Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2.
Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2.
复制标题
DOI：
10.1016/s2352-4642(21)00198-x
复制
发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Duncan EL
中科院分区：
文献类型：
--
作者：
Molteni E;Sudre CH;Canas LS;Bhopal SS;Hughes RC;Antonelli M;Murray B;Kläser K;Kerfoot E;Chen L;Deng J;Hu C;Selvachandran S;Read K;Capdevila Pujol J;Hammers A;Spector TD;Ourselin S;Steves CJ;Modat M;Absoud M;Duncan EL
在儿童中，SARS-CoV-2感染通常无症状或引起短暂的轻度疾病。据报道，有持续性疾病，但其患病率和特征尚不清楚。我们的目的是使用COVID症状研究的数据来确定有症状的英国学龄儿童接受SARS-CoV-2检测的疾病持续时间和特征，该研究是迄今为止英国最大的公民参与流行病学研究之一。在这项前瞻性队列研究中，来自英国学龄儿童（5-17岁）的数据由成人代理报告。参与者是自愿的，并使用由Zoe Limited和伦敦国王学院联合推出的移动的应用程序（app）。对SARS-CoV-2检测呈阳性的儿童的疾病持续时间和症状患病率、持续时间和负担进行了分析，并对总体和年轻（5-11岁）和老年（12-17岁）组进行了评估。应用程序上症状报告间隔超过1周的儿童被排除在分析之外。还评估了SARS-CoV-2检测阴性的有症状儿童的数据，这些儿童的年龄、性别和检测周数均为1：1。在2020年3月24日至2021年2月22日期间，成人代理报告了258790名5-17岁的儿童，其中75529人的SARS-CoV-2检测结果有效。1734名儿童（588名年龄较小的儿童和1146名年龄较大的儿童）在研究时间范围内（2020年9月1日至2021年1月24日之间发病）具有阳性SARS-CoV-2检测结果和可计算的疾病持续时间。最常见的症状是头痛（1079例[62.2%]）和疲劳（954例[55.0%]）。中位病程为6天（IQR 3-11），阴性儿童为3天（2-7），与年龄呈正相关（斯皮尔曼秩次rs 0·19，p<0·0001）。年龄较大的儿童（7天，IQR 3-12）的中位病程长于年龄较小的儿童（5天，2-9）。1734名儿童中有77名（4.4%）的患病时间至少为28天，年龄较大的儿童比年龄较小的儿童更常见（1146名年龄较大的儿童中有59名[5.1%]，588名年龄较小的儿童中有18名[3.1%]; p= 0.046）。这些儿童在患病的前4周内最常见的症状是疲劳（65/77 [84.4%]），头痛（60例[77.9%]），嗅觉丧失（60 [77.9%]/77）;然而，与患病第一周（中位数6个症状，4-8个）相比，第28天后的症状负担较低（中位数2个症状，IQR 1-4）。1379名儿童中只有25名（1.8%）出现症状至少56天。在阴性检测队列中，很少有儿童（15名儿童，0.9%）出现症状至少28天;然而，这些儿童在整个疾病期间（9种症状，IQR 7.7 - 11.0 vs 8，6-9）和第28天后（5种症状，IQR 1.5 - 6.5 vs 2，1-4）比SARS-CoV-2检测阳性的儿童经历了更大的症状负担。虽然COVID-19在儿童中通常持续时间短，症状负担低，但一些患有COVID-19的儿童会经历长时间的疾病。令人欣慰的是，这些儿童的症状负担并没有随着时间的推移而增加，大多数在第56天恢复。一些SARS-CoV-2检测呈阴性的儿童也患有持续和沉重的疾病。在大流行期间，对所有患有持续性疾病的儿童采取综合办法是适当的。Zoe Limited、英国政府卫生和社会保健部、威康信托基金会、英国工程和物理科学研究理事会、英国研究与创新伦敦医学成像和人工智能中心、英国国家健康研究所、英国医学研究理事会、英国心脏基金会和阿尔茨海默氏症协会。
In children, SARS-CoV-2 infection is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, one of the largest UK citizen participatory epidemiological studies to date. In this prospective cohort study, data from UK school-aged children (age 5–17 years) were reported by an adult proxy. Participants were voluntary, and used a mobile application (app) launched jointly by Zoe Limited and King's College London. Illness duration and symptom prevalence, duration, and burden were analysed for children testing positive for SARS-CoV-2 for whom illness duration could be determined, and were assessed overall and for younger (age 5–11 years) and older (age 12–17 years) groups. Children with longer than 1 week between symptomatic reports on the app were excluded from analysis. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed. 258 790 children aged 5–17 years were reported by an adult proxy between March 24, 2020, and Feb 22, 2021, of whom 75 529 had valid test results for SARS-CoV-2. 1734 children (588 younger and 1146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study timeframe (illness onset between Sept 1, 2020, and Jan 24, 2021). The most common symptoms were headache (1079 [62·2%] of 1734 children), and fatigue (954 [55·0%] of 1734 children). Median illness duration was 6 days (IQR 3–11) versus 3 days (2–7) in children testing negative, and was positively associated with age (Spearman's rank-order rs 0·19, p<0·0001). Median illness duration was longer for older children (7 days, IQR 3–12) than younger children (5 days, 2–9). 77 (4·4%) of 1734 children had illness duration of at least 28 days, more commonly in older than younger children (59 [5·1%] of 1146 older children vs 18 [3·1%] of 588 younger children; p=0·046). The commonest symptoms experienced by these children during the first 4 weeks of illness were fatigue (65 [84·4%] of 77), headache (60 [77·9%] of 77), and anosmia (60 [77·9%] of 77); however, after day 28 the symptom burden was low (median 2 symptoms, IQR 1–4) compared with the first week of illness (median 6 symptoms, 4–8). Only 25 (1·8%) of 1379 children experienced symptoms for at least 56 days. Few children (15 children, 0·9%) in the negatively tested cohort had symptoms for at least 28 days; however, these children experienced greater symptom burden throughout their illness (9 symptoms, IQR 7·7–11·0 vs 8, 6–9) and after day 28 (5 symptoms, IQR 1·5–6·5 vs 2, 1–4) than did children who tested positive for SARS-CoV-2. Although COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate. Zoe Limited, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, and Alzheimer's Society.