评估日本 COVID-19 紧急状态下儿科川崎病或传染病住院患者。

Assessment of Pediatric Admissions for Kawasaki Disease or Infectious Disease During the COVID-19 State of Emergency in Japan.

机构信息

Kawasaki Disease Center, Fukuoka Children's Hospital, Kashiiteriha, Higashi-ku, Fukuoka, Japan.

Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-ku, Fukuoka, Japan.

出版信息

JAMA Netw Open. 2021 Apr 1;4(4):e214475. doi: 10.1001/jamanetworkopen.2021.4475.

DOI:10.1001/jamanetworkopen.2021.4475

PMID:33822065

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8025113/

Abstract

IMPORTANCE

The development of Kawasaki disease (KD) has been suggested to be associated with droplet- or contact-transmitted infection; however, its triggers and transmission modes remain to be determined. Under an epidemic of SARS-CoV-2, the COVID-19 state of emergency in Japan served as a nationwide social experiment to investigate the impact of quarantine or isolation on the incidence of KD.

OBJECTIVE

To assess the role of droplet or contact transmission in the etiopathogenesis of KD.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, longitudinal, cross-sectional study was conducted from 2015 to 2020 at Fukuoka Children's Hospital and 5 adjacent general hospitals. The number of admissions for KD and infectious diseases were analyzed. Participants were pediatric patients admitted to the participating hospitals for KD or infectious diseases.

EXPOSURES

Quarantine and isolation owing to the COVID-19 state of emergency.

MAIN OUTCOMES AND MEASURES

The primary end points were the ratios of patients with KD to patients with respiratory tract or gastrointestinal infections admitted from April to May in 2015 to 2019 and 2020. A Poisson regression model was used to analyze them.

RESULTS

The study participants included 1649 patients with KD (median [interquartile range] age, 25 [13-43] months; 901 boys [54.6%]) and 15 586 patients with infectious disease (data on age and sex were not available for these patients). The number of admissions for KD showed no significant change between April and May in 2015 to 2019 vs the same months in 2020 (mean [SD], 24.8 [5.6] vs 18.0 [4.0] admissions per month; 27.4% decrease; adjusted incidence rate ratio [aIRR], 0.73; 95% CI, 0.48-1.10; P = .12). However, the number of admissions for droplet-transmitted or contact-transmitted respiratory tract infections (mean [SD], 157.6 [14.4] vs 39.0 [15.0] admissions per month; 75.3% decrease; aIRR, 0.25; 95% CI, 0.17-0.35; P < .001) and gastrointestinal infections (mean [SD], 43.8 [12.9] vs 6.0 [2.0] admissions per month; 86.3% decrease; aIRR, 0.14; 95% CI, 0.04-0.43; P < .001) showed significant decreases between April and May in 2015 to 2019 vs the same months in 2020 (total, 12 254 infections). Thus, the ratio of KD to droplet- or contact-transmitted respiratory tract and gastrointestinal infections incidence in April and May 2020 was significantly increased (ratio, 0.40 vs 0.12; χ21 = 22.76; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, the significantly increased incidence of KD compared with respiratory tract and gastrointestinal infections during the COVID-19 state of emergency suggests that contact or droplet transmission is not a major route for KD development and that KD may be associated with airborne infections in most cases.

摘要

重要性

川崎病 (KD) 的发展被认为与飞沫或接触传播感染有关;然而，其触发因素和传播模式仍有待确定。在 SARS-CoV-2 大流行期间，日本的 COVID-19 紧急状态为研究隔离或隔离对 KD 发病率的影响提供了一个全国性的社会实验。

目的

评估飞沫或接触传播在 KD 发病机制中的作用。

设计、地点和参与者：这是一项多中心、纵向、横断面研究，于 2015 年至 2020 年在福冈儿童医院和 5 家附近的综合医院进行。分析了 KD 和传染病的入院人数。参与者为因 KD 或传染病入住参与医院的儿科患者。

暴露

因 COVID-19 紧急状态而进行的隔离。

主要结果和措施

主要终点是 2015 年至 2019 年和 2020 年 4 月至 5 月 KD 患者与呼吸道或胃肠道感染患者的比例。采用泊松回归模型进行分析。

结果

研究参与者包括 1649 例 KD 患者（中位数[四分位距]年龄，25 [13-43] 个月；901 名男孩[54.6%]）和 15586 例传染病患者（这些患者的年龄和性别数据不可用）。KD 的入院人数在 2015 年至 2019 年与 2020 年同期 4 月至 5 月之间没有明显变化（平均[SD]，每月 24.8[5.6]与 18.0[4.0]入院；27.4%减少；调整发病率比[aIRR]，0.73；95%CI，0.48-1.10；P = .12）。然而，飞沫或接触传播的呼吸道感染（平均[SD]，157.6[14.4]与 39.0[15.0]入院/月；75.3%减少；aIRR，0.25；95%CI，0.17-0.35；P < .001）和胃肠道感染（平均[SD]，43.8[12.9]与 6.0[2.0]入院/月；86.3%减少；aIRR，0.14；95%CI，0.04-0.43；P < .001）的入院人数在 2015 年至 2019 年与 2020 年同期之间明显减少（总计 12254 例感染）。因此，2020 年 4 月至 5 月 KD 与飞沫或接触传播的呼吸道和胃肠道感染发生率的比值明显升高（比值，0.40 比 0.12；χ21 = 22.76；P < .001）。