Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada.
Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada.
Mult Scler Relat Disord. 2021 Nov;56:103286. doi: 10.1016/j.msard.2021.103286. Epub 2021 Sep 28.
Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children.
We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between January 2015 and March 2021. Age, date, sex, diagnosis, MOG-IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed based on diagnosis between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. We compared the post-lockdown period (March 17th, 2020, to March 31st, 2021) to previous calendar years (2015 to 2019) alone and to previous calendar years and the pre-lockdown 2020 period (January 1st, 2020, to March 16th, 2020). A p-value of < 0.05 was considered significant. Post-hoc pairwise comparisons between the post-lockdown period and previous years were performed on significant results. A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. We hypothesized that the number of new MOGAD would be significantly lower in the post-lockdown period compared to previous years due to decreased regional pathogen transmission.
Among 491 referred cases, we identified 415 new cases of neuroinflammatory disorder between January 2015 and March 2021. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years, with no MOGAD patients presenting in 2020 after the spring lockdown (q=0.0009). In addition, there were significantly fewer parainfectious neuroinflammatory cases (q=0.04) and pathogen detected (q=0.04) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q=0.185 and 0.693 respectively).
Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.
尽管人们对髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）的谱有了更好的描述，但感染在其发病机制中的作用仍不清楚。本研究的目的是评估 2020 年 3 月在安大略省（加拿大）为预防 SARS-CoV-2 传播而采取的公共卫生措施是否与儿童中 MOGAD 和其他神经炎性疾病发病率的变化有关。
我们回顾了 2015 年 1 月至 2021 年 3 月间因疑似神经炎性疾病而转介的单中心儿童队列。确定了年龄、日期、性别、诊断、髓鞘少突胶质细胞糖蛋白抗体状态以及就诊时检出的病原体。基于年度和季节的诊断进行了比较统计分析，使用 Pearson's Chi-squared 检验或 Fisher's 确切检验进行分类变量分析，使用 ANOVA 或 Kruskal-Wallis 检验进行连续变量分析，具体取决于数据类型。我们单独比较了封锁期（2020 年 3 月 17 日至 2021 年 3 月 31 日）与前几年（2015 年至 2019 年），并与前几年和封锁前的 2020 年时期（2020 年 1 月 1 日至 2020 年 3 月 16 日）进行了比较。p 值<0.05 被认为具有统计学意义。对有统计学意义的结果进行了封锁期与前几年之间的事后两两比较。使用调整后的 p 值（q 值）<0.05 进行了错误发现率校正。我们假设由于区域性病原体传播减少，封锁后 MOGAD 的新病例数会明显低于前几年。
在 491 例转介病例中，我们在 2015 年至 2021 年 3 月期间发现了 415 例新的神经炎性疾病诊断。每年的新神经炎性疾病诊断数量没有变化。我们注意到 2020 年的新 MOGAD 诊断明显减少，在春季封锁后 2020 年没有 MOGAD 患者就诊（q=0.0009）。此外，封锁后检测到的新感染性神经炎性病例（q=0.04）和病原体（q=0.04）明显减少。尽管封锁，但多发性硬化症（MS）和水通道蛋白 4 视神经脊髓炎谱系疾病（AQP4-NMOSD）的新病例数量仍保持稳定（q=0.185 和 0.693）。
增强的基于人群的感染控制策略可能在调节 MOGAD 和感染后神经炎性疾病的发病率方面发挥作用，但对 MS 或 AQP4-NMOSD 没有影响。
