Stacevičienė Indrė, Burokienė Sigita, Steponavičienė Aušra, Vaičiūnienė Daiva, Jankauskienė Augustina
Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Eur J Pediatr. 2021 Jul;180(7):2137-2145. doi: 10.1007/s00431-021-03999-z. Epub 2021 Feb 25.
Screening for COVID-19 is based on clinical and epidemiological factors. Children infected with SARS-CoV-2 may have a few or many non-specific symptoms or may be asymptomatic. The aim of this study was to analyze clinical features and exposure to SARS-CoV-2 characteristics of children screened for COVID-19 at the pediatric emergency department in Vilnius during the first 3 months (March-May) of the COVID-19 pandemic in Lithuania. SARS-CoV-2 PCR was positive for 0.6% (8/1348) of all screened children and for 0.9% (7/811) of symptomatic patients, more among children with fever and cough (2.6%, 4/154). There were also COVID-19 cases among children without cough but with other respiratory symptoms (0.5%, 2/409) or gastrointestinal symptoms (1.2%, 3/257). Only one child with positive SARS-CoV-2 did not meet COVID-19 clinical criteria-he presented with vomiting and dehydration only. All COVID-19 cases (n = 8) had a contact with a confirmed COVID-19 family member. There were no COVID-19 cases among children without known exposure to SARS-CoV-2 or among asymptomatic children.Conclusion: Screening for COVID-19 in children is exceptionally challenging due to the diverse and non-specific symptoms of infection they present. Testing strategies should not only focus on the typical COVID-19 symptoms of fever or cough, but also include other symptoms, especially gastrointestinal symptoms, which are also important. The greatest attention should be paid to known exposure to SARS-CoV-2, especially in family clusters. Screening of asymptomatic children with no known exposure should be weighed for medical necessity and cost-effectiveness. What is Known: • Diagnosis of COVID-19 in children is challenging because the disease does not always manifest with typical symptoms. What is New: • Children in our study who did not have symptoms of acute infection and contact with another person infected with COVID-19 were not diagnosed with COVID-19, so the benefit of PCR testing is questionable. Such testing may only be useful for infection control purposes, and to limit intra-hospital transmission.
2019冠状病毒病（COVID-19）的筛查基于临床和流行病学因素。感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿童可能有一些或许多非特异性症状，也可能无症状。本研究的目的是分析在立陶宛COVID-19大流行的前3个月（3月至5月）期间，在维尔纽斯儿科急诊科接受COVID-19筛查的儿童的临床特征以及SARS-CoV-2暴露特征。在所有接受筛查的儿童中，SARS-CoV-2聚合酶链反应（PCR）检测阳性率为0.6%（8/1348），有症状患者的阳性率为0.9%（7/811），发热和咳嗽儿童中的阳性率更高（2.6%，4/154）。在无咳嗽但有其他呼吸道症状的儿童（0.5%，2/409）或胃肠道症状的儿童（1.2%，3/257）中也有COVID-19病例。只有一名SARS-CoV-2检测呈阳性的儿童不符合COVID-19临床标准——他仅表现为呕吐和脱水。所有COVID-19病例（n = 8）均与确诊的COVID-19家庭成员有接触。在没有已知SARS-CoV-2暴露史的儿童或无症状儿童中未发现COVID-19病例。结论：由于儿童感染后症状多样且不具特异性，对儿童进行COVID-19筛查极具挑战性。检测策略不仅应关注发热或咳嗽等典型的COVID-19症状，还应包括其他症状，尤其是胃肠道症状，这些症状也很重要。应特别关注已知的SARS-CoV-2暴露情况，尤其是在家庭聚集性病例中。对于无已知暴露史的无症状儿童进行筛查时应权衡医疗必要性和成本效益。已知信息：• 儿童COVID-19的诊断具有挑战性，因为该疾病并不总是表现出典型症状。新发现：• 在我们的研究中，没有急性感染症状且未与另一名感染COVID-19的人接触的儿童未被诊断为COVID-19，因此PCR检测的益处值得怀疑。这种检测可能仅对感染控制目的有用，并限制院内传播。
