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东京新冠肺炎疫情的地理概况:基于基层医疗诊所即时检验抗体检测的分析

Geographical Profiles of COVID-19 Outbreak in Tokyo: An Analysis of the Primary Care Clinic-Based Point-of-Care Antibody Testing.

作者信息

Takita Morihito, Matsumura Tomoko, Yamamoto Kana, Yamashita Erika, Hosoda Kazutaka, Hamaki Tamae, Kusumi Eiji

机构信息

Navitas Clinic Tachikawa, Tachikawa, Tokyo, Japan.

Navitas Clinic Shinjuku, Shinjuku, Tokyo, Japan.

出版信息

J Prim Care Community Health. 2020 Jan-Dec;11:2150132720942695. doi: 10.1177/2150132720942695.

Abstract

The primary care clinic plays a major role in triage for coronavirus disease 2019 (COVID-19), where seroprevalence in the setting of primary care clinic remains less clear. As a point-of-care immunodiagnostic test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the serosurvey represents an alternative to the polymerase chain reaction (PCR) test to measure the magnitude of COVID-19 outbreak in the communities lacking sufficient diagnostic capability for PCR testing. We assessed seropositivity for the SARS-CoV-2 IgG between April 21 and May 20, 2020, at 2 primary care clinics in Tokyo, Japan. The overall positive percentage of SARS-CoV-2 IgG was 3.83% (95% confidence interval [CI]: 2.76-5.16) for the entire cohort (n = 1071). The 23 special wards of central Tokyo exhibited a significantly higher prevalence compared with the other areas of Tokyo after classification by residence ( = .02, 4.68% [3.08-6.79] vs 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). In central Tokyo, the southern area showed the highest seroprevalence compared with the other areas (7.92% [3.48-15.01]), corresponding to the cumulative number of confirmed COVID-19 patients by PCR test reported by the Tokyo Metropolitan Government. The seroprevalence surveyed in this study was too low for herd immunity, suggesting the need for robust disease control and prevention. A regional-level approach, rather than state- or prefectural-level, could be of importance in ascertaining detailed profiles of the COVID-19 outbreak.

摘要

基层医疗诊所在2019冠状病毒病(COVID-19)的分诊中发挥着重要作用,而基层医疗诊所环境中的血清流行率仍不太明确。作为针对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的即时免疫诊断检测,血清学调查是聚合酶链反应(PCR)检测的一种替代方法,用于在缺乏足够PCR检测诊断能力的社区中衡量COVID-19疫情的规模。我们于2020年4月21日至5月20日在日本东京的两家基层医疗诊所评估了SARS-CoV-2 IgG的血清阳性率。整个队列(n = 1071)中SARS-CoV-2 IgG的总体阳性率为3.83%(95%置信区间[CI]:2.76 - 5.16)。按居住地分类后,东京市中心的23个特别区的患病率明显高于东京其他地区(P = 0.02,分别为4.68%[3.08 - 6.79]和东京市中心及郊区的1.83%[0.68 - 3.95])。在东京市中心,南部地区的血清流行率高于其他地区(7.92%[3.48 - 15.01]),这与东京都政府报告的通过PCR检测确诊的COVID-19患者累计数量相对应。本研究中调查的血清流行率过低,无法实现群体免疫,这表明需要强有力的疾病控制和预防措施。在确定COVID-19疫情的详细情况时,采用区域层面而非国家或县级层面的方法可能很重要。

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