Hyams Catherine, Challen Robert, Begier Elizabeth, Southern Jo, King Jade, Morley Anna, Szasz-Benczur Zsuzsa, Gonzalez Maria Garcia, Kinney Jane, Campling James, Gray Sharon, Oliver Jennifer, Hubler Robin, Valluri Srinivas, Vyse Andrew, McLaughlin John M, Ellsbury Gillian, Maskell Nick A, Gessner Bradford D, Danon Leon, Finn Adam
Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK.
Academic Respiratory Unit, University of Bristol, UK.
Lancet Reg Health Eur. 2022 Oct;21:100473. doi: 10.1016/j.lanepe.2022.100473. Epub 2022 Aug 8.
The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail.
We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis.
12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week).
While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high.
AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
新型冠状病毒肺炎（COVID-19）的出现以及为减少严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染而实施的公共卫生措施，均对急性下呼吸道疾病（aLRTD）的流行病学和发病趋势产生了影响。在此期间，COVID-19与非SARS-CoV-2引起的aLRTD的严重程度尚未进行详细比较。
我们对2020年8月至2021年11月期间入住英国布里斯托尔两家急症医院中任何一家的18岁及以上成年人进行了一项前瞻性队列研究。如果患者出现aLRTD的体征或症状（如咳嗽、胸膜炎），或临床或影像学诊断为aLRTD，则纳入研究。
共发生12557例成人aLRTD住院病例：10087例与感染相关（肺炎或非肺炎性下呼吸道感染[NP-LRTI]），2161例无感染原因，306例提供了最小监测数据集。确诊的SARS-CoV-2感染占呼吸道感染的32%（3178/10087）。总体、COVID-19和非SARS-CoV-2肺炎的年发病率分别为每10万成年人714.1、264.2和449.9例，NP-LRTI的年发病率分别为每10万成年人346.2、43.8和302.4例。COVID-19 aLRTD的每周发病趋势显示出大幅波动（每10万成年人每周入院中位数为6.5[四分位间距0.7-10.2]），而其他感染性aLRTD事件则更为稳定（每10万成年人每周入院中位数为14.3[四分位间距12.8-16.4]），非感染性aLRTD事件也是如此（每10万成年人每周入院中位数为4.4[四分位间距3.5-5.5]）。
在这一疫情期间，虽然COVID-19疾病是aLRTD总数的重要组成部分，但非SARS-CoV-2感染仍是导致大多数呼吸道感染住院的原因。COVID-19疾病的发病频率存在显著的时间波动，在非SARS-CoV-2感染中则不太明显。尽管采取了公共卫生干预措施来减少呼吸道感染，但疾病发病率仍然很高。
雅芳CAP是一项由研究者主导的项目，由辉瑞公司根据合作协议资助。
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