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中国循证儿科杂志

中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (5): 338-343.

• 论著 • 上一篇    下一篇

云南省瑞丽市新型冠状病毒感染/肺炎成人和儿童本土病例的流行病学及临床特征

杨艳娟1a,3, 魏晓娴1b,3, 郑冉2, 杨露1a, 段海仙1a, 尹兆青1a   

  1. 1 云南省德宏州人民医院 芒市，678400，a儿科，b呼吸内科；2 《中国循证儿科杂志》编辑部 上海，201102；3 共同第一作者
  • 收稿日期:2021-10-16 修回日期:2021-10-21 出版日期:2021-10-25 发布日期:2021-10-25
  • 通讯作者: 尹兆青

Analysis of epidemiological and clinical characteristics of local COVID-19 cases of adults and children in Ruili City, Yunnan Province

YANG Yanjuan1a,3,WEI Xiaoxian1b,3,ZHENG Ran2,YANG Lu1a,DUAN Haixian1a,YIN Zhaoqing1a   

  1. 1 People's Hospital of Dehong Prefecture, a. Department of Pediatrics,b.Department of Respiratory Medicine,Mangshi 678400, China; 2 Chinese Journal of Evidence-Based Pediatrics,Shanghai 201102, China; 3 Co-first author
  • Received:2021-10-16 Revised:2021-10-21 Online:2021-10-25 Published:2021-10-25
  • Contact: YIN Zhaoqing

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摘要： 背景：2021年3月和7月云南省瑞丽市发生了2次境外输入病例导致的新型冠状病毒（SARS-CoV-2）感染的局部疫情，而且国内不断有输入病例导致的局部疫情出现。 目的：探讨SARS-CoV-2感染的成人与儿童本土病例流行病学及临床特征，为预防和治疗SARS-CoV-2感染提供借鉴。 设计：病例系列报告。 方法：回顾性收集云南省瑞丽市SARS-CoV-2感染病例定点医院（中医傣医医院）2021年3月29日至4月30日（简称3月疫情，SARS-CoV-2）和2021年7月4~31日［简称7月疫情，新型冠状病毒德尔塔变异株（Delta-CoV）］收治的由输入病例感染的成人和儿童本土病例，采集人口学、流行病学史和临床特征资料。 结果：成人和儿童病例分别为192例（3月和7月疫情分别为112例和80例）和16例（3月和7月疫情分别为5例和11例）；①儿童病例均未接种疫苗，成人仅7月疫情期间15例（18.8%）接种1剂型疫苗，19例接种了2剂型疫苗第1剂，14例（17.5%）接种了第2剂；②成人和儿童通过流行病学调查为密接者3月疫情分别为3.6%和40.0%，7月疫情分别为20.2%和54.5%，P＜0.05。③2次疫情成人和儿童病例无危重型和死亡病例，成人以轻型和普通型为主，儿童以无症状感染、轻型和普通型为主。④成人有基础疾病3月和7月疫情分别为17.0%和13.8%，P＜0.05；7月疫情儿童基础疾病1例为乙肝。⑤7月疫情成人发热病例（41.2%）较3月疫情（15.2%）占比高，P＜0.05，7月疫情儿童发热病例45.4%。⑥成人7月疫情较3月疫情乏力和咽部不适占比更高，儿童以咳嗽和咽部不适为主。⑦成人淋巴细胞减少病例7月疫情较3月疫情占比更高，P＜0.05，儿童仅在7月疫情出现1例；成人病例LDH、ALT、AST、CRP和D-二聚体升高者占比7月疫情均高于3月疫情，儿童仅在7月疫情 LDH、AST、CRP和D-二聚体升高各2例（18.2%）。⑧儿童肺部CT以双肺多发磨玻璃影、浸润影为主，成人病例还表现为以肺外带多发小斑片影及间质改变。⑨2次疫情儿童无氧疗病例，成人氧疗时间7月疫情（150 h）较3月疫情（96 h）更长；2次疫情成人连续二次核酸转阴时间接近(19 d vs 22 d)，儿童病例7月疫情（32 d）较3月疫情（15 d）更长，P＜0.05。 结论：Delta-CoV较SARS-CoV-2感染的成人和儿童本土病例临床表现更重；儿童较成人病例临床表现轻，但核酸转阴时间较成人明显延长；Delta-CoV流行期间，成人病例36.3%完成了疫苗接种。

关键词: 儿童, 新型冠状病毒, 新型冠状病毒德尔塔变异株, 流行病学, 临床特征, 临床特征

Abstract: Background: In March and July of 2021, there were two outbreaks of COVID-19 epidemic in Ruili City, Yunnan Province and there were continuous reports in China of imported infection cases from other countries or regions. Objective: To explore the epidemiological and clinical characteristics of local COVID-19 cases of adults and children and provide reference for the prevention and treatment of COVID-19. Design: Case series report. Methods: We retrospectively collected the local cases of adults and children infected by imported cases, admitted to Chinese Medicine and Dai Medical Hospital,a designated hospital for COVID-19 in Ruili City, from March 29 to April 30 (referred to as 3-29, SARS-CoV-2) and from July 4 to July 31 (referred to as 7-4, delta-CoV).Demographic, epidemiological history and clinical characteristics data of these cases were collected. Results: A total of 208 cases were included with 192 adults cases (3-29: 112 cases, 7-4: 80 cases) and 16 children (3-29: 5 cases, 7-4: 11 cases). None of the children were vaccinated. For adults, there were 15 cases (7-4, 18.8%) for 1 dose of vaccine, 19 cases for the first dose, and 14 cases (17.5%) for the second dose. According to epidemiological surveys, among 3-29 and 7-4 adults and children, close contacts accounted for 3.6% and 40.0%, and 20.2% and 54.5%, respectively. There were no critical or fatal cases in adults and children during these two outbreaks. Adults were mainly mild and common types, and children were mainly asymptomatic infections, mild and common types. 3-29 adults with underlying disease (17.0%) accounted for a higher proportion than those of 7-4 (13.8%), and there was 1 child(7-4) with the underlying disease of hepatitis B. Fever cases of 7-4 adults (41.2%) accounted for a higher proportion than those of 3-29 (15.2%), and children fever cases accounted for 45.4% in 7-4. There was a higher proportion of fatigue and pharyngeal discomfort in 7-4 adults than that of 3-29, and children mainly had cough and pharyngeal discomfort. The number of adult cases of lymphopenia in 7-4 adults was more than that of 3-29, and only one child case of lymphopenia was found in the group of 7-4. The proportion of adults with elevated LDH, ALT, AST, CRP and D-dimer was higher in the group of 7-4 than that of 3-29, and for children there were 2 cases (7-4) in elevated LDH, AST, CRP and D-dimer respectively, accounting for 18.2%. CT scan showed that children were mainly characterized by multiple ground-glass shadows and infiltration shadows in both lungs. In addition, adult cases also showed multiple small patch shadows and interstitial changes outside the lungs. No children received oxygen therapy. The oxygen therapy time for 7-4 and 3-29 adults was 150 h and 96 h, respectively. The time for nucleic acid test results turning negative was close (19 d vs 22 d) in the adults during the two outbreaks, while for children, the time for 7-4 (32 d) was longer that of 3-29 (15 d). Conclusion: The clinical manifestations of local adults and children infected by delta-CoV were more severe than those infected by SARS-CoV-2. The clinical manifestations of adult cases were more severe than that of children. The time for nucleic acid test results turning negative was shorter in children compared with adults. During the epidemic of delta-CoV, the proportion of vaccine breakthrough infections in 7-4 adults was up to 36.3%.

Key words: Children, SARS-CoV-2, Delta-CoV, Epidemiology, clinical features., Clinical characteristic