新冠疫情期间COVID-19严重程度和死亡率的转折点：卡塔尔的一项全国队列研究
Turning point in COVID-19 severity and fatality during the pandemic: a national cohort study in Qatar.
作者信息
Chemaitelly Hiam, Ayoub Houssein H, Faust Jeremy Samuel, Coyle Peter, Tang Patrick, Hasan Mohammad R, Yassine Hadi M, Al-Khatib Hebah A, Al Thani Asmaa A, Al-Kanaani Zaina, Al-Kuwari Einas, Jeremijenko Andrew, Kaleeckal Anvar Hassan, Latif Ali, Shaik Riyazuddin Mohammad, Abdul-Rahim Hanan F, Nasrallah Gheyath K, Al-Kuwari Mohamed Ghaith, Butt Adeel Ajwad, Al-Romaihi Hamad, Al-Thani Mohamed H, Al-Khal Abdullatif, Bertollini Roberto, Abu-Raddad Laith J
机构信息
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
出版信息
BMJ Public Health. 2023 Oct 29;1(1):e000479. doi: 10.1136/bmjph-2023-000479. eCollection 2023 Nov.
OBJECTIVE
To assess the evolution of COVID-19 severity and fatality in a unique setting that consistently applied, throughout the pandemic, rigorous and standardised criteria for defining severe COVID-19 outcomes.
METHODS AND ANALYSIS
We conducted a national cohort study on 312 109 Qatari citizens to investigate incidence of severe, critical or fatal COVID-19 classified according to the WHO criteria between 28 February 2020 and 21 April 2023. Incidence rates for severe, critical or fatal COVID-19 were estimated during the pre-omicron phase, first omicron wave, combined phases and throughout the pandemic.
RESULTS
Cumulative incidence of severe, critical or fatal COVID-19 after 3.14 years of follow-up was 0.45% (95% CI 0.43% to 0.47%). Incidence rate for severe, critical or fatal COVID-19 throughout the pandemic was 1.43 (95% CI 1.35 to 1.50) per 1000 person years. In the pre-omicron phase, first omicron wave, and combined phases, it was 2.01 (95% CI 1.90 to 2.13), 3.70 (95% CI 3.25 to 4.22) and 2.18 (95% CI 2.07 to 2.30) per 1000 person years, respectively. The post-first omicron phase saw a drastic drop to 0.10 (95% CI 0.08 to 0.14) per 1000 person years, a 95.4% reduction. Among all severe, critical and fatal cases, 99.5% occurred during the primary infection. Cumulative incidence of fatal COVID-19 was 0.042% (95% CI 0.036% to 0.050%), with an incidence rate of 0.13 (95% CI 0.11 to 0.16) per 1000 person years. In the post-first omicron phase, incidence rate of fatal COVID-19 decreased by 90.0% compared with earlier stages. Both severity and fatality exhibited an exponential increase with age and a linear increase with the number of coexisting conditions.
CONCLUSION
The conclusion of the first omicron wave was a turning point in the severity of the pandemic. While vaccination and enhanced case management reduced severity gradually, the rapid accumulation of natural immunity during the first omicron wave appears to have played a critical role in driving this shift in severity.
目的
在整个疫情期间始终采用严格且标准化的标准来定义新冠肺炎严重后果的独特背景下，评估新冠肺炎严重程度和死亡率的演变情况。
方法与分析
我们对312109名卡塔尔公民进行了一项全国队列研究，以调查2020年2月28日至2023年4月21日期间根据世界卫生组织标准分类的严重、危重症或致命性新冠肺炎的发病率。在奥密克戎毒株出现前阶段、首个奥密克戎毒株浪潮期、各阶段合并期以及整个疫情期间，对严重、危重症或致命性新冠肺炎的发病率进行了估计。
结果
经过3.14年的随访，严重、危重症或致命性新冠肺炎的累积发病率为0.45%（95%置信区间为0.43%至0.47%）。整个疫情期间，严重、危重症或致命性新冠肺炎的发病率为每1000人年1.43（95%置信区间为1.35至1.50）。在奥密克戎毒株出现前阶段、首个奥密克戎毒株浪潮期以及各阶段合并期，发病率分别为每1000人年2.01（95%置信区间为1.90至2.13）、3.70（95%置信区间为3.25至4.22）和2.18（95%置信区间为2.07至2.30）。首个奥密克戎毒株浪潮期之后降至每1000人年0.10（95%置信区间为0.08至0.14），下降了95.4%。在所有严重、危重症和致命病例中，99.5%发生在初次感染期间。致命性新冠肺炎的累积发病率为0.042%（95%置信区间为0.036%至0.050%），发病率为每1000人年0.13（95%置信区间为0.11至0.16）。在首个奥密克戎毒株浪潮期之后，致命性新冠肺炎的发病率与早期阶段相比下降了90.0%。严重程度和死亡率均随年龄呈指数增长，随并存疾病数量呈线性增长。
结论
首个奥密克戎毒株浪潮期是疫情严重程度的一个转折点。虽然疫苗接种和加强病例管理逐渐降低了严重程度，但首个奥密克戎毒株浪潮期期间自然免疫力的快速积累似乎在推动这种严重程度的转变中起到了关键作用。
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