Freitas André Ricardo Ribas, Beckedorff Otto Albuquerque, Cavalcanti Luciano Pamplona de Góes, Siqueira Andre M, Castro Daniel Barros de, Costa Cristiano Fernandes da, Lemos Daniele Rocha Queiróz, Barros Eliana N C
Faculdade de Medicina São Leopoldo Mandic de Campinas, Campinas-SP, Brazil.
Programa de Pós-graduação em Saúde Coletiva da Universidade Federal do Ceará, Fortaleza-CE, Brazil.
Lancet Reg Health Am. 2021 Sep;1:100021. doi: 10.1016/j.lana.2021.100021. Epub 2021 Jul 13.
Since the end of 2020, there has been a great deal of international concern about the variants of SARS-COV-2 B.1.1.7, identified in the United Kingdom; B.1.351 discovered in South Africa and P.1, originating from the Brazilian state of Amazonas. The three variants were associated with an increase in transmissibility and worsening of the epidemiological situation in the places where they expanded. The lineage B.1.1.7 was associated with the increase in case fatality rate in the United Kingdom. There are still no studies on the case fatality rate of the other two variants. The aim of this study was to analyze the mortality profile before and after the emergence of the P.1 strain in the Amazonas state.
We analyzed data from the Influenza Epidemiological Surveillance Information System, SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe), comparing two distinct epidemiological periods: during the peak of the first wave, between April and May 2020, and in January 2021 (the second wave), the month in which the new variant came to predominate. We calculated mortality rates, overall case fatality rate and case fatality rate among hospitalized patients; all rates were calculated by age and gender and 95% confidence intervals (95% CI) were determined.
We observed that in the second wave there were a higher incidence and an increase in the proportion of cases of COVID-19 in the younger age groups. There was also an increase in the proportion of women among Severe Acute Respiratory Infection (SARI) cases from 40% (2,709) in the first wave to 47% (2,898) in the second wave and in the proportion of deaths due to COVID-19 between the two periods varying from 34% (1,051) to 47% (1,724), respectively. In addition, the proportion of deaths among people between 20 and 59 years old has increased in both sexes. The case fatality rate among those hospitalized in the population between 20 and 39 years old during the second wave was 2.7 times the rate observed in the first wave (female rate ratio = 2.71; 95% CI: 1.9-3.9], p <0.0001; male rate ratio = 2.70, 95%CI:2.0-3.7), and in the general population the rate ratios were 1.15 (95% CI: 1.1-1.2) in females and 0.78 (95% CI: 0.7-0.8) in males].
Based on this prompt analysis of the epidemiological scenario in the Amazonas state, the observed changes in the pattern of mortality due to COVID-19 between age groups and gender simultaneously with the emergence of the P.1 strain suggest changes in the pathogenicity and virulence profile of this new variant. Further studies are needed to better understanding of SARS-CoV-2 variants profile and their impact for the health population.
There was no funding for this study.
自2020年底以来，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的B.1.1.7变种（在英国发现）、B.1.351变种（在南非发现）和源自巴西亚马孙州的P.1变种引发了国际社会的广泛关注。这三种变种与传播性增加以及在其传播地区的疫情恶化有关。B.1.1.7谱系与英国病死率上升有关。关于其他两种变种的病死率尚无研究。本研究的目的是分析亚马孙州出现P.1毒株前后的死亡情况。
我们分析了流感流行病学监测信息系统（SIVEP-Gripe，即流感流行病学监测信息系统）的数据，比较了两个不同的流行时期：2020年4月至5月第一波疫情高峰期，以及2021年1月（第二波疫情），即新变种开始占主导地位的月份。我们计算了死亡率、总体病死率以及住院患者的病死率；所有率均按年龄和性别计算，并确定了95%置信区间（95%CI）。
我们观察到，在第二波疫情中，较年轻年龄组的新冠肺炎发病率更高，病例比例增加。重症急性呼吸感染（SARI）病例中女性的比例也有所增加，从第一波的40%（2709例）增至第二波的47%（2898例），两个时期因新冠肺炎死亡的比例分别从34%（1051例）增至47%（1724例）。此外，20至59岁人群中男女的死亡比例均有所增加。第二波疫情期间，20至39岁人群中住院患者的病死率是第一波观察到的病死率的2.7倍（女性率比=2.71；95%CI：1.9-3.9，p<0.0001；男性率比=2.70，95%CI：2.0-3.7），在普通人群中，女性率比为1.15（95%CI：1.1-1.2），男性率比为0.78（95%CI：0.7-0.8）。
基于对亚马孙州疫情的快速分析，随着P.1毒株的出现，各年龄组和性别间新冠肺炎死亡模式的变化表明这种新变种的致病性和毒力特征发生了变化。需要进一步研究以更好地了解SARS-CoV-2变种的特征及其对健康人群的影响。
本研究没有资金支持。
