目的:本研究旨在调查西南地区儿童社区获得性肺炎(CAP)的病原流行病学,COVID-19非药物干预(NPI)期间和之后。
方法:住院儿童CAP的病原体数据,包括对七种病毒的多种直接免疫荧光测试,肺炎支原体的细菌培养和聚合酶链反应(PCR),分三个阶段进行了分析:第一阶段(NPI前:2019年1月1日至2019年12月31日),第二阶段(NPI期间:2020年1月1日至2020年12月31日)和第三阶段(NPI后:2023年1月1日至2023年12月31日)。
结果:共纳入7533例,包括第一阶段的2444、1642和3447人,II和III,分别。肺炎支原体在第一阶段和第三阶段占主导地位(23.4%和35.5%,分别)。在第二阶段,呼吸道合胞病毒(RSV)是主要病原体(20.3%),而甲型流感病毒(流感A)和肺炎支原体的检出率处于较低水平(1.8%和9.6%,分别)。在第三阶段,甲型流感(15.8%)和肺炎支原体疫情均出现反弹,而RSV检测率回到阶段I水平,与Ⅰ期相比,肺炎链球菌和流感嗜血杆菌的检出率明显下降。年龄分层分析和月度变化支持上述发现。在第二阶段和第三阶段,多种病原体的季节性模式被破坏。
结论:COVID-19NPI对儿童CAP病原体流行有明显影响,在肺炎支原体和流感A患病率中观察到NPI后增加。持续的病原体监测对于有效预防和控制儿科CAP至关重要。
OBJECTIVE: This study aimed to investigate the pathogen epidemiology of community-acquired pneumonia (CAP) among children in Southwest China before, during and after the COVID-19 non-pharmaceutical interventions (NPIs).
METHODS: Pathogen data of hospitalised children with CAP, including multiple direct immunofluorescence test for seven viruses, bacterial culture and polymerase chain reaction (PCR) for Mycoplasma pneumoniae, were analysed across three phases: Phase I (pre-NPIs: 1 January 2019 to 31 December 2019), Phase II (NPI period: 1 January 2020 to 31 December 2020) and Phase III (post-NPIs: 1 January 2023 to 31 December 2023).
RESULTS: A total of 7533 cases were enrolled, including 2444, 1642 and 3447 individuals in Phases I, II and III, respectively. M. pneumoniae predominated in Phases I and III (23.4% and 35.5%, respectively). In Phase II, respiratory syncytial virus (RSV) emerged as the primary pathogen (20.3%), whereas detection rates of influenza A virus (Flu A) and M. pneumoniae were at a low level (1.8% and 9.6%, respectively). In Phase III, both Flu A (15.8%) and M. pneumoniae epidemic rebounded, whereas RSV detection rate returned to Phase I level, and detection rates of Streptococcus pneumoniae and Haemophilus influenzae decreased significantly compared to those in Phase I. Detection rates of adenovirus and parainfluenza virus type 3 decreased phase by phase. Age-stratified analysis and monthly variations supported the above findings. Seasonal patterns of multiple pathogens were disrupted during Phases II and III.
CONCLUSIONS: COVID-19 NPIs exhibited a distinct impact on CAP pathogen epidemic among children, with post-NPIs increases observed in M. pneumoniae and Flu A prevalence. Continuous pathogen monitoring is crucial for effective prevention and control of paediatric CAP.