智利与 COVID-19 相关的儿童多系统炎症综合征的动态：大流行期间、儿童接种疫苗前后的流行趋势。

Dynamics of multisystem inflammatory syndrome in children associated to COVID-19 in Chile: Epidemiologic trends during pandemic, before and after children vaccination.

机构信息

Faculty of Medicine, Universidad de Chile, Chile; Department of Pediatrics, Hospital de niños Dr. Exequiel González Cortés, Chile.

出版信息

Vaccine. 2024 Sep 17;42(22):126015. doi: 10.1016/j.vaccine.2024.05.063. Epub 2024 Jun 8.

DOI:10.1016/j.vaccine.2024.05.063

PMID:38852034

Abstract

BACKGROUND

Multisystem inflammatory syndrome associated to Covid-19 (MIS-C) is one of the most severe outcomes of SARS-CoV-2 in children. Covid-19 vaccines were successfully implemented in Chile for the pediatric population since 2021, using both mRNA and inactivated platforms. Effectiveness against MIS-C has been reported for mRNA vaccines. The aim of this study was to describe the epidemiologic trend of MIS-C in Chile during Covid-19 pandemic, both before and after the availability of vaccination for children.

MATERIALS AND METHODS

Analytic study of MIS-C cases from April 2020 to December 2022. Epidemiological data, SARS-CoV-2 variants and vaccination uptake information were obtained from the Epidemiology Department-Ministry of Health, Institute of Public Health and the National Immunization Program, respectively.

RESULTS

496 cases of MIS-C were reported, 58 % males. Median age was 5 years and most frequent age-cohorts were 6-11 and 0-2 years old with a 33 % each. After the introduction of the Covid-19 vaccine, most cases occurred in children aged 0-2 years. Incidence rates were 3.8, 5.4 and 1.7 per 100,000 inhabitants in 2020, 2021 and 2022, respectively. 97 % of cases (481) occurred in unvaccinated subjects. On those previously vaccinated (15), all but one case occurred in children receiving the inactivated vaccine. No association among circulating variants and incidence was observed. Incidence rate reduction (IRR) comparison between 2020 and 2021-2022 periods was 0.72 (CI 95 % 0.65-0.81, p < 0.05) overall; 0.86 for 0-2 years (CI 95 %:0.71-1; p = 0.12); 0.88 for 3-5 years (CI 95 %:0.69-1.11; p = 0.28); 0.61 for 6-11 years (CI 95 %: 0.50-0.75; p < 0.05); and 0.64 for 12-17 years (CI 95 %:0.47-0.89; p < 0.05), consistent with vaccination uptake during the studied period: 63 % for 3-5 years, 91 % for 6-11 years, and 99 % for 12-17 years.

CONCLUSIONS

A decline of MIS-C incidence and a shift to younger, unvaccinated population overtime was observed. IRR decreased in age-cohorts which achieved high vaccination rates.

摘要

背景

与 COVID-19 相关的多系统炎症综合征（MIS-C）是儿童感染 SARS-CoV-2 后最严重的后果之一。自 2021 年以来，智利已成功为儿科人群使用 mRNA 和灭活平台疫苗实施 COVID-19 疫苗接种。已报告 mRNA 疫苗对 MIS-C 有效。本研究旨在描述 COVID-19 大流行期间智利 MIS-C 的流行病学趋势，包括在儿童可接种疫苗之前和之后。

材料和方法

对 2020 年 4 月至 2022 年 12 月期间的 MIS-C 病例进行分析性研究。流行病学数据、SARS-CoV-2 变异体和疫苗接种情况分别来自卫生部流行病学司、公共卫生研究所和国家免疫计划。

结果

报告了 496 例 MIS-C 病例，其中 58%为男性。中位年龄为 5 岁，最常见的年龄组为 6-11 岁和 0-2 岁，各占 33%。在 COVID-19 疫苗推出后，大多数病例发生在 0-2 岁的儿童中。2020 年、2021 年和 2022 年每 100,000 居民的发病率分别为 3.8、5.4 和 1.7。97%的病例（481 例）发生在未接种疫苗的人群中。在之前接种过疫苗的 15 例中，除一例外，所有病例均发生在接受灭活疫苗的儿童中。未观察到循环变异体与发病率之间存在关联。2020 年与 2021-2022 年期间的发病率降低率（IRR）比较总体为 0.72（95%CI：0.65-0.81，p<0.05）；0-2 岁为 0.86（95%CI：0.71-1；p=0.12）；3-5 岁为 0.88（95%CI：0.69-1.11；p=0.28）；6-11 岁为 0.61（95%CI：0.50-0.75；p<0.05）；12-17 岁为 0.64（95%CI：0.47-0.89；p<0.05），与研究期间的疫苗接种率一致：3-5 岁为 63%，6-11 岁为 91%，12-17 岁为 99%。