目的 分析亲子病房收治模式下，家庭聚集性感染Omicron变异株的儿童及其家属的临床特点及转归。 方法 回顾性收集上海市第六人民医院新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）定点医院于2022年4月8日至5月10日收治确诊的感染Omicron变异株患儿190例及其家属190例的临床资料，进行分析总结。 结果 儿童组和成人组均以轻型为主，儿童组轻型比例高于成人组（P<0.05）；2组临床表现均以上呼吸道症状为主，儿童组发热、腹痛腹泻、喘息发生率高于成人组（P<0.05），鼻塞流涕咳嗽、咽干咽痒咽痛发生率低于成人组（P<0.05）；成人组治疗连花清瘟颗粒/小儿豉翘清热颗粒、中药汤剂、重组人干扰素α2b喷雾剂、止咳化痰药、奈玛特韦/利托那韦片使用率均高于儿童组（P<0.05）；儿童组疫苗接种率（30.5%）较成人组（71.1%）低（P<0.001），而儿童组严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）核酸阳性持续时间短于成人组（P<0.05）。2组临床轻型者SARS-CoV-2核酸阳性持续时间短于普通型者（P<0.05）。2组有基础疾病者SARS-CoV-2核酸阳性持续时间长于无基础疾病者（P<0.05）。 结论 家庭聚集性Omicron变异株感染儿童和成人的临床分型均以轻型为主。尽管儿童疫苗接种率较低，但在亲子病房收治模式中，疾病恢复较快，SARS-CoV-2核酸阳性持续时间短于成人。
Abstract
Objective To study the clinical features and prognosis of children and their family members with family clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection under the admission mode of parent-child ward. Methods A retrospective analysis was performed on the medical data of 190 children and 190 family members with SARS-CoV-2 Omicron variant infection who were admitted to Shanghai Sixth People's Hospital, the designated hospital for coronavirus disease 2019 (COVID-19), April 8 to May 10, 2022. Results Both the child and adult groups were mainly mild COVID-19, and the proportion of mild cases in the child group was higher than that in the adult group (P<0.05). Respiratory symptoms were the main clinical manifestations in both groups. Compared with the adult group, the child group had higher incidence rates of fever, abdominal pain, diarrhea, and wheezing (P<0.05) and lower incidence rates of nasal obstruction, runny nose, cough, dry throat, throat itching, and throat pain (P<0.05). Compared with the child group, the adult group had higher rates of use of Chinese patent drugs, traditional Chinese medicine decoction, recombinant interferon spray, cough-relieving and phlegm-eliminating drugs, and nirmatrelvir/ritonavir tablets (P<0.05). Compared with the adult group, the child group had a lower vaccination rate of SARS-CoV-2 vaccine (30.5% vs 71.1%, P<0.001) and a shorter duration of positive SARS-CoV-2 nucleic acid (P<0.05). The patients with mild COVID-19 had a shorter duration of positive SARS-CoV-2 nucleic acid than those with common COVID-19 in both groups (P<0.05). The patients with underlying diseases had a longer duration of positive SARS-CoV-2 nucleic acid than those without such diseases in both groups (P<0.05). Conclusions Both children and adults with family clusters of SARS-CoV-2 Omicron variant infection manifest mainly mild COVID-19. Despite lower vaccination rate of SARS-CoV-2 vaccine in children, they have rapid disease recovery, with a shorter duration of positive SARS-CoV-2 nucleic acid than adults, under the admission mode of parent-child ward.
关键词
新型冠状病毒肺炎 /
Omicron变异株 /
家庭聚集性感染 /
临床特点 /
儿童
Key words
Coronavirus disease 2019 /
Omicron variant /
Family cluster infection /
Clinical feature /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction[J]. BMJ, 2020, 368: m1036. PMID: 32165426. DOI: 10.1136/bmj.m1036.
2 蒋荣猛, 谢正德, 姜毅, 等. 儿童新型冠状病毒感染诊断、治疗和预防专家共识(第三版)[J]. 中华实用儿科临床杂志, 2021, 36(10): 721-732. DOI: 10.3760/cma.j.cn101070-20210226-00235.
3 Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster[J]. Lancet, 2020, 395(10223): 514-523. PMID: 31986261. PMCID: PMC7159286. DOI: 10.1016/S0140-6736(20)30154-9.
4 Maltezou HC, Magaziotou I, Dedoukou X, et al. Children and adolescents with SARS-CoV-2 infection: epidemiology, clinical course and viral loads[J]. Pediatr Infect Dis J, 2020, 39(12): e388-e392. PMID: 33031141. DOI: 10.1097/INF.0000000000002899.
5 中国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第九版)[J]. 国际流行病学传染病学杂志, 2022, 49(2): 73-80. DOI: 10.3760/cma.j.cn331340-20220325-00065.
6 Chia PY, Coleman KK, Tan YK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients[J]. Nat Commun, 2020, 11(1): 2800. PMID: 32472043. PMCID: PMC7260225. DOI: 10.1038/s41467-020-16670-2.
7 Ong SWX, Tan YK, Chia PY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient[J]. JAMA, 2020, 323(16): 1610-1612. PMID: 32129805. PMCID: PMC7057172. DOI: 10.1001/jama.2020.3227.
8 Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19[J]. JAMA, 2020, 323(18): 1837-1838. PMID: 32215590. DOI: 10.1001/jama.2020.4756.
9 Bikbov B, Bikbov A. Maximum incubation period for COVID-19 infection: do we need to rethink the 14-day quarantine policy?[J]. Travel Med Infect Dis, 2021, 40: 101976. PMID: 33476809. PMCID: PMC7816956. DOI: 10.1016/j.tmaid.2021.101976.
10 Qiu C, Deng Z, Xiao Q, et al. Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China[J]. J Med Virol, 2020, 92(10): 2027-2035. PMID: 32369217. PMCID: PMC7267432. DOI: 10.1002/jmv.25975.
11 World Health Organization. Antigen-detection in the diagnosis of SARS-CoV-2 infection: interim guidance, 6 October 2021[EB/OL]. (2021-10-06)[2022-03-05]. https://apps.who.int/iris/handle/10665/345948.
12 申昆玲, 尚云晓, 张国成, 等. α干扰素在儿科临床合理应用专家共识[J]. 中华实用儿科临床杂志, 2018, 33(17): 1301-1308. DOI: 10.3760/cma.j.issn.2095-428X.2018.17.006.
13 LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet][M]. Bethesda(MD): National Institute of Diabetes and Digestive and Kidney Diseases, 2012. PMID: 31643176.
14 中华中医药学会医院药学分会, 北京中医药学会人才培养工作委员会, 北京中医药大学临床药学重点专科联盟. 新型冠状病毒肺炎中药合理使用专家共识(第一版)[J]. 北京中医药, 2020, 39(7): 657-664. DOI: 10.16025/j.1674-1307.2020.07.002.
15 中国中药协会呼吸病药物研究专业委员会, 世界中医药学会联合会呼吸病专业委员会, 中国医药教育协会慢性气道疾病专业委员会. 中成药防治新型冠状病毒肺炎专家共识[J]. 中国中西医结合杂志, 2022, 42(3): 294-297. DOI: 10.7661/j.cjim.20220126.034.
16 Callaway E, Ledford H. How bad is Omicron? What scientists know so far[J]. Nature, 2021, 600(7888): 197-199. PMID: 34857948. DOI: 10.1038/d41586-021-03614-z.
17 Pulliam JRC, van Schalkwyk C, Govender N, et al. Increased risk of SARS-CoV-2 reinfection associated with emergence of Omicron in South Africa[J]. Science, 2022, 376(6593): eabn4947. PMID: 35289632. PMCID: PMC8995029. DOI: 10.1126/science.abn4947.
18 徐湘茹, 孙鼎, 曹敏, 等. 上海市4?264例无症状及轻型新冠病毒感染者临床特征及预后转归分析[J]. 中华危重病急救医学, 2022, 34(5): 449-453. PMID: 35728842. DOI: 10.3760/cma.j.cn121430-20220516-00490.
19 时艳艳, 卢燕鸣, 闫钢风, 等. 儿童新型冠状病毒Omicron株和肺炎支原体混合感染重症肺炎1例[J]. 中华儿科杂志, 2022, 60(6): 600-602. PMID: 35582946. DOI: 10.3760/cma.j.cn112140-20220430-00400.
20 Sharma RP, Gautam S, Sharma P, et al. Clinico epidemiological profile of Omicron variant of SARS CoV2 in Rajasthan[J]. medRxiv[Preprint]. (2022-02-13) [2022-03-29]. DOI: 10.1101/2022.02.11.22270698.
21 Bojkova D, Widera M, Ciesek S, et al. Reduced interferon antagonism but similar drug sensitivity in Omicron variant compared to Delta variant of SARS-CoV-2 isolates[J]. Cell Res, 2022, 32(3): 319-321. PMID: 35064226. PMCID: PMC8781709. DOI: 10.1038/s41422-022-00619-9.
22 Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children[J]. Pediatr Infect Dis J, 2020, 39(5): 355-368. PMID: 32310621. PMCID: PMC7158880. DOI: 10.1097/INF.0000000000002660.
23 吕莹, 袁伟, 施冬玲, 等. 2019新型冠状病毒奥密克戎变异株感染者的临床特征分析[J]. 中华传染病杂志, 2022, 40(5): 257-263. DOI: 10.3760/cma.j.cn311365-20220210-00044.
24 Brandal LT, MacDonald E, Veneti L, et al. Outbreak caused by the SARS-CoV-2 Omicron variant in Norway, November to December 2021[J]. Euro Surveill, 2021, 26(50): 2101147. PMID: 34915975. PMCID: PMC8728491. DOI: 10.2807/1560-7917.ES.2021.26.50.2101147.
25 Jansen L, Tegomoh B, Lange K, et al. Investigation of a SARS-CoV-2 B.1.1.529 (Omicron) variant cluster—Nebraska, November-December 2021[J]. MMWR Morb Mortal Wkly Rep, 2021, 70(5152): 1782-1784. PMID: 34968376. PMCID: PMC8736273. DOI: 10.15585/mmwr.mm705152e3.
26 王雪琳, 翟嘉, 邹映雪. 新型冠状病毒Omicron变异株感染患儿的临床特征及免疫效应分析[J]. 中华儿科杂志, 2022, 60(7): 671-675. PMID: 35750640. DOI: 10.3760/cma.j.cn112140-20220506-00417.
27 World Health Organization. WHO coronavirus disease (COVID-19) dashboard[EB/OL]. (2021-08-08)[2022-04-02]. https://dashboards-dev.sprinklr.com/.
28 Espenhain L, Funk T, Overvad M, et al. Epidemiological characterisation of the first 785 SARS-CoV-2 Omicron variant cases in Denmark, December 2021[J]. Euro Surveill, 2021, 26(50): 2101146. PMID: 34915977. PMCID: PMC8728489. DOI: 10.2807/1560-7917.ES.2021.26.50.2101146.
29 Maslo C, Friedland R, Toubkin M, et al. Characteristics and outcomes of hospitalized patients in South Africa during the COVID-19 Omicron wave compared with previous waves[J]. JAMA, 2022, 327(6): 583-584. PMID: 34967859. PMCID: PMC8719272. DOI: 10.1001/jama.2021.24868.
30 Gold JAW, Wong KK, Szablewski CM, et al. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19—Georgia, March 2020[J]. MMWR Morb Mortal Wkly Rep, 2020, 69(18): 545-550. PMID: 32379729. PMCID: PMC7737948. DOI: 10.15585/mmwr.mm6918e1.
31 薛凤霞, 申昆玲. 5岁以下儿童新型冠状病毒感染的免疫预防最新进展[J]. 中华实用儿科临床杂志, 2022, 37(14): 1041-1045. DOI: 10.3760/cma.j.cn101070-20220705-00824.
32 U.S. Food and Drug Administration. Coronavirus (COVID-19) update: FDA authorizes Moderna and Pfizer-BioNTech COVID-19 vaccines for children down to 6 months of age[EB/OL]. (2022-06-17)[2022-06-27]. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-covid-19-vaccines-children.
33 Opel DJ, Diekema DS, Ross LF. Should we mandate a COVID-19 vaccine for children?[J]. JAMA Pediatr, 2021, 175(2): 125-126. PMID: 32926083. DOI: 10.1001/jamapediatrics.2020.3019.
34 Jiehao C, Jin X, Daojiong L, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features[J]. Clin Infect Dis, 2020, 71(6): 1547-1551. PMID: 32112072. PMCID: PMC7108143. DOI: 10.1093/cid/ciaa198.
35 Yan G, Zhou J, Zhu H, et al. The feasibility, safety, and efficacy of Paxlovid treatment in SARS-CoV-2-infected children aged 6-14 years: a cohort study[J]. Ann Transl Med, 2022, 10(11): 619. PMID: 35813342. PMCID: PMC9263777. DOI: 10.21037/atm-22-2791.
基金
2022年度抗击新型冠状病毒肺炎疫情应急专题项目（ynxg202213）。
PDF(591 KB)
