Burden of SARS-CoV-2 and protection from symptomatic second infection in children.
Burden of SARS-CoV-2 and protection from symptomatic second infection in children.
复制标题
SARS-CoV-2 的负担以及儿童免受有症状的二次感染的保护。
DOI：
10.1101/2022.01.03.22268684
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Cerpas,Cr
中科院分区：
文献类型：
--
作者：
Kubale,John;Balmaseda,Angel;Frutos,AaronM;Sanchez,Nery;Plazaola,Miguel;Ojeda,Sergio;Saborio,Saira;Lopez,Roger;Barilla,Carlos;Vasquez,Gerald;Moreira,Hanny;Gajewski,Anna;Campredon,Lora;Maier,Hannah;Chowdhury,Mahboob;Cerpas,Cr
重要性 SARS-CoV-2 大流行对儿童的影响仍不清楚。更好地了解儿童中 COVID-19 的负担及其防止再次感染的保护至关重要，因为他们将是最后接种疫苗的群体之一。目的 描述 COVID-19 负担的特征，并评估针对儿童症状性再次感染的保护措施如何因年龄而异。设计 一项前瞻性、基于社区的儿科队列研究，于 2020 年 3 月 1 日至 2021 年 10 月 15 日进行。 设置 尼加拉瓜儿科流感队列是尼加拉瓜马那瓜第 2 区的一个基于社区的队列。参与者 共有 1964 名 0-14 岁的儿童参与了该队列。非免疫功能低下的儿童是从之前的儿童流感队列中随机选择的。每月通过家访随机选择其他年龄≤4周的新生儿并入组。暴露 经阳性抗 SARS-CoV-2 抗体（受体结合域 [RBD] 和刺突蛋白）或实时 RT-PCR 确认的既往 COVID-19 感染，在当前 COVID-19 之前 ≥60 天确诊为 COVID-19 感染。主要成果和措施 通过实时 RT-PCR 确诊有症状的 COVID-19 病例，并在确诊的 COVID-19 病例出现症状 28 天内住院。结果 总体而言，在研究过程中，49.8% 的受测儿童血清呈阳性。还有 207 例 PCR 确诊的 COVID-19 病例，其中 12 例（6.4%）病情严重需要住院治疗。 COVID-19 的发病率在 2 岁以下儿童中最高，每 100 人年有 16.1 例（95% 置信区间 [CI]：12.5，20.5），大约是所评估的任何其他年龄组儿童的三倍。此外，41 例 (19.8%) 有症状的 SARS-CoV-2 发作是再次感染，年龄较小的儿童对有症状的再次感染的保护程度稍高。在6-59个月的儿童中，保护率为61%（比率[RR]：0.39，95% CI：0.2、0.8），而在5-9岁和10-14岁儿童中的保护率分别为64%（RR：0.36、0.2、0.7）和49%（RR：0.51、0.3-0.9）。结论和相关性 在这一基于社区的前瞻性儿科队列中，最年轻的参与者中，有症状和严重的 COVID-19 发病率最高，发病率稳定在 5 岁左右。再感染占 PCR 阳性病例的很大一部分，10 岁以下的儿童表现出更好的预防有症状再感染的能力。迫切需要针对 5 岁以下儿童的疫苗。
Importance The impact of the SARS-CoV-2 pandemic on children remains unclear. Better understanding of the burden of COVID-19 among children and their protection against re-infection is crucial as they will be among the last groups vaccinated. Objective To characterize the burden of COVID-19 and assess how protection from symptomatic re-infection among children may vary by age. Design A prospective, community-based pediatric cohort study conducted from March 1, 2020 through October 15, 2021. Setting The Nicaraguan Pediatric Influenza Cohort is a community-based cohort in District 2 of Managua, Nicaragua. Participants A total of 1964 children aged 0–14 years participated in the cohort. Non-immunocompromised children were enrolled by random selection from a previous pediatric influenza cohort. Additional newborn infants aged ≤4 weeks were randomly selected and enrolled monthly, via home visits. Exposures Prior COVID-19 infection as confirmed by positive anti SARS-CoV-2 antibodies (receptor binding domain [RBD] and spike protein) or real time RT-PCR confirmed COVID-19 infection ≥60 days prior to current COVID-19. Main Outcomes and Measures Symptomatic COVID-19 cases confirmed by real time RT-PCR and hospitalization within 28 days of symptom onset of confirmed COVID-19 case. Results Overall, 49.8% of children tested were seropositive over the course of the study. There were also 207 PCR-confirmed COVID-19 cases, 12 (6.4%) of which were severe enough to require hospitalization. Incidence of COVID-19 was highest among children aged <2 years—16.1 per 100 person-years (95% Confidence Interval [CI]: 12.5, 20.5)—approximately three times that of children in any other age group assessed. Additionally, 41 (19.8%) symptomatic SARS-CoV-2 episodes were re-infections, with younger children slightly more protected against symptomatic reinfection. Among children aged 6–59 months, protection was 61% (Rate Ratio [RR]:0.39, 95% CI:0.2,0.8), while protection among children aged 5–9 and 10–14 years was 64% (RR:0.36,0.2,0.7), and 49% (RR:0.51,0.3–0.9), respectively. Conclusions and Relevance In this prospective community-based pediatric cohort rates of symptomatic and severe COVID-19 were highest among the youngest participants, with rates stabilizing around age 5. Reinfections represent a large proportion of PCR-positive cases, with children <10 years displaying greater protection from symptomatic reinfection. A vaccine for children <5 years is urgently needed.