jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2015-7-3-22-32jofin-417Research ArticleОбзорыReviewВирусные гастроэнтериты у детей: современные представления об эпидемиологии и профилактикеViral gastroenteritis in children: modern concepts of epidemiology and preventionЕрмоленкоК. Д.ErmolenkoK. D.

очный аспирант Научно-исследовательского института детских инфекций, научный сотрудник лаборатории иммунологии Санкт-Петербурского научно-исследовательского института эпидемиологии и микробиологии им. Пастера; тел.: +7-952-371-28-80; 8(812)234-60-40

kostyaermolenko@yandex.ruЛобзинЮ. В.LobzinYu. V.

директор Научно-исследовательского института детских инфекций, заведующий кафедрой инфекционных болезней Северо-Западного государственного медицинского университета им. И.И. Мечникова, д.м.н., профессор, академик РАН; тел.: 8(812)234-60-04

niidi@niidi.ruГончарН. В.GoncharN. V.

и.о. руководителя отдела кишечных инфекций, старший научный сотрудник Научно-исследовательского института детских инфекций, профессор кафедры педиатрии и неонатологии Северо-Западного государственного медицинского университета им. И.И. Мечникова, д.м.н., профессор; тел.: +7-921-369-32-97; 8(812)234-60-40

nvgonchar@yandex.ruНаучно-исследовательский институт детских инфекций, Санкт-Петербург, Россия Санкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии им. Пастера, Санкт-Петербург, РоссияРоссияScience Research Institute of Children’s Infections, Saint-Petersburg, Russia Saint-Petersburg Science Research Institute of Epidemiology and Microbiology named after Pasteur, Saint-Petersburg, RussiaRussian FederationНаучно-исследовательский институт детских инфекций, Санкт-Петербург, Россия Северо-Западный государственный медицинский университет им. И.И. Мечникова, Санкт-Петербург, РоссияРоссияScience Research Institute of Children’s Infections, Saint-Petersburg, Russia North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, RussiaRussian Federation201501112015732232Copyright © Ермоленко К.Д., Лобзин Ю.В., Гончар Н.В., 20152015Ермоленко К.Д., Лобзин Ю.В., Гончар Н.В.Ermolenko K.D., Lobzin Y.V., Gonchar N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/417

Проанализировано более 60 оригинальных статей и обзоров с целью изучения современного состояния вопросов эпидемиологии и профилактики острых кишечных инфекций (ОКИ) вирусной этиологии в мире. Интерес к проблеме вирусных ОКИ определяется их широчайшей распространённостью и огромными затратами, связанными с устранением их последствий. Известны как минимум 8 семейств вирусов, являющихся причиной развития острых гастроэнтеритов. В расширение представлений об эпидемиологии вирусных гастроэнтеритов существенный вклад внесла возрастающая доступность современных методов диагностики. Лидирующие позиции в этиологической диагностике вирусных диарей принадлежат полимеразной цепной реакции. Структура вирусных ОКИ в Российской Федерации сопоставима со среднестатистическими мировыми показателями. Наиболее значимыми по частоте возбудителями являются ротавирусы и норовирусы. В статье отражены современные тенденции в эпидемиологии острых вирусных диарейных заболеваний: особенности циркуляции доминирующих и редких серотипов ротавирусов в различных регионах; сезонные изменения доминирующих штаммов ротавирусов; увеличение частоты норовирусных гастроэнтеритов в структуре ОКИ и повышение летальности детей от норовирусной инфекции. Представлены данные о филогенетическом разнообразии норовирусов и особенностях циркуляции GI и GII генотипов. После введения массовой вакцинации против ротавирусов в развитых странах повышается доля астровирусной и аденовирусной инфекции в структуре ОКИ. Высокая частота астровирусной инфекции отмечается у лиц со сниженным иммунитетом. Заметен рост частоты смешанных вирусных и вирусно-бактериальных ассоциаций возбудителей, учащение регистрации ОКИ у детей, вызванных редко встречающимися вирусами и вирусами, поражающими животных. Приведены сведения об эффективности вакцинации от ротавирусов в различных регионах мира, о разработке новых вакцин для профилактики оровирусных гастроэнтеритов. Новые знания об эпидемиологических особенностях вирусных гастроэнтеритов будут способствовать разработке эффективных мер специфической профилактики, основанных на внедрении вакцинации против наиболее распространённых серогрупп возбудителей и применении вакцинных препаратов с высокой иммуногенностью.

More than 60 original articles and reviews were analyzed in order to study the current state of the epidemiology and prevention of acute intestinal infections (AII) of viral etiology in the world. Interest in a problem of viral AII is determined by their widest prevalence and huge costs associated with the elimination of their consequences. There are at least eight families of viruses that are the cause of acute gastroenteritis. The expansion of the ideas on the epidemiology of viral gastroenteritis has made a significant contribution to increasing the availability of modern diagnostic methods. Leading positions in the etiological diagnosis of viral diarrhea belong to the polymerase chain reaction. The structure of the viral AII in Russia is comparable with the average global rate. The most important frequency agents are rotaviruses and noroviruses. The article reflects the current trends in the epidemiology of acute viral diarrheal diseases: particularly dominant circulating serotypes of rotavirus and rare serotypes in various regions; seasonal changes of dominant strains of rotaviruses; increased frequency of norovirus gastroenteritis in the structure of the AII and increase mortality of children from norovirus infection. Presents data on the phylogenetic diversity of noroviruses and features of GI and GII circulation of genotypes. After the introduction of mass vaccination against rotaviruses in developed countries increases the share of astroviral and adenoviral infection in the structure of the AII. High frequency of astroviral infection is noticed in people with immunodeficiency. Much attention in article is paid to the increase in incidence and mortality of noroviruses, rise in detection rate of mixed viral and viral-bacterial associations and often registration of rare viruses and animal viruses in children. Presents data on the effectiveness of vaccination against rotaviruses in different regions of the world, the development of new vaccines for the prevention of norovirus gastroenteritis. New knowledge about the epidemiology of viral gastroenteritis will contribute to the development of effective  measures of specific preventive maintenance, based on the introduction of vaccination against the most common serogroups of pathogens and application of vaccines with high immunogenicity.

кишечные инфекциивирусные диареидетиротавирусыноровирусы диагностикаполимеразная цепная реакциявакцинацияintestinal infectionsviral diarrheachildrenrotavirusesnoroviruses diagnosispolymerase chain reactionvaccination.ReferencesWHO. World health statistics 2010. – WHO, 2010.WHO. World health statistics 2010. – WHO, 2010.Lanata CF, Fischer-Walker CL, Olascoaga AC. Child Health Epidemiology Reference Group of the World Health Organization and UNICEF Global causes of diarrheal disease mortality in children younger 5 years of age: a systematic review. PLoS One. 2013; 8(9): e72788.Lanata CF, Fischer-Walker CL, Olascoaga AC. Child Health Epidemiology Reference Group of the World Health Organization and UNICEF Global causes of diarrheal disease mortality in children younger 5 years of age: a systematic review. PLoS One. 2013; 8(9): e72788.Lozano R, Naghavi M, Foreman K. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380(9859): 2095-128.Lozano R, Naghavi M, Foreman K. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380(9859): 2095-128.Centers for Disease Control and Prevention (CDC) Rotavirus surveillance-worldwide, 2001-2008. MMWR. 2008; 57(46): 1255.Centers for Disease Control and Prevention (CDC) Rotavirus surveillance-worldwide, 2001-2008. MMWR. 2008; 57(46): 1255.Oh DY, Gaedicke G, Schreier E. Viral agents of acute gastroenteritis in German children: prevalence and molecular diversity. J of Med Virol. 2003; 71(1): 82-93.Oh DY, Gaedicke G, Schreier E. Viral agents of acute gastroenteritis in German children: prevalence and molecular diversity. J of Med Virol. 2003; 71(1): 82-93.Ahmed S.M., Hall AJ, Robinson AE. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infects Dis. 2014; 14(8): 725-30.Ahmed S.M., Hall AJ, Robinson AE. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infects Dis. 2014; 14(8): 725-30.Parashar UD, Hummelman EG, BreseeJS. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003; 9 (5); 565.Parashar UD, Hummelman EG, BreseeJS. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003; 9 (5); 565.De Bruin E, Duizer E, Vennema H, Koopmans MP. Diagnosis of Norovirus outbreaks by commercial ELISA or RTPCR. J Virol Meth. 2006; 137: 259.De Bruin E, Duizer E, Vennema H, Koopmans MP. Diagnosis of Norovirus outbreaks by commercial ELISA or RTPCR. J Virol Meth. 2006; 137: 259.Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New Engl J of Med. 2009; 361(18): 1776-85.Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New Engl J of Med. 2009; 361(18): 1776-85.Martínez MA, de los Dolores Soto-del M, Gutiérrez RM, et al. DNA microarray for detection of gastrointestinal viruses. J of Clin Microb. 2015; 53(1): 136-45.Martínez MA, de los Dolores Soto-del M, Gutiérrez RM, et al. DNA microarray for detection of gastrointestinal viruses. J of Clin Microb. 2015; 53(1): 136-45.Sachsenröder J, Braun A, Machnowska P, et al. Metagenomic identification of novel enteric viruses in urban wild rats and genome characterization of a group A rotavirus. J of Gener Virol. 2014; vir.0.070029-0.Sachsenröder J, Braun A, Machnowska P, et al. Metagenomic identification of novel enteric viruses in urban wild rats and genome characterization of a group A rotavirus. J of Gener Virol. 2014; vir.0.070029-0.Rospotrebnadzor Forma № 1, 2014.Rospotrebnadzor Forma № 1, 2014.KulichenkoTV, Bakradze MD, Patrusheva JuS. 2009; 3:102-9 (in Russian).KulichenkoTV, Bakradze MD, Patrusheva JuS. 2009; 3:102-9 (in Russian).Flahault A, Hanslik T. Epidemiology of viral gastroenteritis in France and Europe. Bull de l’Académie nationale de médecine. 2010; 194(8): 1415-24.Flahault A, Hanslik T. Epidemiology of viral gastroenteritis in France and Europe. Bull de l’Académie nationale de médecine. 2010; 194(8): 1415-24.Glass RI, Bresee J, Jiang B, Gentsch J, et al. Gastroenteritis viruses: an overview. Novartis Foundation Symposium. Chichester; New York: John Wiley; 1999, 2001: 5-25.Glass RI, Bresee J, Jiang B, Gentsch J, et al. Gastroenteritis viruses: an overview. Novartis Foundation Symposium. Chichester; New York: John Wiley; 1999, 2001: 5-25.Patel MM, Steele D, Gentsch JR, et al. Real-world impact of rotavirus vaccination. The Pediatr Infect Dis J. 2011; 30(1): S1-5.Patel MM, Steele D, Gentsch JR, et al. Real-world impact of rotavirus vaccination. The Pediatr Infect Dis J. 2011; 30(1): S1-5.Chiba S, Estes MK, Nakata S, Calisher CH. Viral gastroenteritis. Springer Science & Business Media. 2012; Vol. 2.Chiba S, Estes MK, Nakata S, Calisher CH. Viral gastroenteritis. Springer Science & Business Media. 2012; Vol. 2.Nataro JP. Hot Topics in Infection and Immunity in Children. Springer: New York, 2013; IX: Diarrhea among children in developing countries: 73-80.Nataro JP. Hot Topics in Infection and Immunity in Children. Springer: New York, 2013; IX: Diarrhea among children in developing countries: 73-80.Lanata CF, Walker CL, Olascoaga AC, et al. Child Health Epidemiology Reference Group of the World Health Organization and UNICEF. Global causes of diarrheal disease mortality in children younger 5 years of age: a systematic review. PLoS One. 2013; 8 (9): 72788.Lanata CF, Walker CL, Olascoaga AC, et al. Child Health Epidemiology Reference Group of the World Health Organization and UNICEF. Global causes of diarrheal disease mortality in children younger 5 years of age: a systematic review. PLoS One. 2013; 8 (9): 72788.Luk’janova AM, Behtereva MK, Ptichnikova NN. Zhurnal infektologii. – 2014; 6(1): 60-6 (in Russian).Luk’janova AM, Behtereva MK, Ptichnikova NN. Zhurnal infektologii. – 2014; 6(1): 60-6 (in Russian).Das JK, Salam RA, Bhutta ZA. Global burden of childhood diarrhea and interventions. Currt Opin in Infect Dis. 2014; 27(5), 451-8.Das JK, Salam RA, Bhutta ZA. Global burden of childhood diarrhea and interventions. Currt Opin in Infect Dis. 2014; 27(5), 451-8.World Health Organization (2011) Rotavirus surveillance worldwide – 2009; WHO weekly epidemiol record 86: 174–76.World Health Organization (2011) Rotavirus surveillance worldwide – 2009; WHO weekly epidemiol record 86: 174–76.Kirkwood CD, Roczo-Farkas S, Bishop RF, Barnes GL. Australian Rotavirus Surveillance Program annual report, 2012 // New South. 2013; 2: 10.Kirkwood CD, Roczo-Farkas S, Bishop RF, Barnes GL. Australian Rotavirus Surveillance Program annual report, 2012 // New South. 2013; 2: 10.Denisjuk NB. Zhurnal infektologii. 2015; 7(1): 31-8 (in Russian).Denisjuk NB. Zhurnal infektologii. 2015; 7(1): 31-8 (in Russian).Mandal S, Mandal MD. Is rotavirus gastroenteritis a global emerging / Re-Emerg Probl. Transl Med. 2014; 4(143): 2161-1025.1000143.Mandal S, Mandal MD. Is rotavirus gastroenteritis a global emerging / Re-Emerg Probl. Transl Med. 2014; 4(143): 2161-1025.1000143.De Donno A, Grassi T, Bagordo F. Emergence of unusual human rotavirus strains in Salento, Italy, during 2006– 2007. BMC Infect Dis. 2009; 9(1): 43.De Donno A, Grassi T, Bagordo F. Emergence of unusual human rotavirus strains in Salento, Italy, during 2006– 2007. BMC Infect Dis. 2009; 9(1): 43.Griffin DD, Kirkwood CD, Parashar UD, et al. Surveillance of rotavirus strains in the United States: identification of unusual strains. J of Clin Microbiol. 2000; 38(7): 278-7.Griffin DD, Kirkwood CD, Parashar UD, et al. Surveillance of rotavirus strains in the United States: identification of unusual strains. J of Clin Microbiol. 2000; 38(7): 278-7.Parra GI, Espínola EE, Amarilla AA, et al. Diversity of group A rotavirus strains circulating in Paraguay from 2002 to 2005: detection of an atypical G1 in South America. J of Clinl Virol. 2007; 40(2): 135-41.Parra GI, Espínola EE, Amarilla AA, et al. Diversity of group A rotavirus strains circulating in Paraguay from 2002 to 2005: detection of an atypical G1 in South America. J of Clinl Virol. 2007; 40(2): 135-41.Parra GI. Seasonal shifts of group A rotavirus strains as a possible mechanism of persistence in the human population. J of Med Virol. 2009; 81(3): 568-71.Parra GI. Seasonal shifts of group A rotavirus strains as a possible mechanism of persistence in the human population. J of Med Virol. 2009; 81(3): 568-71.Ch’ng LS, Lee WS, Kirkwood CD. Rare rotavirus strains in children with severe diarrhea, Malaysia. Emerg Infect Dis. 2011; 17(5): 948.Ch’ng LS, Lee WS, Kirkwood CD. Rare rotavirus strains in children with severe diarrhea, Malaysia. Emerg Infect Dis. 2011; 17(5): 948.Karst SM, Wobus CE, Goodfellow IG. Advances in norovirus biology. Cell host & microbe. 2014: 15(6): 668-80.Karst SM, Wobus CE, Goodfellow IG. Advances in norovirus biology. Cell host & microbe. 2014: 15(6): 668-80.Dennehy PH. Viral gastroenteritis in children. Pediatr Infect Dis J. 2011; 30(1): 63-4.Dennehy PH. Viral gastroenteritis in children. Pediatr Infect Dis J. 2011; 30(1): 63-4.Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New Engl J of Med. 2009; 361(18): 1776-85.Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New Engl J of Med. 2009; 361(18): 1776-85.Frenck R, Bernstein DI, Xia M. Predicting susceptibility to norovirus GII. 4 by use of a challenge model involving humans. J of Infect Dis. 2012: 514.Frenck R, Bernstein DI, Xia M. Predicting susceptibility to norovirus GII. 4 by use of a challenge model involving humans. J of Infect Dis. 2012: 514.Matthews JE, Dickey BW, Miller RD. The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup. Epidemiol and Infect. 2012; 140(7): 1161-72.Matthews JE, Dickey BW, Miller RD. The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup. Epidemiol and Infect. 2012; 140(7): 1161-72.Desai R, Hembree CD, Handel A, et al. Severe outcomes are associated with genogroup 2 genotype 4 norovirus 55:189-93.Desai R, Hembree CD, Handel A, et al. Severe outcomes are associated with genogroup 2 genotype 4 norovirus 55:189-93.Liu P, Wang X, Lee JC, et al. Genetic susceptibility to norovirus GII. 3 and GII.4 infections in Chinese pediatric diarrheal disease. Pediatr Infect Dis J. 2014; 33(11): e305-9.Liu P, Wang X, Lee JC, et al. Genetic susceptibility to norovirus GII. 3 and GII.4 infections in Chinese pediatric diarrheal disease. Pediatr Infect Dis J. 2014; 33(11): e305-9.Parashar UD, Li JF, Cama R, et al. Human caliciviruses as a cause of severe gastroenteritis in Peruvian children. J of Infect Dis. 2004; 190(6): 1088-92.Parashar UD, Li JF, Cama R, et al. Human caliciviruses as a cause of severe gastroenteritis in Peruvian children. J of Infect Dis. 2004; 190(6): 1088-92.Moyo S, Hanevik K, Blomberg B, et al. Genetic diversity of norovirus in hospitalized diarrhoeic children and asymptomatic controls in Dar es Salaam. Infect, Genet and Evol. 2014; 26: 340-7.Moyo S, Hanevik K, Blomberg B, et al. Genetic diversity of norovirus in hospitalized diarrhoeic children and asymptomatic controls in Dar es Salaam. Infect, Genet and Evol. 2014; 26: 340-7.De Wit MA, Koopmans MP, Kortbeek LM, et al. Gastroenteritis in sentinel general practices, The Netherlands. Emerg Infect Dis. 2001; 7(1): 82.De Wit MA, Koopmans MP, Kortbeek LM, et al. Gastroenteritis in sentinel general practices, The Netherlands. Emerg Infect Dis. 2001; 7(1): 82.Mason J, Iturriza-Gomara M, O’Brien SJ. Campylobacter infection in children in Malawi is common and is frequently associated with enteric virus co-infections. PloS One. 2013; 8(3): e59663.Mason J, Iturriza-Gomara M, O’Brien SJ. Campylobacter infection in children in Malawi is common and is frequently associated with enteric virus co-infections. PloS One. 2013; 8(3): e59663.Friesema IHM, De Boer RF, Duizer E. Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands. Europ J of Clin Microb & Infect Dis. 2012; 31(4): 405-15.Friesema IHM, De Boer RF, Duizer E. Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands. Europ J of Clin Microb & Infect Dis. 2012; 31(4): 405-15.Chhabra P, Payne DC, Szilagyi PG. Etiology of viral gastroenteritis in children younger 5 years of age in the United States, 2008–2009. J of Infect Dis. 2013; 208(5): 790-800.Chhabra P, Payne DC, Szilagyi PG. Etiology of viral gastroenteritis in children younger 5 years of age in the United States, 2008–2009. J of Infect Dis. 2013; 208(5): 790-800.World Health Organization. Rotavirus vaccines. WHO position paper – January, 2013. Wkly Epidemiol Rec. 2013; 88: 49-64World Health Organization. Rotavirus vaccines. WHO position paper – January, 2013. Wkly Epidemiol Rec. 2013; 88: 49-64Bhan A, Green SK. Balancing safety, efficacy and cost: Improving rotavirus vaccine adoption in low-and middleincome countries. J Glob Health. 2011; 1:148-53.Bhan A, Green SK. Balancing safety, efficacy and cost: Improving rotavirus vaccine adoption in low-and middleincome countries. J Glob Health. 2011; 1:148-53.Widdowson MA, Meltzer MI, Zhang X. Cost-effectiveness and potential impact of rotavirus vaccination in the United States. Pediatrics. 2007; 119(4): 684-97.Widdowson MA, Meltzer MI, Zhang X. Cost-effectiveness and potential impact of rotavirus vaccination in the United States. Pediatrics. 2007; 119(4): 684-97.Simmons K, Gambhir M, Leon J, Lopman B. Duration of immunity to norovirus gastroenteritis. Emerg Infect Dis. 2013; 19(8): 1260.Simmons K, Gambhir M, Leon J, Lopman B. Duration of immunity to norovirus gastroenteritis. Emerg Infect Dis. 2013; 19(8): 1260.Blazevic V, Lappalainen S, Nurminen K. Norovirus VLPs and rotavirus VP6 protein as combined vaccine for childhood gastroenteritis. Vaccine. 2011; 29(45): 8126-33.Blazevic V, Lappalainen S, Nurminen K. Norovirus VLPs and rotavirus VP6 protein as combined vaccine for childhood gastroenteritis. Vaccine. 2011; 29(45): 8126-33.

The authors declare that there are no conflicts of interest present.