| BACKGRANDS AND OBJECTIVESChildhood pneumonia is the leading single cause of mortality in children aged less than 5 years, and is responsible for about 19% of all deaths in children aged less than 5 years worldwide. There are about 21 million new childhood pneumonia episodes each year in China. Pneumonia is also the leading cause of mortality for Chinese children aged less than 5 years. Therefore it is important to strengthen the prevention and treatment of clinical pneumonia, espicallly of severe pneumonia in children, thus to reduce morbidity and mortality of childhood pneumonia.RSV (Respiratory syncytial virus, RSV), influenza A virus (Influenza A virus, FV) and adenovirus (Adenovirus, ADV) are all common pathogen of childhood pneumonia. Childhood severe pneumonia can cause death, and may cause epidemic spread. But so far, there are limited effective treatments for childhood pneumonia infected with RSV, FV and ADV. It is considered that prevention is the key. This requires understanding clinical characteristics by sex, age, seasonal and annual distribution of children's RSV, FV and ADV infected pneumonia and clinical features of severe pneumonia of them, for children with RSV, FV and ADV virus pneumonia prevention and control of reference.Previous studies showed that clinical features by sex, age, season and annual distribution of children with RSV, FV and ADV infection are different in different regions. Thus, the prevention and control work of childhood pneumonia infected with RSV, FV and ADV in different regions should be executed according to clinical features by sex, age, season, annual distribution and clinical features of severe pneumonia of the three viruses infected pneumonia children in regions themselves. Guangzhou is the same. However, there are few literatures about clinical features by sex, age, season, annual distribution and clinical features of severe pneumonia of the three viruses infected pneumonia children in Guangzhou, and there are no comparative literatures for them three in Guangzhou.Based on the above background, clinical features of childhood pneumonia with RSV, FV and ADV infection in 12,195 cases of hospitalized pneumonia children in Guangzhou Children's Hospital in 2005-2007 were retrospectively analyzed and compared, thus to understand the clinical characteristics by sex, age, season, the annual distribution and severe pneumonia clinical features of RSV, FV and ADV pneumonia for hospitalized pneumonia children in Guangzhou, to provide reference for prevention and control work of hospitalized pneumonia children infected with the three viruses in Guangzhou.METHODS1. All the cases were from the hospitalized patients of Guangzhou children's hospital, the largest children's hospital of south China. All the cases selected from January 1st,2005,to December 31st,2007. The age of them were 0-14 years old (00.05).The average hospitalized days between them were also had no significance (P>0.05).1.2 Age distributionThe infection rate of 0-1,1-3,3-6 and 6-14 years old was 9.67%,6.811%,3.49% and 0.80%,respectively. The infection rate between each two age stags had significantly difference(P<0.05).Cases of 0-3 years old occupied 92.03%. The average hospitalized days of 0-1 years old were longer than 3-6 and 6-14 years old(P <0.05),and those of 3-6 years old were longer than 6-14 years old.However, those between each two of the other age stages had no significantly difference (P>0.05).1.3 Season distributionThe infection rate of spring, summer, autumn and winter was 11.17%,6.32%,3.54% and 5.57%, respectively. The infection rate of spring was significantly higher than that of summer, autumn and winter(P<0.05).Cases from March to August accounted for 79.18%. The average hospitalized days between each two of them had no significantly difference (P>0.05).1.4 Year distributionThe RSV infection rate in 2005,2006 and 2007 were 4.00%,8.92% and 8.85%, respectively. The infection rate between 2005 and 2006(χ2=78.556,P=0.000), between 2005 and 2007 (χ2=74.113,P=0.000)were both significant(P<0.05),while infection rate between 2006 and 2007 had no significantly difference(P>0.05).The peak infected age stage in 2005,2006 and 2007 were all 0-3 years old, and the peak season in 2005,2006 and 2007 were all in spring and summer, Apil was the most peakest month. The average hospitalized days between each two of them had no significantly difference (P>0.05).1.5 Severe pneumonia casesThere were 69 cases RSV infected severe pneumonia cases from 2005 to 2007, and the severe pneumonia incidence rate of RSV was 7.64%. Two cases of severe pneumonia children cases died.The average hospitalized days of the servere cases were significantly longer than the common cases(P<0.05)2. Features of the influenza A virus infected pneumonia cases242 cases of FV positive hospitalized pneumonia cases were detected and the infection rate was 1.98%.2.1 Sex distributionThe difference of infection rate between male (2.08%) and female(1.78%) had no significance(χ2=1.164,P=0.281).The average hospitalized days between them had no significantly difference (P>0.05).2.2 Age distributionThe infection rate of 0-lyears old, 1-3years old,3-6 years old and 6-14 years old was 1.40%,2.73%,2.76% and 1.82%, respectively. And the infection rate of 1-3 years old and 3-6 years old both were significantly different from that of the 0-1 years old(P<0.05). FV infected children for 0 to 3 years old occupied 74.79%. The average hospitalized days of 0-1 years old were longer than 3-6 and 6-14 years old (P<0.05), and those between each two of the other age stages had no significantly difference (P >0.05).2.3 Season distributionThe infection rate of spring, summer, autumn and winter was 2.21%,2.71%, 1.27% and 1.01%,respectively. And the infection rate between spring and autum (χ2=7.609, P=0.006),between spring and winter (/=9.894, P=0.002),between summer and autumn (χ2=14.623,P=0.000),between summer and winte (χ2=16.263,P=0.000) were all had significantly difference(P<0.05). Cases of spring and summer occupied 79.34%.The average hospitalized days between each two of the seasons had no significantly difference (P>0.05).2.4 Year distributionFV Infected cases in 2005,2006 and 2007 were 20,136 and 86 cases, respectively. And the infection rate of 2005,2006 and 2007 were 0.54%,3.30% and 2.14%, respectively. The infection rate of 2005 was significantly less than 2006 and 2007 (χ2=67.349,P=0.000 and =34.456,P=0.000),the infection rate of 2006 was significantly higher than 2007(χ2=67.349,P=0.010).The peak infected age stage in 2005,2006 and 2007 were all 0-3 years old, and the peak season in 2005,2006 and 2007 were all in spring and summer.The average hospitalized days between each two of the years had no significantly difference (P>0.05).2.5 Severe pneumonia casesThere were 12 cases of FV infected severe pneumonia cases from 2005 to 2007, and the severe pneumonia incidence rate of FV was 4.96%. One case of severe pneumonia children died. The average hospitalized days of the severe cases were longer than the common cases, while had no significantly difference (P>0.05).3. Features of the adenovirus infected pneumonia cases737 case for ADV-IgM positive of hospitalized pneumonia cases were detected and the total ADV infection rate was 6.04%.The average hospitalized days of them were 7.98±3.55d.3.1 Sex distributionThe infection rate of female (7.92%) was significantly(P<0.05)higher than the infection rate of male (5.21%).The average hospitalized days between them had no significance (P>0.05). 3.2 Age distributionThe infection rate of 0-1,1-3,3-6 and 6-14 years old was 3.71%,7.99%,9.92% and 7.95%,respectively.Furthermore,the infection rate of 0-1 years old was significantly less than that of the other age stages(P<0.05),and the infection rate of 3-6 years old was significantly higher than that of all the other age stases(P<0.05) ADV infected pneumonia cases of 0-3 years old occupied 68.52%.The average hospitalized days of 0-1 years old were longer than 3-6 years old(P<0.05),and those between each two of the other age stages had no significant difference (P>0.05).3.3 Season distributionThe infection rate of spring, summer, autumn and winter was 5.31%,5.98%, 5.73% and 8.44%, respectively. And the infection rate of winter is significantly higher than the infection rate of spring(χ2=21.262, P=0.000),summer (χ2=11.210,P=0.001)and autum(χ2=11.924,P=0.001).Cases from March to August accounted 60.11% of all the ADV infected cases.The average hospitalized days each two of the seasons had no significantly difference (P>0.05).3.4 Year distributionADV infected hospitalized pneumonia cases in 2005,2006 and 2007 were 263 cases,301 cases and 173 cases, respectively. And the ADV infection rate of 2005, 2006 and 2007 were 7.11%,6.71% and 4.31%, respectively. Infection rate of 2007 was significantly less than that of 2005 and 2006. The peak age stage in 2005,2006 and 2007 were all 0-3 years old, while the peak months had some difference in different years. The average hospitalized days between each two of them had no significantly difference (P>0.05).3.5 Severe pneumonia casesThere were 26 cases of ADV infected severe pneumonia cases from 2005 to 2007, and the severe pneumonia incidence rate of ADV was 3.53%.The average hospitalized days between the severe and the common pneumonia had no significantly difference (P>0.05).4. Comparison of the three viruses infected pneumonia cases4.1 Comparison as a wholeThe differences of infection rate between each two of the viruses were significant (between RSV and FV:χ2=400.387,P=0.000;between RSV and ADV:χ2=18.014,P=0.000;between ADV and FV:χ2=260.747,P=0.000).4.2 Comparison by SexThe infected rates of the male of RSV, FV and ADV were 7.53%,2.08% and 5.21%,respectively.The infected rates of the female of RSV, FV and ADV were 7.12%.1.78% and 7.92%,respectively. The infected rates of the male between each two viruses had significantly difference:between RSV and FVχ2=274.415,P=0.000; RSV and ADV:χ2=38.202,P=0.000;ADV and FV:χ2=117.800,P=0.000).As for the female:between RSV and FV:χ2=126.218,P=0.000<0.05;between RSV and ADV:χ2=1.719,P=0.190>0.05;between ADV and FV:χ2=153.646,P=0.000<0.05.4.3 Comparison by ageFor children of 0-1 years old, the infection rate of RSV,FV and was ADV 9.67%,8.71% and 1.40%,respectively, each of two of them had significant difference (P<0.05).For children of 1-3 years old, the infection rate of RSV,FV and was 6.81%,7.99% and 2.73%,respectively, and the infection rate between RSV and ADV (χ2=62.429,P=0.000),between FV and ADV(χ2=92.755,P=0.000)were both had significant difference(P<0.05).For children of 3-6 years old, the infection rate of RSV,FV and ADV was 3.49%,9.92% and 2.76%,respectively, and the infection rate between FV and RSV(χ2=53.961,P=0.000),between FV and ADV(χ2=70.605, P=0.000)were both had significant difference(P<0.05).For children of 6-14 years old, the infection rate of RSV,FV and ADV was 0.80%,1.82% and 7.95%,respectively. The infection rate between ADV and RSV(χ2=53.904, P=0.000),between ADV and FV(χ2=35.649,P=0.000)were both had significant difference(P<0.05).All of the most prevalent infected age of RSV, FV and ADV were 0-3 years old.4.4 Comparison by yearThe infection rate of RSV, FV and ADV in 2005 were 4.00%,0.54% and 7.11%,respectivey, each two of them had significantly difference(P<0.05).The infection rate of RSV, FV and ADV in 2006 were 8.92%,3.30% and 6.71%, respectivey,each two of them had significantly difference(P<0.05). The infection rate of RSV, FV and ADV in 2007 were 8.85%,2.14% and 4.31%,respectivey,each two of them had significantly difference(P<0.05)4.5 Comparison by seasonThe infection rate for RSV,FV and ADV in spring was 11.17%,2.21% and 5.31%,respectively,each two of them had significant difference(between RSV and FV:χ2=285.786, P=0.000;between RSV and ADV:χ2=100.644, P=0.000;between ADV and FV:χ2=59.246,P=0.000. The infection rate of RSV,FV and ADV in summer was 6.32%,2.71% and 5.98%,respectively. And the infection rate between RSV and FV(χ2=52.282,P=0.000),ADV and FV(χ2=44.349,P=0.000)both had signifficant difference(P<0.05).The infection rate of RSV,FV and ADV in autumn was 3.54%,1.27% and 5.73%,respectively. Each of them had significant difference (RSV and FV:χ2=27.514,P=0.000; RSV and ADV:χ2=13.614,P=0.000;FV and ADV:χ2=73.860,P=0.000;The infection rate of RSV,FV and ADV in winter was 5.57%,1.01% and 8.44%,respectively, each of them had significant difference(RSV and FV:χ2=57.937,P=0.000;RSV and ADV:χ2=11.263, P=0.001;FV and ADV:χ2=108.857,P=0.000).5)The infection rate of RSV,FV and ADV in 2005 was 4.00%,0.54% and 7.11%,respectively; in 2006 was 8.92%,3.30% and 6.71%,respectively; in 2007 was 8.85%,2.14% and 4.31%,respectively.Each of them in the three years were different significantly(P<0.05).4.6 Comparison by the severe casesSevere pneumonia incidence rates of RSV, FV and ADV were 7.64%,4.96% and 3.53%,respectively. Severe pneumonia incidence rates between RSV and ADV had significantly difference (χ2=12.582, P=0.000), while which between RSV and FV, between FV and ADV had no significantly difference (P> 0.05). As for RSV, FV and ADV, severe pneumonia in children aged 0-3 were 100%,100% and 96.15%, respectively. Comprehensive treatments with antibiotics, ribavirin, inhaled bronchodilators, systemic hormones, intravenous immunoglobulin and mechanical ventilatory support had good therapeutic effect to severe RSV, FV and ADV infected hospitalized pneumonia children.CONCLUSIONSClinical features of RSV,FV and ADV infected hospitalized pneumonia children in Guangzhou Children's Hospital in 2005-2007 were analyzed in this paper, results were as follows:1.RSV, FV, and ADV were all common pathogens of hospitalized pneumonia children,and RSV-was the most common pneumonia cause of the three viruses.2.Infection rates of the male of RSV, FV and ADV pneumonia cases were 7.53%,2.08% and 5.21%,respectively. For female of them were 7.12%,1.78% and 7.92%, respectively. RSV was the most important pneumonia causes of the three viruses for the male, and FV was the least important pneumonia causes of the three viruses for the female. Male to female ratio of RSV, FV and ADV pneumonia cases were 2.37:1,2.61:1 and 1.47:1,respectively.For three of them, the male cases were all more than the female.3.RSV was the most common causes in 0-1 age stages of the three viruses, and ADV were the most common causes in 3-6 and 6-14 age stages. Pneumonia case of 0-3 years old occupied 92.91%,74.79% and 68.52% of all the RSV, FV and ADV cases, respectively, were the common peak infected age stages for all of the three viruses.4. RSV was the most common causes in spring of the three viruses, and ADV were the most common causes in autumn and winter. Pneumonia cases in spring and summer occupied 79.18%,79.34% and 60.11% cases of RSV, FV and ADV pneumonia cases, respectively, were the common peak seasons for the three viruses.5.RSV was the most common causes in spring of the three viruses in 2006 and 2007, however, ADV were the most common causes in 2005.6. Severe pneumonia cases incidence rates of RSV, FV and ADV were 7.64%,4.96% and 3.53%,respectively. Cases of 0-3 years old occupied 100%,100% and 96.25% of severe pneumonia cases of RSV, FV and ADV infected pneumonia cases, respectively. Complex treat had functions to RSV, FV and ADV infected pneumonia cases.In conclusion, this study suggests that prevention and therapy works for RSV, FV and ADV infected childhood pneumonia in Guangzhou should be focused on age stage of 0-3 years old, particularly boys; and should also be focused on seasons of March-August and be adjusted in different years to the epidemic circumstances of the year. Severe pneumonia cases caused by the three viruses musted mostly in 0-3 year old children and these severe pneumonia cases should be complex treated.
|
PDF Full Text Request