儿童严重急性呼吸综合征血清流行病学特征初探

目的　了解儿童严重急性呼吸综合征 (SARS)患者SARS相关冠状病毒 (SARS CoV)特异抗体水平 ;初步调查与成人SARS患者密切接触的儿童 /成人及与SARS患儿密切接触的家长中隐性感染的情况。方法　 (1)采用间接免疫荧光 (IFA)和ELISA两种方法 ,对北京市恢复期儿童SARS患者 2 1例、与其密切接触的家长 2 3位、与SARS成人患者密切接触的儿童 2 4名和成人 34名 ,分别进行了SARS CoV特异抗体的检测 ,其中IFA检测IgG抗体 ,ELISA检测混合抗体。 (2 )通过入户问卷收集流行病学资料。结果　 (1)IFA测定SARS患儿血清SARS CoV IgG阳性者 8例 (38% ) ,同时经ELISA法测定SARS CoV混合抗体阳性者 7例 (33% )。 (2 )有SARS接触史的患儿在抗体阳性组中为 7/8,而在抗体阴性组中为 1/13。 (3)SARS患儿的家长中一位 (患儿的祖母 )经IFA检测SARS CoV IgG和ELISA法检测混合抗体为阳性 (1/2 3,4 % ) ,该患儿的祖父为SARS患者。 (4)对成人SARS患者的密切接触儿童调查结果为 :2 4份受检标本中 1份SARS CoV IgG阳性 (4% ) ;34份受检成人标本中 1份经IFA检测SARS CoV IgG和ELISA法检测混合抗体均为阳性 (3% )。 结论(1)临床诊断的儿童SARS患儿中有 38%经血清学证实为SARS CoV感染。(2 )流行病学资料显示 ,有SARS接触史的患儿在抗体阳性     

严重呼吸综合征患儿及密切接触者血清SARS相关冠状病毒抗体的检测分析

目的　了解严重急性呼吸综合征(severeacuterespiratorysyndrome ,SARS)患儿SARS相关冠状病毒(SARS CoV)特异性抗体水平和与SARS患儿密切接触的成人有无隐性感染。方法　采用间接免疫荧光(IFA)和ELISA两种方法检测北京市2 4例恢复期儿童SARS患者和2 6名与其密切接触的家长血清SARS CoV特异抗体,其中IFA法检测IgM和IgG抗体,ELISA检测IgM和混合抗体;同时通过入户问卷收集流行病学资料。结果　( 1 )IFA法测定血清SARS CoV IgG的阳性者1 0例( 4 2 % ) ,SARS CoV IgM阳性2例( 8% ) ;经ELISA法测定SARS CoV混合抗体的阳性者9例( 3 8% )。( 2 )流行病学资料显示抗体阳性的1 0例患儿中有明确SARS接触史的患儿8例,而在抗体阴性的1 3例中仅1例阳性(P <0 . 0 5)。( 3 ) 1位受检家长(患儿的祖母)IFA法检测SARS CoV IgG和ELISA法检测混合抗体均为阳性,约占4% ( 1 / 2 6) ,该患儿的祖父亦为SARS患者。结论　( 1 )有SARS接触史的患儿在抗体阳性组的比例较之在抗体阴性组的比例明显增高,提示流行病学史在儿科SARS临床诊断中具有重要价值。( 2 )未能证实与儿童SARS患者接触的成人中存在隐性感染。     

非严重急性呼吸道综合征人群抗SARS冠状病毒特异性IgG的检测及分析

目的 研究非严重急性呼吸道综合征(SARS)人群血清中是否存在抗SARS冠状病毒特异性IgG。方法 研究对象为4组:第1组为2002年非SARS患儿88例(2002年备存血清);第2组为2003年SARS流行期间非SARS患儿89例;第3组为某SARS定点医院一线医务人员65例,均在SARS临床一线工作1个月;第4组为北京儿童医院非SARS一线工作人员33例。所用方法为间接ELISA法。结果 第1组抗SARS冠状病毒的特异性IgG检出率为19.1%,第2组为12.5%,两组差异没有显著性意义(P>0.05)。第3组和第4组抗SARS冠状病毒的特异性IgG检出率分别为1.54%和3.03%,两组差异也没有显著性意义(P>0.05)。若分别将第1组和第2组合并、第3组和第4组合并进行比较,则儿童组抗SARS冠状病毒的特异性IgG检出率为15.82%,成人组为2%,两组差异有非常显著性意义(P<0.01)。另外,把儿童研究对象按年龄分为3组:<1岁、～6岁、>6岁,<1岁年龄组抗SARS冠状病毒的特异性IgG检出率达36.36%,其余两组分别为8.77%和9.21%;<1岁年龄组的检出率与其余两组相比,差异均有显著性意义,P<0.01和P<0.01。结论 非SARS儿童血清中可检测出抗SARS冠状病毒特异性IgG,其检出率为15.82%,其中<1岁年龄组抗SARS冠状病毒特异性IgG的检出率达36.36%。但该特异性IgG产生的原因及意义有待进一步研究。     

北京地区部分儿童严重急性呼吸综合征的血清学研究

目的 确定临床诊断为严重急性呼吸综合征（SAILS）患儿感染的病原是否为SAILS相关冠状病毒（SAILS-CoV）;同时探讨儿童sARS患者的传播能力。方法2003年6-8月收集到的SAILS患者及其接触者血清标本177例,同时期的来源于非疫区择期手术儿童血清标本49例,以及无SAILS接触史的北京健康儿童血清标本93例,SAILS流行前儿童血清标本90例,总计409例。应用不同方法（包括酶联免疫吸附实验、间接免疫荧光、Western-blot等）、不同单位生产的试剂盒测定抗SAILS-CoV抗体。结果不同检测方法中,SAILS．CoV特异性IgG抗体阳性率在SAILS患儿中为39．1％-43．5％。成人SAILS患者中为57．1％-71．4％;与SAILS患儿接触的儿童中均为阴性。与SAILS患儿接触的成人中为6．0％-9．0％;与成人SAILS接触的儿童中为0-9．7％;与成人SAILS接触的成人中为4．4％-7．1％;同时期的正常儿童与非疫区择期手术儿童以及SAILS流行前的正常儿童血清标本用不同方法和试剂检测结果不尽相同。结论临床诊断为SAILS的患儿SAILS-CoV特异性IgG抗体阳性率（40％左右）明显低于临床诊断为SAILS的成人患者。提示在流行期间有相当一部分儿童sARS实际上是由其他的呼吸道病毒感染所致。与成人sARS接触的儿童和成人中,有一部分SAILS抗体为阳性,提示可能存在SAILS-CoV的隐性感染。目前已推广使用的SAILS诊断试剂对于儿童SAILS诊断的正确性还需要进一步的验证。     

Severe acute respiratory syndrome (SARS) in neonates and children

Severe acute respiratory syndrome (SARS) runs a more benign course in children during the acute phase. Infants born to mothers with the disease did not acquire the infection through vertical transmission. The treatment strategy for children with SARS has not been standardised and is based on adult experience. Thus far, no deaths have been reported in the paediatric age group. Exercise impairment and residual radiological abnormalities were present six months after diagnosis. It is important to assess these patients on a regular basis to detect and provide appropriate management for any persistent or emerging long term sequelae in the physical, psychological, and social domains. This review describes the current understanding of SARS coronavirus infection in newborns and children.     

Long-term sequelae of SARS in children

Severe acute respiratory syndrome (SARS) runs a more benign course in children during the acute phase. Unlike adult patients, no fatalities were reported among the paediatric SARS patients. Published data on long-term sequelae of SARS are very limited. In our follow-up study, although patients have clinically recovered from their initial illness, exercise impairment and residual radiological abnormalities were demonstrated at 6 months after diagnosis. It is important to assess these patients on a regular basis to detect and provide appropriate management for persistent or emerging long-term sequelae in the physical, psychological and social domains.     

Adolescent twin sisters with severe acute respiratory syndrome (SARS)

A novel coronavirus-associated communicable respiratory disease, severe acute respiratory syndrome (SARS), spread worldwide after an outbreak in Guangdong Province of the People's Republic of China in November 2002. Since late February 2003, there has been an epidemic in Hong Kong involving both adult and pediatric patients. The clinical course, intensive care, and outcome of adolescent twin sisters with SARS are described. Adolescents infected with SARS may develop severe illness as adults, and close monitoring for disease progression in terms of both clinical and radiologic deterioration is warranted.     

Severe acute respiratory syndrome in Singapore.

AIMS: To describe the epidemiological and clinical features of paediatric severe acute respiratory syndrome (SARS) in Singapore. METHODS: The following data were retrospectively collected from the case records of all 71 patients (aged 7 months to 14 years) admitted from 23 March to 22 May 2003 to the SARS paediatric unit: patient demographics, contact history, clinical features, physiological parameters, investigations, treatment, and outcome. Using WHO criteria there were seven probable (P), 23 suspect (S), and 41 observe (O) cases. RESULTS: Compared to the O cases P patients had a longer mean duration of fever (3.66 (SD 2.3) v 8.57 (SD 2.44) days), lower mean thrombocytopenia (248.3 (SD 82.7) v 173.7 (SD 49.0)x10(9)/l), leucopenia (8.19 (SD 4.45) v 3.06 (SD 1.02)x10(9)/l), lymphopenia (2.79 (SD 1.97) v 1.44 (SD 0.75)x10(9)/l), and neutropenia (4.48 (SD 2.88) v 1.24 (SD 0.43)x10(9)/l). Chest auscultation was abnormal in 71% of P patients, with mild crepitations detected. All had abnormal chest radiographs versus 39% of S cases, and 27% of O cases. CONCLUSIONS: There are no distinguishing clinical features of paediatric SARS. The diagnosis is suggested by the paucity of clinical signs with an abnormal chest radiograph, and laboratory evidence of leucopenia, lymphopenia, and thrombocytopenia.     

A young infant with severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS), a new contagious respiratory disease associated with a novel coronavirus, has spread worldwide and become a global health concern after its first outbreak in Guangdong Province of the People's Republic of China in November 2002. The clinical presentation and the radiologic, hematologic, biochemical, and microbiologic findings of a 56-day-old male infant with SARS are described. Some clinical and laboratory features are similar to those reported in adult and pediatric patients. However, this infant had a more severe clinical course as compared with the older children. This is the youngest patient with symptomatic SARS reported to date.     

Severe acute respiratory syndrome in children

BACKGROUND: Severe acute respiratory syndrome (SARS) is a febrile, respiratory tract illness caused by infection with the newly identified SARS-associated coronavirus. A notable feature of the 2003 global SARS outbreak was the relative paucity of cases reported among children. We reviewed the epidemiologic and clinical features of SARS in children and discuss implications of these findings for diagnosis, treatment and prevention of SARS. METHODS: We performed a literature search to identify reports of pediatric (younger than 18 years of age) patients meeting the World Health Organization case definitions for SARS and abstracted relevant clinical and epidemiologic information. RESULTS: We identified 6 case series reporting 135 pediatric SARS patients (80 laboratory-confirmed, 27 probable and 28 suspect) from Canada, Hong Kong, Taiwan and Singapore. Among laboratory-confirmed and probable SARS cases, the most common symptoms included fever (98%), cough (60%) and nausea or vomiting (41%); 97% had radiographic abnormalities. The clinical presentation of SARS in patients older than 12 years of age was similar to that in adults. However, patients 12 years of age or younger had milder disease and were less likely than older children to be admitted to an intensive care unit, receive supplemental oxygen or be treated with methylprednisolone. No deaths were reported among children or adolescents with SARS, and at 6 months after illness only mild residual changes were reported in exercise tolerance and pulmonary function. There is only 1 published report of transmission of SARS virus from a pediatric patient. CONCLUSIONS: Children and adolescents are susceptible to SARS-associated coronavirus infection, although the clinical course and outcome are more favorable in children younger than 12 years of age compared with adolescents and adults. Transmission of SARS from pediatric patients appears to be uncommon but is possible.     

A case-control study of SARS versus community acquired pneumonia

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.     

A case-control study of SARS versus community acquired pneumonia.

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.     

Rentabilidad de las muestras respiratorias pediátricas en la red centinela de vigilancia de la gripe en las Islas Baleares

IntroductionInfluenza disease is subjected to surveillance by national networks (RC) that predict the epidemic behaviour by reporting clinical and virological data.ObjectivesTo evaluate the effectiveness of the paediatric respiratory samples in the Balearic Islands RC in the last five epidemic seasons.Material and patientsA breath sample was taken from paediatric patients in the RC who had flu symptoms. The samples were inoculated in the MDCK cell line. We reviewed the epidemiological data of patients with a culture positive to influenza A and B.ResultsA total of 338 pharyngeal swabs from the RC were analysed during the study period. Of these, 65 (19.3%) belonged to <14 years old patients, and 44.6% of the samples were positive as opposed to 39.1% of adult respiratory samples. The influenza A virus was isolated in 24 paediatric samples (82.7%) and the influenza B virus in 5 (17.3%). The mean age of the paediatric patients of the RC who were positive was 8.5 years. Only 3 patients in the 0–4 year old group were positive (10.3%) and 26 patients (89.7%) in the 5–14 years old group.ConclusionsIn spite that paediatricians represented only 22% of the RC doctors and obtain the 19.3% of all respiratory samples, the percentage and effectiveness of these is higher that that obtained in the adult population.     

Post-SARS infection control in the hospital and clinic

The recent severe acute respiratory syndrome (SARS) outbreak has almost mandated a re-evaluation of infection control practices in hospitals, clinics, schools and domestic environments, especially for patients with respiratory tract symptoms. Triage, early case detection followed by prompt isolation and quarantine are major preventive measures. Respiratory tract infections are the most common childhood illnesses and paediatric SARS poses special problems in diagnosis because of its non-specific presentation. The main lessons learnt from the outbreak were: (1) despite well established guidelines on infection control precautions, poor understanding of underlying principles and deficiencies in compliance are common among healthcare professionals, especially during emergencies; (2) even a slight lapse can be fatal; and (3) over-protection can be counterproductive. Hence it is important to: (1) be protected to protect others; (2) be vigilant and prepared for emerging infections; (3) be proficient and scrupulous in infection control measures; (4) be apposite and practical on personal protective equipments to ensure sustainability; and (5) be dutiful and prompt in informing of potential threats and work closely with others.     

The widening scope of coronaviruses

PURPOSE OF REVIEW: In the past 2 years, at least three distinct human coronaviruses have been discovered, including the etiological agent associated with severe acquired respiratory syndrome (SARS). These recently discovered viruses, with the exception of the SARS associated coronavirus (SARS-CoV), are likely to be common respiratory viruses and may be responsible for a substantial proportion of respiratory tract disease. RECENT FINDINGS: The SARS-CoV first appeared in 2002 and spread rapidly around the globe. Although the worldwide spread of SARS-CoV may have been halted, the emergence of this new virus demonstrates the potential threat represented by species-to-species transmission of coronaviruses. NL63, initially isolated from a young child with lower respiratory tract disease, represents a group of newly described group I coronaviruses that have been identified worldwide, which are associated with both upper and lower respiratory tract disease, particularly in young children. The distribution of HKU1, a newly identified group II coronavirus, is not yet established. NL63 and HKU1 are related to the common human coronaviruses 229E and OC43, respectively. SUMMARY: The discovery of at least three new human coronaviruses represents significant advances in the investigation of human respiratory tract disease. Further studies are required to fully define the impact of these new pathogens.     

Severe acute respiratory syndrome (SARS): chest radiographic features in children

Background Severe acute respiratory syndrome (SARS) is a recently recognized condition of viral origin associated with substantial morbidity and mortality rates in adults. Little information is available on its radiologic manifestations in children.Objective The goal of this study was to characterize the radiographic presentation of children with SARS.Materials and methods We abstracted data (n=62) on the radiologic appearance and course of SARS in pediatric patients with suspect (n=25) or probable (n=37) SARS, diagnosed in five hospital sites located in three cities: Toronto, Singapore, and Hong Kong. Available chest radiographs and thoracic CTs were reviewed for the presence of the following radiographic findings: airspace disease, air bronchograms, airways inflammation and peribronchial thickening, interstitial disease, pleural effusion, and hilar adenopathy.Results A total of 62 patients (suspect=25, probable=37) were evaluated for SARS. Patient ages ranged from 5.5 months to 17 years and 11.5 months (average, 6 years and 10 months) with a female-to-male ratio of 32:30. Forty-one patients (66.1%) were in close contact with other probable, suspect, or quarantined cases; 10 patients (16.1%) had recently traveled to WHO-designated affected areas within 10 days; and 7 patients (11.2%) were transferred from other hospitals that had SARS patients. Three patients, who did not have close/hospital contact or travel history to affected areas, were classified as SARS cases based on their clinical signs and symptoms and on the fact that they were living in an endemic area. The most prominent clinical presentations were fever, with a temperature over 38 °C (100%), cough (62.9%), rhinorrhea (22.6%), myalgia (17.7%), chills (14.5%), and headache (11.3%). Other findings included sore throat (9.7%), gastrointestinal symptoms (9.7%), rigor (8.1%), and lethargy (6.5%). In general, fever and cough were the most common clinical presentations amongst younger pediatric SARS cases (age<10 years), whereas, in addition to these symptoms, headache, myalgia, sore throat, chills, and/or rigor were common in older patients (age10 years). The chest radiographs of 35.5% of patients were normal. The most prominent radiological findings that were observed in the remaining patients were areas of consolidation (45.2%), often peripheral with multifocal lesions in 22.6%. Peribronchial thickening was noted on chest radiographs of 14.5% of patients. Pleural effusion was observed only in one patient (age 17 years and 11.5 months), whereas interstitial disease was not observed in any patient.Conclusion In pediatric cases, SARS manifests with nonspecific radiographic features making radiological differentiation difficult, especially from other commonly encountered childhood respiratory viral illnesses causing airspace disease. The radiographic presentation of suspected SARS cases ranged from normal to mild perihilar peribronchial thickening. The radiographic presentations, as expected, were relatively more pronounced in the SARS probable cases.