在英国普通人群中的症状和严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）阳性。
Symptoms and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positivity in the General Population in the United Kingdom.
机构信息
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, United Kingdom.
出版信息
Clin Infect Dis. 2022 Aug 24;75(1):e329-e337. doi: 10.1093/cid/ciab945.
BACKGROUND
"Classic" symptoms (cough, fever, loss of taste/smell) prompt severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing in the United Kingdom. Studies have assessed the ability of different symptoms to identify infection, but few have compared symptoms over time (reflecting variants) and by vaccination status.
METHODS
Using the COVID-19 Infection Survey, sampling households across the United Kingdom, we compared symptoms in PCR-positives vs PCR-negatives, evaluating sensitivity of combinations of 12 symptoms (percentage symptomatic PCR-positives reporting specific symptoms) and tests per case (TPC) (PCR-positives or PCR-negatives reporting specific symptoms/ PCR-positives reporting specific symptoms).
RESULTS
Between April 2020 and August 2021, 27 869 SARS-CoV-2 PCR-positive episodes occurred in 27 692 participants (median 42 years), of whom 13 427 (48%) self-reported symptoms ("symptomatic PCR-positives"). The comparator comprised 3 806 692 test-negative visits (457 215 participants); 130 612 (3%) self-reported symptoms ("symptomatic PCR-negatives"). Symptom reporting in PCR-positives varied by age, sex, and ethnicity, and over time, reflecting changes in prevalence of viral variants, incidental changes (eg, seasonal pathogens (with sore throat increasing in PCR-positives and PCR-negatives from April 2021), schools reopening) and vaccination rollout. After May 2021 when Delta emerged, headache and fever substantially increased in PCR-positives, but not PCR-negatives. Sensitivity of symptom-based detection increased from 74% using "classic" symptoms, to 81% adding fatigue/weakness, and 90% including all 8 additional symptoms. However, this increased TPC from 4.6 to 5.3 to 8.7.
CONCLUSIONS
Expanded symptom combinations may provide modest benefits for sensitivity of PCR-based case detection, but this will vary between settings and over time, and increases tests/case. Large-scale changes to targeted PCR-testing approaches require careful evaluation given substantial resource and infrastructure implications.
背景
“经典”症状（咳嗽、发热、味觉/嗅觉丧失）促使英国对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）聚合酶链反应（PCR）进行检测。已有研究评估了不同症状识别感染的能力，但很少有研究比较随时间推移（反映变体）和接种疫苗状态的症状。
方法
使用 COVID-19 感染调查，在英国各地抽样家庭，我们比较了 PCR 阳性者与 PCR 阴性者的症状，评估了 12 种症状组合（报告特定症状的 PCR 阳性百分比）和每例检测数（TPC）（报告特定症状的 PCR 阳性或 PCR 阴性/报告特定症状的 PCR 阳性）的敏感性。
结果
2020 年 4 月至 2021 年 8 月，27692 名参与者（中位年龄 42 岁）中发生了 27869 例 SARS-CoV-2 PCR 阳性病例，其中 13427 例（48%）自我报告有症状（“有症状的 PCR 阳性者”）。对照组包括 3806692 次检测阴性就诊（457215 名参与者）；130612 例（3%）自我报告有症状（“有症状的 PCR 阴性者”）。PCR 阳性者的症状报告因年龄、性别和种族而异，且随时间推移而变化，反映了病毒变体流行率的变化、偶发变化（例如，季节性病原体（PCR 阳性者和 PCR 阴性者的喉咙痛增加），学校重新开放）和疫苗接种推广。2021 年 5 月 Delta 出现后，PCR 阳性者的头痛和发热显著增加，但 PCR 阴性者没有。基于症状的检测敏感性从使用“经典”症状时的 74%增加到增加疲劳/虚弱时的 81%，以及包括所有 8 种附加症状时的 90%。然而，这增加了每例检测数从 4.6 增加到 5.3 增加到 8.7。
结论
扩大症状组合可能会适度提高基于 PCR 的病例检测敏感性，但这种提高会因设置和时间的不同而不同，并且会增加检测/病例数。鉴于对资源和基础设施的重大影响，需要对大规模改变针对 PCR 检测的方法进行仔细评估。
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