenteritis belonged up to one year of the age, with an incidence of 40.91%. RNA profile of rotaviruses suggested circulation of 5 different electropherotypes in this geographical locale of the country, indicating existence of genomic diversity among human rotaviruses. Majority of the isolates were of long pattern (66.67%), whereas short pattern was detected only in one third of the viruses. This preliminary study emphasizes for further detailed studies on the molecular characterization of rotaviruses circulating in this part of country and their relationship with other human rotavirus strains and animal strains in the country.     

G-serotypes of group a rotaviruses in Pilsen region (Czechia)

A total of 260 feces samples from children with confirmed rotavirus infection collected during 1999-2002 were serotyped, using enzymoimmunoassay with VP7 specific monoclonal antibodies for G1-G4 serotypes. The serotypes were identified in 185 feces, i.e. 71.2 %. Individual serotypes occurred in 43, 2, 16 and 2 %; 8 % samples reacted with 2 type-specific monoclonal antibodies. The G1 serotype was prevalent over the whole period. The G3 type occurred with a statistically higher significance in children of up to 36 months (chi2 = 4.6, p = 0.028). In 4 children a different serotype was demonstrated in the first and second, or in the second and third stools, respectively. No dominant serotype was found in children with nosocomial infection.     

Rotavirus vaccine efficacy up to 2 years of age and against diverse circulating rotavirus strains in Niger: Extended follow-up of a randomized controlled trial

BackgroundRotavirus vaccination is recommended in all countries to reduce the burden of diarrhea-related morbidity and mortality in children. In resource-limited settings, rotavirus vaccination in the national immunization program has important cost implications, and evidence for protection beyond the first year of life and against the evolving variety of rotavirus strains is important. We assessed the extended and strain-specific vaccine efficacy of a heat-stable, affordable oral rotavirus vaccine (Rotasiil, Serum Institute of India, Pune, India) against severe rotavirus gastroenteritis (SRVGE) among healthy infants in Niger.Methods and findingsFrom August 2014 to November 2015, infants were randomized in a 1:1 ratio to receive 3 doses of Rotasiil or placebo at approximately 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and graded using the Vesikari score. The primary endpoint was vaccine efficacy of 3 doses of vaccine versus placebo against a first episode of laboratory-confirmed SRVGE (Vesikari score ≥ 11) from 28 days after dose 3, as previously reported. At the time of the primary analysis, median age was 9.8 months. In the present paper, analyses of extended efficacy were undertaken for 3 periods (28 days after dose 3 to 1 year of age, 1 to 2 years of age, and the combined period 28 days after dose 3 to 2 years of age) and by individual rotavirus G type. Among the 3,508 infants included in the per-protocol efficacy analysis (mean age at first dose 6.5 weeks; 49% male), the vaccine provided significant protection against SRVGE through the first year of life (3.96 and 9.98 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 60.3%, 95% CI 43.6% to 72.1%) and over the entire efficacy follow-up period up to 2 years of age (2.13 and 4.69 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 54.7%, 95% CI 38.1% to 66.8%), but the difference was not statistically significant in the second year of life. Up to 2 years of age, rotavirus vaccination prevented 2.56 episodes of SRVGE per 100 child-years. Estimates of efficacy against SRVGE by individual rotavirus genotype were consistent with the overall protective efficacy. Study limitations include limited generalizability to settings with administration of oral polio virus due to low concomitant administration, limited power to assess vaccine efficacy in the second year of life owing to a low number of events among older children, potential bias due to censoring of placebo children at the time of study vaccine receipt, and suboptimal adapted severity scoring based on the Vesikari score, which was designed for use in settings with high parental literacy.ConclusionsRotasiil provided protection against SRVGE in infants through an extended follow-up period of approximately 2 years. Protection was significant in the first year of life, when the disease burden and risk of death are highest, and against a changing pattern of rotavirus strains during the 2-year efficacy period. Rotavirus vaccines that are safe, effective, and protective against multiple strains represent the best hope for preventing the severe consequences of rotavirus infection, especially in resource-limited settings, where access to care may be limited. Studies such as this provide valuable information for the planning of national immunization programs and future vaccine development.Trial registrationClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02145000","term_id":"NCT02145000"}}NCT02145000.

Sheila Isanaka and co-workers report extended follow-up of a rotavirus vaccine trial in Niger.     

Genetic Diversity of Circulating Rotavirus Strains in Tanzania Prior to the Introduction of Vaccination

Background

Tanzania currently rolls out vaccination against rotavirus-diarrhea, a major cause of child illness and death. As the vaccine covers a limited number of rotavirus variants, this study describes the molecular epidemiology of rotavirus among children under two years in Dar es Salaam, Tanzania, prior to implementation of vaccination.

Methods

Stool specimens, demographic and clinical information, were collected from 690 children admitted to hospital due to diarrhea (cases) and 545 children without diarrhea (controls) during one year. Controls were inpatient or children attending child health clinics. Rotavirus antigen was detected using ELISA and positive samples were typed by multiplex semi-nested PCR and sequencing.

Results

The prevalence of rotavirus was higher in cases (32.5%) than in controls (7.7%, P<0.001). The most common G genotypes were G1 followed by G8, G12, and G4 in cases and G1, G12 and G8 in controls. The Tanzanian G1 variants displayed 94% similarity with the Rotarix vaccine G1 variant. The commonest P genotypes were P[8], P[4] and P[6], and the commonest G/P combination G1 P[8] (n = 123), G8 P[4] and G12 P[6]. Overall, rotavirus prevalence was higher in cool (23.9%) than hot months (17.1%) of the year (P = 0.012). We also observed significant seasonal variation of G genotypes. Rotavirus was most frequently found in the age group of four to six months. The prevalence of rotavirus in cases was lower in stunted children (28.9%) than in non-stunted children (40.1%, P = 0.003) and lower in HIV-infected (15.4%, 4/26) than in HIV-uninfected children (55.3%, 42/76, P<0.001).

Conclusion

This pre-vaccination study shows predominance of genotype G1 in Tanzania, which is phylogenetically distantly related to the vaccine strains. We confirm the emergence of genotype G8 and G12. Rotavirus infection and circulating genotypes showed seasonal variation. This study also suggests that rotavirus may not be an opportunistic pathogen in children infected with HIV.     

Evaluation of the Intussusception Risk after Pentavalent Rotavirus Vaccination in Finnish Infants

Background

An association between rotavirus immunisation and intussusception (IS) has been suggested with present rotavirus vaccines in post-licensure studies. In Finland, rotavirus vaccination programme was implemented in September 2009 using a 2, 3, and 5 months schedule with the pentavalent rotavirus vaccine. By the end of 2013, it is estimated that 719 000 rotavirus vaccine doses have been given in the national programme of which 240 000 were first doses. Nationwide register allows us to evaluate the association between rotavirus vaccination and IS.

Methods and Materials

Cases of IS diagnosed during 1999–2013 were identified from National Hospital Discharge Register. All cases under 250 days of age diagnosed during 2009–2013 were confirmed by reviewing medical charts. Self-controlled case-series method was used to assess the risk of IS during 1–21 days compared to 22–42 days post vaccination.

Findings

In register data the relative incidence of IS at 2 months of age between the post and pre vaccination era was 9.1 (95%CI 2.0–84.3). We identified 22 verified cases with date of admission less than 43 days after any of the three rotavirus vaccine doses. The incidence of IS in the risk period after the 1st dose relative to the control period was 2.0 (95% CI 0.5–8.4; p = 0.34.) Number of excess IS cases per 100 000 first vaccine doses was therefore estimated to be 1.04 (95% CI 0.0–2.5), i.e. one additional IS case per 96 000 first doses of rotavirus vaccine (95% CI 54 600 to ∞). There was no risk detected after 2nd and 3rd doses.

Conclusion

The finding is in line with the recent published estimates. The benefits of rotavirus immunisation programme outweigh possible small risks of intussusception.     

Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya

Background

Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention.

Methods and Findings

Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as “cases” if admitted with diarrhoea, and “controls” if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478 (437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children.

Conclusions

In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management.