Klein Anke, Langenwalder Felicia, Heinrich Fabian, Meißner Kira, Schröder Ann Sophie, Püschel Klaus, Ondruschka Benjamin, Lütgehetmann Marc, Heinemann Axel
Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland.
Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland.
Rechtsmedizin (Berl). 2021;31(5):427-433. doi: 10.1007/s00194-021-00481-w. Epub 2021 Apr 20.
In the context of the COVID-19-pandemic, mortality and incidence are key determinants to assess the transmission dynamics and the resulting potential threat. Systematic microbiological monitoring of deaths provides a fundamental basis to particularly assess underrecording of community-acquired mortality. It should be further elucidated whether a death cohort of previously unreported cases may be structurally different from the cohort of officially registered cases.
A systematic reverse transcription (RT) qPCR testing for SARS-CoV‑2 infections from nasopharyngeal swab samples was carried out. A representative sample of corpses from crematoria and the Institute of Legal Medicine of the Federal State of Hamburg were included. A comparative analysis of primarily reported and unreported fatalities in an 8‑week period after occurrence of the first pandemic-related deaths in Hamburg was performed.
A total of 1231 deaths were included, all of which were previously unsuspicious for SARS-CoV‑2 infection. Thereof 29 cases of previously unknown infections were recorded. In the first phase of the pandemic, incidental findings predominantly occurred among younger people from domestic environments with unclear or unnatural manner of death at the Institute of Legal Medicine. Over time, incidental findings investigated at the crematoria increased, mostly related to nursing home residents. The overall cohort showed no significant sociodemographic differences to a comparative collective of known SARS-CoV‑2-associated deaths. Primarily unreported cases showed a significantly lower proportion of COVID-19 as the underlying cause of death.
A systematic PCR-based monitoring of deaths allows a more targeted detection and classification of SARS-CoV‑2 positive cases. A preventive contribution can be made by disclosing unreported pandemic-related cases of death.
在新冠疫情背景下，死亡率和发病率是评估传播动态及由此产生的潜在威胁的关键决定因素。对死亡病例进行系统的微生物学监测为特别评估社区获得性死亡的漏报情况提供了基本依据。此前未报告病例的死亡队列在结构上是否可能与官方登记病例的队列有所不同，这一点有待进一步阐明。
对鼻咽拭子样本进行了针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的系统性逆转录（RT）定量聚合酶链反应（qPCR）检测。纳入了来自汉堡联邦州火葬场和法医学研究所的具有代表性的尸体样本。对汉堡首次出现与疫情相关死亡后的8周内最初报告和未报告的死亡病例进行了比较分析。
共纳入1231例死亡病例，所有病例此前均未怀疑感染SARS-CoV-2。其中记录到29例此前未知的感染病例。在疫情的第一阶段，偶然发现主要发生在法医学研究所内来自家庭环境、死亡方式不明或不自然的年轻人中。随着时间的推移，在火葬场调查的偶然发现有所增加，主要与养老院居民有关。总体队列与已知的SARS-CoV-2相关死亡的对照群体相比，在社会人口统计学方面没有显著差异。最初未报告的病例中，新冠病毒作为根本死因的比例显著较低。
基于PCR的系统性死亡监测能够更有针对性地检测和分类SARS-CoV-2阳性病例。通过披露未报告的与疫情相关的死亡病例可做出预防性贡献。
