Broadening symptom criteria improves early case identification in SARS-CoV-2 contacts.
Broadening symptom criteria improves early case identification in SARS-CoV-2 contacts.
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DOI：
10.1183/13993003.02308-2021
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发表时间：
2022-07
期刊：
影响因子：
--
通讯作者：
Lalvani A
中科院分区：
文献类型：
--
作者：
Houston H;Hakki S;Pillay TD;Madon K;Derqui-Fernandez N;Koycheva A;Singanayagam A;Fenn J;Kundu R;Conibear E;Varro R;Cutajar J;Quinn V;Wang L;Narean JS;Tolosa-Wright MR;Barnett J;Kon OM;Tedder R;Taylor G;Zambon M;Ferguson N;Dunning J;Deeks JJ;Lalvani A
控制严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 传播的病例隔离和接触者追踪能否成功取决于病例识别的准确性和速度。我们评估了在三种典型症状（CS）（即发烧、咳嗽和嗅觉或味觉丧失或变化）的同时纳入其他症状是否可以改善病例定义并加速 SARS-CoV-2 接触者的病例识别。在暴露后 5 天内招募的两个基于伦敦（英国）社区 SARS-CoV-2 接触者的前瞻性纵向队列提供了独立的训练和测试数据集。感染和未感染的接触者从最早的时间点开始完成每日症状日记。通过将症状添加到 CS 中获得的诊断信息使用似然比和受试者工作特征曲线下面积进行量化。将灵敏度和检测时间的改进与测试所需的特异性和数量方面的惩罚进行比较。在两个队列的 529 名接触者中，有 164 人 (31%) 出现 PCR 确诊感染，365 人 (69%) 仍未感染。在训练数据集中 (n=168)，29% 的受感染接触者没有报告 CS。四种症状（喉咙痛、肌肉酸痛、头痛和食欲不振）被确定为早期预测因素 (EP)，这增加了 CS 的诊断价值。扩大的症状标准“≥1个CS，或≥2个EP”比“≥1个CS”在暴露后平均早2天（p=0.07）在测试数据集中识别出PCR阳性接触者，特异性仅略有下降（5.7%）。扩大症状标准，将患有至少两种肌肉疼痛、头痛、食欲不振和喉咙痛的个体纳入其中，可识别更多感染并缩短检测时间，从而为预防 SARS-CoV-2 传播提供更多机会。来自两个基于社区的前瞻性纵向队列的数据显示，扩大的症状标准可以识别更多的 SARS-CoV-2 感染，并缩短检测时间，同时将特异性降低最小化，从而为预防传播提供了更多机会。 https://bit.ly/3wRpMeW
The success of case isolation and contact tracing for the control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission depends on the accuracy and speed of case identification. We assessed whether inclusion of additional symptoms alongside three canonical symptoms (CS), i.e. fever, cough and loss or change in smell or taste, could improve case definitions and accelerate case identification in SARS-CoV-2 contacts. Two prospective longitudinal London (UK)-based cohorts of community SARS-CoV-2 contacts, recruited within 5 days of exposure, provided independent training and test datasets. Infected and uninfected contacts completed daily symptom diaries from the earliest possible time-points. Diagnostic information gained by adding symptoms to the CS was quantified using likelihood ratios and area under the receiver operating characteristic curve. Improvements in sensitivity and time to detection were compared with penalties in terms of specificity and number needed to test. Of 529 contacts within two cohorts, 164 (31%) developed PCR-confirmed infection and 365 (69%) remained uninfected. In the training dataset (n=168), 29% of infected contacts did not report the CS. Four symptoms (sore throat, muscle aches, headache and appetite loss) were identified as early-predictors (EP) which added diagnostic value to the CS. The broadened symptom criterion “≥1 of the CS, or ≥2 of the EP” identified PCR-positive contacts in the test dataset on average 2 days earlier after exposure (p=0.07) than “≥1 of the CS”, with only modest reduction in specificity (5.7%). Broadening symptom criteria to include individuals with at least two of muscle aches, headache, appetite loss and sore throat identifies more infections and reduces time to detection, providing greater opportunities to prevent SARS-CoV-2 transmission. Data from two prospective longitudinal community-based cohorts show broadened symptom criteria identify more SARS-CoV-2 infections and reduce time to detection with minimal reductions in specificity, providing greater opportunities to prevent transmission. https://bit.ly/3wRpMeW
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影响因子：
2
作者：
SPIEGELHALTER, DJ
通讯作者：
SPIEGELHALTER, DJ
DOI：
10.1016/j.jinf.2021.02.015
发表时间：
2021-03
期刊：
The Journal of infection
影响因子：
--
作者：
Antonelli M;Capdevila J;Chaudhari A;Granerod J;Canas LS;Graham MS;Klaser K;Modat M;Molteni E;Murray B;Sudre CH;Davies R;May A;Nguyen LH;Drew DA;Joshi A;Chan AT;Cramer JP;Spector T;Wolf J;Ourselin S;Steves CJ;Loeliger AE
通讯作者：
Loeliger AE
影响因子：
11.8
作者：
Bullard, Jared;Dust, Kerry;Poliquin, Guillaume
通讯作者：
Poliquin, Guillaume
DOI：
10.2307/2981737
发表时间：
1984-01-01
影响因子：
2
作者：
SPIEGELHALTER, DJ;KNILLJONES, RP
通讯作者：
KNILLJONES, RP
影响因子：
105.7
作者：
SEYMOUR, DG;GREEN, M;VAZ, FG
通讯作者：
VAZ, FG