A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster
A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster
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DOI：
10.1016/s0140-6736(20)30154-9
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发表时间：
2020-02-15
期刊：
影响因子：
168.9
通讯作者：
Yuen, Kwok-Yung
中科院分区：
文献类型：
--
作者：
Chan, Jasper Fuk-Woo;Yuan, Shuofeng;Yuen, Kwok-Yung
背景中国湖北省武汉市报告了一起持续的新型冠状病毒相关肺炎疫情。受影响的患者在地理上与当地菜市场有联系，这是潜在的来源。迄今尚未公布关于人际或医院传播的数据。方法在本研究中，我们报告了5例家庭聚集性患者的流行病学、临床、实验室、放射学和微生物学结果，这些患者在访问武汉后返回中国广东省深圳后出现不明原因肺炎，另外1名家庭成员未前往武汉。对这些患者的基因序列进行系统发育分析。从2020年1月10日开始，我们招募了一个6人的家庭，他们在2019年12月29日至2020年1月4日期间从深圳前往武汉。在前往武汉的6名家庭成员中，有5人被确诊感染了新型冠状病毒。此外，一名没有去过武汉的家庭成员在与其中四名家庭成员接触几天后感染了病毒。这些家庭成员都没有接触过武汉的市场或动物，尽管有两人去过武汉的一家医院。5名家庭成员（36-66岁）在接触后3-6天出现发热、上呼吸道或下呼吸道症状或腹泻，或这些症状的组合。他们在症状出现后6-10天来到我们医院（香港大学深圳医院，深圳）。他们和一名无症状儿童（10岁）有放射性磨玻璃肺混浊。老年患者（60岁~ 60岁）有更多的全身性症状，广泛的放射学磨玻璃肺改变，淋巴细胞减少，血小板减少，c反应蛋白和乳酸脱氢酶水平升高。6例患者的鼻咽拭子经即时多重RT-PCR检测均为已知呼吸道微生物阴性，但有5例患者（4例成人和1例儿童）经Sanger测序证实为新型冠状病毒内部RNA依赖RNA聚合酶和表面刺突蛋白编码基因阳性。对5例患者的RT-PCR扩增子和2个全基因组进行新一代测序的系统发育分析表明，这是一种新型冠状病毒，与中国马蹄蝠中发现的蝙蝠SARS相关冠状病毒最接近。我们的发现与这种新型冠状病毒在医院和家庭环境中的人际传播以及其他地理区域感染旅行者的报告一致。爱思唯尔版权所有版权所有。
Background An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, Hubei province, China. Affected patients were geographically linked with a local wet market as a potential source. No data on person-to-person or nosocomial transmission have been published to date.Methods In this study, we report the epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan. Phylogenetic analysis of genetic sequences from these patients were done.Findings From Jan 10, 2020, we enrolled a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020. Of six family members who travelled to Wuhan, five were identified as infected with the novel coronavirus. Additionally, one family member, who did not travel to Wuhan, became infected with the virus after several days of contact with four of the family members. None of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36-66 years) presented with fever, upper or lower respiratory tract symptoms, or diarrhoea, or a combination of these 3-6 days after exposure. They presented to our hospital (The University of Hong Kong-Shenzhen Hospital, Shenzhen) 6-10 days after symptom onset. They and one asymptomatic child (aged 10 years) had radiological ground-glass lung opacities. Older patients (aged >60 years) had more systemic symptoms, extensive radiological ground-glass lung changes, lymphopenia, thrombocytopenia, and increased C-reactive protein and lactate dehydrogenase levels. The nasopharyngeal or throat swabs of these six patients were negative for known respiratory microbes by point-of-care multiplex RT-PCR, but five patients (four adults and the child) were RT-PCR positive for genes encoding the internal RNA-dependent RNA polymerase and surface Spike protein of this novel coronavirus, which were confirmed by Sanger sequencing. Phylogenetic analysis of these five patients' RT-PCR amplicons and two full genomes by next-generation sequencing showed that this is a novel coronavirus, which is closest to the bat severe acute respiatory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats.Interpretation Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. Copyright (C) 2020 Elsevier Ltd. All rights reserved.