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新型冠狀病毒疫情系列之十一 — 兒童及孕婦

2020/3/28 — 12:51

人們的一般習性是保護兒童,一般習性是帶孫子探訪爺爺奶奶。新型冠狀病毒的很多特性尚未明朗,但它在一些地方以人們的一般想法的相反方向行事,其中一項就是兒童。它差不多不對兒童肆虐。這意味著兒童可能成為隱性帶病毒者,成了天使殺手。意大利的大量長者死亡不知與此因素是否有關。

西班牙

西班牙和意大利在今次疫情的死亡人數已超過了中國。西班牙至今有5萬6千人確診,3月25日在24小時之內死去655人,死亡人數為4,089人。

廣告

但有一個奇怪現象,死亡之中沒有一個兒童案例(註一)。最新的數字顯示,它只有一宗九歲的兒童因而入院,沒有任何10至19歲的入院紀錄;在30歲以下的只有5人因感染此病毒而死亡;59歲以下的死亡率少於1%。

意大利

廣告

意大利在同日的一天死亡人數為651人,4千個新症,死亡人數總數超過5千,確診病例接近7萬。

在倫巴第大區的醫生群組中,醫生們表示:「我們沒有兒童的危殆病人。病毒好像水痘或麻疹般,對兒童的入侵性很小」(註二)。

孕婦

雖然各地將孕婦放在特別需要照顧的一群,但新型冠狀病毒對孕婦影響的所知不詳。美國疾控中心表明,至今在這方面沒有科學數據(註三)。

有報導指(註3.1),只有8%的受感染孕婦的病情較為重,當中只有一位需要進入深切治療室。

《柳葉刀》期刊有一篇早期的研究報導(註四),它們在大陸找到30名孕婦確診者,其時為2月8日,中國31個省份的確診病例為3萬6千人。

研究小組紀錄了7名孕婦,三例為初產,平均年齡為32歲,平均胎齡為39週加一天;2名患有慢性疾症;3名患有子宮內膜息肉;病毒平均潛伏期為5天;6人在入院時發燒;1名咳嗽;1名患呼吸急促症;1名腹瀉。

她們的治療結果良好,母子平安,順產,不需進入深切治療室,當中的一位嬰兒的喉部檢測樣本帶有新型冠狀病毒,但該嬰兒沒有病癥,在觀察2周後出院。其他嬰兒均表現健康。

新型冠狀病毒是否由母傳至嬰兒未能確定。她們的胎盤和臍帶血的病毒檢測為陰性,因此不能確定有否發生子宮內垂直傳播。

兒童案例研究一

3月18日的《新英倫》期刊的文章(註五)表示,在中國的7萬2千個確診個案中,少於1%的涉及10歲以下的兒童。

在1391名病毒測試的兒童中,171名(12.3%)的為陽性,這171名兒童患者的平均年齡為6.7歲,60.8%為男童;沒有病徵患者有15.8%;家庭同時受感染者達九成;他/她們之中有48.5%咳嗽;41.5%發燒,平均發燒期為3天;有12名兒童的肺片顯示肺炎,但他們仍然沒有發病徵狀。全數171名患者只有3名需要進入深切治療室和接受插喉輸氧,大部份兒童患者均屬輕症,只有一名死亡個案,該嬰兒10個月大,入院4周後因多個內臟衰竭而死亡。`

兒童案例研究二

3月25日的《柳葉刀》期刊的文章(註六)表示,在44,672中國案例中有2.1%的患者年齡低於21歲。1.2%為沒有病癥患者。

報告比較了兒童在患上新型冠狀病毒、沙士和流感的情況。其順序結果是,當中的無病癥比例為28%,0%,少於5%;併發症比例為0%,11%,4%;輕度或中度病情比例為100%,79%,81%。他們研究的36名兒童病例在治療後全數復。

由此可見兒童在適應新型冠狀病毒的能力可能比流感還高。

備註

註一

What we know about the coronavirus cases in Spain

The latest data shows that across the whole of Spain, only one case of a child under the age of nine is being treated in hospital. There are no cases of anyone between the ages of ten and 19 being hospitalized so far. Although between the 20 to 50 age group some 13 percent of hospitalised cases have been admitted into the ICU.

This puts the mortality rate in those under 59 at less than 1 percent.

Only five people under the age of 30 have reportedly died in Spain from the coronavirus.

註二

'Healthcare on brink of collapsing': Doctors share stories from inside the Italy coronavirus quarantine

She added: "This virus is so infectious that the only way to avoid a 'massacre' is to have the least number possible getting infected over the longest possible timescale.

"Right now, if we get 10,000 people in Italy in need of ventilators - when we only have 3,000 in the country - 7,000 people will die.

"Rome right now is like where Milan was 10 days ago. In 10 days there has been an incredible escalation.

"Lombardy, which has the best healthcare in the country, is collapsing, so I don’t dare to think what would happen in less efficient regions.

"We've had no critical cases among children but with children, viruses are much less aggressive - think chickenpox or measles.

註三

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnant-women-and-children.html

Information on COVID-19 and Pregnant Women and Children

There is not currently information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19.

There is no evidence that children are more susceptible to COVID-19. In fact, most confirmed cases of COVID-19 reported from China have occurred in adults. Infections in children have been reported, including in very young children. There is an ongoing investigation to determine more about this outbreak. This is a rapidly evolving situation and information will be updated as it becomes available. Information about children and pregnant women and COVID-19 is available on this page.

註3.1

https://bcog.com/covid-19-and-pregnancy/

註四

Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30176-6/fulltext

Thus far, more than 49 000 confirmed cases, including health-care workers, have been identified in Wuhan, and many cases have been confirmed in other provinces in China, and in Italy, Iran, South Korea, Spain, and other countries worldwide.5,  6,  7,  8,  9 The number of pregnant women with COVID-19 is also increasing; there were already more than 30 pregnant patients with COVID-19 in China by Feb 8, 2020.

七例患者中的三例為初產,四例為多胎,入院時平均年齡為32歲(29-34歲),平均胎齡為39週加1天(37周至41週加2天)。 2名(29%)患有慢性疾病(甲狀腺功能低下和多囊卵巢綜合徵),三名(43%)患有子宮瘢痕形成。 平均潛伏期為5天(範圍2–9天)。 入院時,有6名(86%)患者發燒,1名(14%)患者咳嗽,1名(14%)患者呼吸急促,1名(14%)患者腹瀉

The neonatal birthweights and Apgar scores were normal. Four infants were taken home and were not tested for SARS-CoV-2; no fever, pathological jaundice, or other symptoms were reported during the follow-up call at 28 days after birth. Another three infants remained for observation in the neonatology department and were tested for SARS-CoV-2. Nucleic acid test for the throat swab of one neonate (child of patient 1) was positive at 36 h after birth; nucleic acid tests for the other two were negative. Subsequently, this infected neonate was transferred to Wuhan Children's Hospital, a designated hospital for children infected with COVID-19. After admission, the neonate had no fever and cough, with mild shortness of breath symptoms. Chest x-ray revealed mild pulmonary infection. The shortness of breath relieved quickly under neonatal care and monitoring. The neonate was discharged after 2 weeks following two consecutive negative nucleic acid test results. At 28 days after birth, the remaining three neonates were healthy and had no respiratory symptoms or feve

註五

SARS-CoV-2 Infection in Children

https://www.nejm.org/doi/full/10.1056/NEJMc2005073?query=featured_home

As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited.1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age.

As of March 8, 2020, there was one death. A 10-month-old child with intussusception had multiorgan failure and died 4 weeks after admission. A total of 21 patients were in stable condition in the general wards, and 149 have been discharged from the hospital.

This report describes a spectrum of illness from SARS-CoV-2 infection in children. In contrast with infected adults, most infected children appear to have a milder clinical course. Asymptomatic infections were not uncommon.2 Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic.

註六

Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study

Although all paediatric patients in our cohort had mild or moderate type of COVID-19, the large proportion of asymptomatic children indicates the difficulty in identifying paediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections.

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