Clinical characteristics of children with family clusters of SARS-CoV-2 Omicron variant infection in Guangzhou in 2022
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摘要:
目的 探讨家庭聚集性儿童新型冠状病毒Omicron变异株感染的临床特征及影像学变化。 方法 将2022年10~12月在广东省第二人民医院收治的241例6岁以下确诊为新型冠状病毒Omicron变异株感染的儿童作为研究对象, 根据感染年龄分为3组: 0~1岁(n=76), 1~3岁(n=80), 3~6岁(n=85)。比较3组患儿的临床特征、实验室检查结果、疫苗接种史、影像学检查结果及转归。 结果 241例患儿中, 轻型203例(84.2%), 重型38例(15.8%), 无中型及危重型。发热为主要症状(97.5%), 其次是咳嗽(54.4%)、腹泻(29.9%)、鼻塞或流涕(25.7%)、惊厥(15.4%)。3~6岁的发热热程最低, 核酸转阴时间最短, 容易出现上呼吸道症状; 0~1岁的发热热峰最低, 以咳嗽、腹泻及皮疹为主要症状。0~1岁婴儿较年长儿容易出现肺炎性状的影像学表型, X线可表现为双肺野见斑片状和或云雾状阴影; 胸部CT可表现为双肺纹理增粗, 肺野通亮度减低, 见条状和或片状高密度影, 边界模糊。1~3岁重型发生率最高(22.5%), 较0~1岁更容易发生惊厥。与轻型相比, 重型的SARS-CoV-2 N基因循环阈值更低, 更容易出现淋巴细胞计数减少、中性粒细胞与淋巴细胞计数比值升高及血清淀粉样蛋白A升高。在3~6岁患儿中, 与接种0剂或1剂疫苗者相比, 接种2剂疫苗的患儿发热热程超过2 d的风险更低(OR=0.373, 95%CI: 0.152~0.912, P=0.029), 发生腹泻的风险降低(OR=0.298, 95%CI: 0.096~0.922, P=0.030), 核酸转阴时间更短(OR=0.359, 95%CI: 0.149~0.867, P=0.021), 重型的发生率降低17.3%(OR=0.237, 95%CI: 0.061~0.922, P=0.040)。 结论 家庭聚集性Omicron变异株感染儿童以发热、咳嗽为主要症状, 胸部CT可呈现肺部炎性改变。1~3岁儿童较0~1岁更容易发生惊厥。中性粒细胞与淋巴细胞计数比值和血清淀粉样蛋白A有助于预测感染的严重程度。疫苗接种可降低3~6岁儿童发生重型的风险, 降低病毒载量, 减少核酸阳性持续时间。 -
关键词:
- 新型冠状病毒 /
- Omicron变异株 /
- 家庭聚集性 /
- 儿童 /
- 临床特征
Abstract:Objective To investigate the clinical characteristics and chest CT or X-ray features of family-clustered children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Methods A retrospective analysis was performed on the medical data of 241 children with SARS-CoV-2 Omicron variant infection who were admitted to Guangdong Second Provincial General Hospital, the designated hospital for COVID-19 from October 2022 to December 2022.The children were divided into 76 cases of 0-1 year, 80 cases of 1-3 years old and 85 cases of 3-6 years old according to the age of infection.The clinical characteristics, results of laboratory examination, chest CT or X-ray findings and outcome of the three groups were compared. Results Among 241 children, 203 cases (84.2%) were mild, 38 cases (15.8%) were severe, no moderate or critical.Fever was the most common symptom (97.5%), followed by cough (54.4%), diarrhea (29.9%), nasal congestion and/or runny nose (25.7%), and convulsion (15.4%).Children aged 3-6 years old were prone to upper respiratory symptoms, with the lowest fever duration and the shortest nucleic acid negative conversion time.Children aged 0-1 year mainly showed symptoms of cough, diarrhea and rash, with the lowest peak of fever.Infants aged 0-1 year were more likely to present radiological phenotype of pneumonia than older children.X-rays showed patchy and/or cloudy shadows in both lung fields, while chest CT showed thickened lung texture, decreased transparency of lung fields, and linear or patchy high-density shadows with blurred boundaries.Children aged 1-3 years old had the highest incidence of severe COVID-19 infection (22.5%), and they were more likely to have convulsions than those aged 0-1 year.Compared with mild cases, severe cases had lower cycle threshold value of SARS-CoV-2 N gene, lower lymphocyte count, higher neutrophil-to-lymphocyte ratio and higher serum amyloid A level.Among children aged 3-6 years, compared with those who received 0 or 1 dose of the vaccine, children who received 2 doses of the vaccine had a lower risk of fever lasting more than 2 d (OR=0.373, 95%CI: 0.152-0.912, P=0.029), a lower risk of diarrhea (OR=0.298, 95% CI: 0.096-0.922, P=0.030), a shorter time for nucleic acid negative conversion (OR=0.359, 95% CI: 0.149-0.867, P=0.021), and a lower incidence of severe cases (OR=0.237, 95%CI: 0.061-0.922, P=0.040). Conclusion Fever and cough are the main symptoms of children with family clustering SARS-CoV-2 Omicron variant infection, and chest CT can show pulmonary inflammatory changes.Children aged 1-3 years old are more likely to have convulsions than those aged 0-1 year.The neutrophil-to-lymphocyte ratio and serum amyloid A levels are helpful in predicting the severity of infection.Vaccination can reduce the risk of severe infection in children aged 3-6 years, decrease the viral load and shorten nucleic acid negative conversion time. -
Key words:
- COVID-19 /
- Omicron variant /
- family cluster infection /
- child /
- clinical feature
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图 1 Omicron变异株感染患者治疗前及治疗后影像学结果
Figure 1. Imaging results of patients with Omicron variant infection before and after treatment. A, C, E: The characteristics of chest X-ray or chest CT before treatment; B, D, F: The characteristics of chest X-ray or chest CT after treatment.
表 1 不同年龄组奥密克戎变异株感染患儿的临床特征
Table 1. Clinical characteristics of children infected with SARS-CoV-2 Omicron variant in different age groups
Index All patients
(n=241)0-1 year old
(n=76)1-3 years old
(n=80)3-6 years old
(n=85)χ2/H/F/Fisher P Gender[n(%)] 0.498 0.779 Male 138(57.3) 41(53.9) 47(58.7) 50(58.8) Female 103(42.7) 35(46.1) 33(41.3) 35(41.2) Time of diagnosis [d, M(P25, P75)] 2.0(1.0, 3.0) 2.0(1.0, 2.75) 2.0(1.0, 3.0) 2.0(1.0, 3.0) 1.711 0.425 Nuclecapsid Protein gene [M(P25, P75)] 29.53(26.21, 31.96) 29.66(25.52, 31.48) 29.08(25.08, 31.06) 30.41(27.25, 33.14)ab 6.021 0.045 ORFla gene (Mean±SD) 29.59 ± 3.67 29.17 ± 3.46 29.38 ± 3.68 30.17 ± 3.80 1.715 0.182 Time of nucleic acid negative conversion [d, M(P25, P75)] 6.0(5.0, 7.0) 6.0(5.0, 7.0) 6.0(5.0, 8.0) 5.0(4.0, 7.0)ab 14.750 < 0.001 Time of hospitalization [d, M(P25, P75)] 6.0(8.0, 11.5) 6.0(9.0, 12.0) 6.0(8.0, 12.0) 8.0(7.0, 10.5) 0.091 0.956 Clinical classification [n(%)] 6.309 0.043 Mild group 203(84.2) 70(92.1) 62(77.5)a 71(83.5) Severe group 38(15.8) 6(7.9) 18(22.5)a 14(16.5) Symptoms Fever [n(%)] 235(97.5) 74(97.4) 79(98.8) 82(96.5) 0.948 0.781 Fever peak [℃, M(P25, P75)] 39.0(38.6, 40.0) 39.0(38.5, 39.93) 39.5(38.9, 40.0)a 39.0(38.6, 39.8) 7.964 0.019 Time of fever [d, M(P25, P75)] 2.0(3.0, 3.0) 2.0(3.0, 3.0) 2.0(3.0, 3.0) 2.0(3.0, 3.0)ab 12.053 0.002 Convulsive seizure [n(%)] 37(15.4) 5(6.6) 18(22.5)a 14(16.5) 7.728 0.021 Cough [n(%)] 131(54.4) 45(59.2) 34(42.5 52(61.2)b 6.848 0.033 Hoarseness/sore throat [n(%)] 31(12.9) 1(1.3) 9(11.9)a 21(24.7)a 21.434 < 0.001 Snivel [n(%)] 62(25.7) 25(32.9) 20(25.0) 17(20.0) 3.525 0.172 Diarrhea [n(%)] 72(29.9) 31(40.8) 24(30.0) 17(20.0)a 8.279 0.016 Vomiting [n(%)] 23(9.5) 7(9.2) 11(13.8) 5(5.9) 2.969 0.227 Rash attack [n(%)] 29(12.0) 16(21.1) 8(10.0) 5(5.9)b 9.191 0.010 aP < 0.05 vs 0-1 year old；bP < 0.05 vs 1-3 years old. 
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表 2 奥密克戎变异株感染患者轻重型的单因素分析
Table 2. Single factor analysis of the severity of patients infected with the Omicron variant
Clinical information Mild group (n=203) Severe group (n=38) χ2/t/Z/Fisher P Gender [n(%)] 0.007 0.931 Male 116(57.1) 22(57.9) Female 87(42.9) 16(42.1) Nuclecapsid protein gene (Mean±SD) 29.31 ± 3.95 27.66 ± 4.12 2.338 0.020 ORFla gene [M(P25, P75)] 30.26(27.33, 32.44) 28.37(24.98, 30.91) -2.409 0.016 Laboratory examination White blood cell count [×109/L, M(P25, P75)] 6.65(5.08, 8.39) 6.07(4.88, 8.55) -0.671 0.502 Lymphocyte count [×109/L, M(P25, P75)] 2.53(1.64, 4.12) 1.51(0.88, 2.52) -3.896 < 0.001 Lymphocyte percentage [%, M(P25, P75)] 46.1(29.0, 61.2) 31.0(18.9, 41.1) -3.390 < 0.001 Neutrophil count [×109/L, M(P25, P75)] 2.31(1.35, 3.80) 3.35(2.30, 5.93) -2.651 0.008 Neutrophil percentage [%, M(P25, P75)] 36.5(25.0, 55.1) 56.1(42.8, 70.2) -3.724 < 0.001 Lymphocytopenia [ < 1×109/L, n(%)] 9（7.5） 10（31.3） 13.029 < 0.001 Neutropenia [ < 1.5×109/L, n(%)] 33（27.5） 4（12.5） - 0.105 Neutrophil-lymphocyte ratio [M(P25, P75)] 0.82(0.40, 1.87) 1.92(1.04, 4.36) -3.941 < 0.001 Platelet count [×109/L, M(P25, P75)] 247.5(201.3, 314.8) 229.5(190.3, 279.5) -1.652 0.099 Hypersensitive C-reactive protein [mg/L, M(P25, P75)] 1.48(0.80, 7.00) 2.46(0.83, 6.22) -0.525 0.599 Serum amyloid A [mg/L, M(P25, P75)] 16.80(4.80, 45.80) 70.64(25.04, 133.82) -3.447 < 0.001 Vaccination [n(%)] - 0.156 0 or 1 dose 165(81.3) 35(92.1) 2 doses 38(18.7) 3(7.9)
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表 3 疫苗接种对3~6岁奥密克戎变异株感染患儿临床特征及转归的影响
Table 3. Effects of vaccination on clinical characteristics and outcomes of children aged 3-6 years old with Omicron variant infection [n(%)]
Index 0 or 1 dose（n=44） 2 doses (n=41) OR（95% CI） χ2/Fisher P Clinical classification 0.237（0.061-0.922） - Mild group 33(75.0) 38(92.7) Severe group 11(25.0) 3(7.3) Nucleic acid negative conversion ≤5 d 18(40.9) 27(65.9) 0.359（0.149-0.867） 5.301 0.021 Time of hospitalization ≤7 d 19(43.2) 14(34.1) 1.466（0.609-3.530） 0.730 0.393 Fever 44(100.0) 38(92.7) - - 0.108 Time of fever ≤2 d 16(36.4) 23(60.5) 0.373（0.152-0.912） 4.773 0.029 Cough 26(59.1) 26(63.4) 1.200（0.500-2.878） 0.167 0.683 Diarrhea 14(31.8) 5(12.2) 0.298（0.096-0.922） 4.709 0.030
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