Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children.
- 作者列表："Zimmermann P","Curtis N
:Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.
冠状病毒 (Coronaviruses，CoVs) 是一大类有包膜的单链人畜共患RNA病毒。四种冠状病毒通常在人类中循环: HCoV2-229E、-HKU1 、-NL63 和-oc43。然而，CoVs可以迅速突变和重组，导致新的CoVs可以从动物传播给人类。新型CoVs严重急性呼吸综合征冠状病毒传染性非典型肺炎-CoV) 出现于 2002 年，中东呼吸综合征冠状病毒 (MERS-CoV) 出现于 2012 年。2019 新型冠状病毒 (SARS-CoV-2) 目前正在中国和其他多个国家引起严重的疾病爆发 (称为新型冠状病毒肺炎)，威胁到全球大流行。在人类中，CoVs主要引起呼吸和胃肠道症状。临床表现从普通感冒到支气管炎、肺炎、重症急性呼吸窘迫综合征、多器官功能衰竭甚至死亡等更严重的疾病。传染性非典型肺炎-CoV，中东呼吸综合征冠状病毒和传染性非典型肺炎-CoV-2 似乎较少影响儿童和使症状较少和较不严重的疾病在这个年龄段，与成人相比，并与低得多的病死率相关。初步证据表明，儿童与成人一样可能感染SARS-CoV-2，但不太可能出现症状或出现严重症状。然而，儿童在传播病毒方面的重要性仍然不确定。与成人相比，儿童更容易出现胃肠道症状。传染性非典型肺炎-CoV的儿童存在发热，但其他新型CoV并非如此。许多受MERS-CoV影响的儿童无症状。大多数被新型CoVs感染的儿童有记录的家庭接触，经常在他们之前表现出症状。相比之下，成年人更经常有院内暴露。在这篇综述中，我们总结了流行病学、临床和诊断结果，以及人类常见循环和新型CoVs感染的治疗和预防选择，重点是儿童感染。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.