儿童SARS血清流行病学调查及其依从性初步分析

Primary investigation on the serological and epidemiological characteristics of pediatric SARS and the degree of compliance with the study

目的①了解儿童严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者SARS相关冠状病毒(SARSCoV)特异抗体水平;初步调查与成人SARS患者密切接触的儿童及与SARS患儿密切接触的家长中隐性感染情况。②了解本次血清流行病调查的依从性。方法①对开展本研究中的电话联系过程及结果予以记录和分析。②入户收集流行病学资料和采集标本。③采用间接免疫荧光(IFA)方法对北京市24例恢复期儿童SARS患者;与SARS成人患者密切接触的30名儿童和与上述SARS患儿密切接触的29位家长进行血清SARSCoV特异IgG检测。结果①在试图联系的527户家庭中,共与431个家庭进行了有效通话,其中191户因不符合条件被排除研究;176户拒绝参加本项研究;在193个符合条件的家庭中,最终64户同意纳入研究(33.2%)。②儿童SARS患儿血清SARSCoVIgG阳性者10例(42%)。③儿童患者抗体阳性组中有明确SARS接触史的患儿所占比例为8/10,而在抗体阴性组的比例为1/14(P<0.05)。④与成人SARS患者接触的儿童标本中1份SARSCoVIgG阳性(1/30,3%);SARS患儿的家长中一位(患儿的祖母)SARSCoVIgG为阳性(1/29,3%),该患儿的祖父为SARS患者。结论①本次儿童SARS血清流行病调查依从性较低。②临床诊断为SARS的患儿中有42%经血清学证实为SARSCoV感染。③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。④在与成人SARS患者密切接触的儿童和成人中可能存在隐性感染。未能证实与儿童SARS患儿接触的成人中存在隐性感染。

Objective ① To primarily examine the presence of serum specific antibodies against severe acute respiratory syndrome-associated coronavirus virus （SARS-CoV） in pediatric SARS patients and explore the possibility of subclinical infection in children / adults through close association with SARS cases. ② To understand the level of compliance with the epidemical investigation and serological tests after SARS . Methods ① To register and analysis the results of connecting with SARS patient＇ s families by telephone. ② To inyestigate general and epidemiological information about the subjects using a standard questionnaire and collect serum specimens. ③ Specific IgG against SARS-CoV was assayed by indirect immunnofluorescence assay （IFA）. Serum specimens came from 24 clinically confirmed pediatric SARS cases and their 29 paterfamilias, 30 children in close contact with infected adults.Result ① Of the 527 SARS patient＇s families with which we tried to come into contact, a total of 431 families＇ member answered the phone. 191 families that did not met the criterion were exclude from the investigation , 176 refused to take part in .Among 193 in accord with the request of study, 64 families＇ member agreed to be participant （33 % ） ② The positive rate of specific IgG was 42% （ 10/ 24） in pediatric cases. ③The rate of the patients who had close contact to SARS patients was 8/10 among cases with positive reaction vs 1/14 for those with negative results（ P 〈0.05 ）. ④ The antibody of IgG emerged in one of 30 children, whose mother had suffered from SARS （3 % ）. Among 29 parents of children with SARS one showed positive for IgG . whose grandson and husband suffered from SARS . Conclusions ① There was poor compliance in our study.SARS-CoV infection was cofirmed by Serological method in 42% ofclinically diagnosed pediatric SAILS, which leading to the assumption that diagnosis of pediatric SARS correctly calls for accurate and efficient way for screening of antigen or gene of SARS-CoV. ③ The rate of the patient who had close contact to SARS patients among cases with positive reaction was higher than the rate for those with negative results. ④ SARS probably had the potentiality of subclinical infection in children and adults. Our data did not confirm that SARS had subclinical infection among adults having been in close contact to pediatric SARS cases.