Abstract
As a cause of vulvovaginitis in prepubertal girls, Streptococcus pyogenes (S. pyogenes) is commonly isolated from vaginal introitus swabs. Studies have identified several risk factors, but have not focused on the correlation between ambient air pollutants and S. pyogenes-induced vulvovaginitis in prepubertal girls. This study was conducted to determine whether ambient air pollutants were associated with S. pyogenes-induced vulvovaginitis in prepubertal girls. Daily data about S. pyogenes-induced vulvovaginitis in prepubertal girls from the outpatient department of Children’s Hospital at the Zhejiang University School of Medicine in Hangzhou City between January 1, 2015, and December 31, 2018, were retrospectively reviewed. Ambient air pollutants in Hangzhou were measured daily. A generalized additive model (GAM) was utilized to assess the associations between daily air pollutants and S. pyogenes isolates obtained from vaginal introitus swabs of prepubertal girls. The mean daily concentration of nitrogen dioxide (NO2) in Hangzhou City during the study period was 44.6 μg/m3 (25th–75th percentiles, 32.0–56.0 μg/m3). The GAM showed that the largest estimate effects in S. pyogenes-induced vulvovaginitis in prepubertal girls were found in NO2 with a moving (accumulative) average on day 3. The excess risk of NO2 in terms of the daily number of S. pyogenes isolates obtained from the vaginal introitus swabs was 14.91% (95% confidence interval [CI]: 4.85–25.94%) in the single-pollutant model. The multipollutant model revealed that an increase of 10 μg/m3 in NO2 exposure was associated with an 18.33% increased risk for acquiring S. pyogenes-induced vulvovaginitis in prepubertal girls (95% CI: 1.21–38.35%; P < 0.05). In conclusion, short-term NO2 exposure was strongly associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls.
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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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CF takes responsibility for conception and writing the manuscript. ZZ takes responsibility for analysis of data. MZ contributed to acquisition and interpretation of data. JL and XC take responsibility for reviewing and editing the manuscript. All authors read and approved the final manuscript.
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This work was approved by the ethics committee of the Children’s Hospital, Zhejiang University School of Medicine, China (2019-IRB-074). The requirement of informed consent was waived, because anonymized and de-identified data collected from medical and laboratory records were used.
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Fang, C., Zhou, Z., Li, J. et al. Short-term nitrogen dioxide exposure is associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls in Hangzhou, China. Environ Sci Pollut Res 28, 35790–35797 (2021). https://doi.org/10.1007/s11356-021-13268-z
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DOI: https://doi.org/10.1007/s11356-021-13268-z