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Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s): Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s): We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR: 3.45, 95% CI (2.98, 3.99)], hypertension [OR: 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR: 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR: 1.51, 95% CI (1.22, 1.86)], and diabetes [OR: 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s): This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.
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Sudden infectious diseases and other malignant events cause excessive costs in the supply chain, particularly in the transportation sector. This issue, along with the uncertainty of the development of global epidemics and the frequency of extreme natural disaster events, continues to provoke discussion and reflection. However, transport systems involve interactions between different modes, which are further complicated by the reliable coupling of multiple modes. Therefore, for the vital subsystem of the supply chain-multimodal transport, in this paper, a heuristic algorithm considering node topology and transport characteristics in a multimodal transport network (MTN): the Reliability Oriented Routing Algorithm (RORA), is proposed based on the super-network and improved k-shell (IKS) algorithm. An empirical case based on the Yangtze River Delta region of China demonstrates that RORA enables a 16% reduction in the boundary value for route failure and a reduction of about 60.58% in the route cost increase compared to the typical cost-optimal algorithm, which means that RORA results in a more reliable routing solution. The analysis of network reliability also shows that the IKS values of the nodes are positively correlated with the reliability of the MTN, and nodes with different modes may have different transport reliabilities (highest for highways and lowest for inland waterways). These findings inform a reliability-based scheme and network design for multimodal transportation. Practical Applications: Recently, the COVID-19 epidemic and the frequency of natural disasters such as floods have prompted scholars to consider transport reliability. Therefore, efficient and reliable cargo transportation solutions are crucial for the sustainable development of multimodal transport in a country or region. In this paper, a new algorithm is designed to obtain a reliability-oriented optimal routing scheme for multimodal transport. Using actual data from the Yangtze River Delta region of China as an example for experimental analysis, we obtain that: (1) the proposed algorithm is superior in terms of efficiency, accuracy, and route reliability, which means that the new algorithm can quickly find more reliable routing solutions in the event of urban transport infrastructure failures;and (2) highway hubs have the greatest transport reliability. Conversely, inland waterway hubs are the least reliable. The influence of national highways and railways on the multimodal transport system is unbalanced. These findings provide decision support to transport policymakers on reliability. For example, transport investments should be focused on building large infrastructure and increasing transport capacity, strengthening the connectivity of inland waterway hubs to hubs with higher transport advantages, and leveraging the role of large hubs. © 2023 American Society of Civil Engineers.
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The crime of human trafficking is an abnormal (involuntary, passive) phenomenon of population migration (disappearance, persecution);it has attracted great attention from the public and academic community because of its resultant social harm and far-reaching impacts on individuals and families. Constrained by the concealment, dispersion, variability, and complexity of the crime of human trafficking in China, the perspectives of earlier research topics were relatively clustered and limited. During the last 10 years, geographers have gradually achieved certain new understandings and progress through continuous exploration. From the perspective of the related sub-disciplines of geography, this study focuses on the main progress, existing issues, future trends, and crime governance paths to review studies on the crime of human trafficking in China. The results indicate the following: (1) Regarding the interdisciplinary situation: The crime of human trafficking is a social pain point of common concern among multiple disciplines. Geography has the advantage of being a latecomer and its integration with other disciplines will help understand the problem in depth and solve it systematically. Geographers will have a broad stage for future research in the field of human trafficking crimes. (2) Regarding the research objects: The earlier studies on the crime of child trafficking in China in the international context were actually subject studies of human trafficking in the Chinese criminal law context. The crime of human trafficking in China is unique compared to other countries and other types of crimes. (3) Regarding the research data: In the past, the data sources mainly comprised non-governmental organizations and individuals. The current data sources show the co-occurrence of non-governmental and official sources and the trend of the integration of offline and online availability. The integration and utilization of multi-source data will be the main path to future studies. (4) Regarding field investigation: In the context of the COVID-19 pandemic's impact and the upgrading of related family tracing means, field investigation has opened up new ways, and online investigations (online interviews, participatory observation in live broadcasting rooms, etc.) have become complementary or alternative channels of traditional field investigations and surveys. (5) Regarding patterns and trends: Based on the update and verification of available data, it is found that the stability of the spatiotemporal pattern of trafficking crimes and the dependence on the main routes in China, and cross-border and inter-provincial border areas, are worthy of attention. Future research trend will shift from being independent to comprehensive—from a quantitative study to a qualitative or mixed study;from case numbers to individuals, families, and their social networks;from the source area to the bridging of source, flow, and sink areas;and from a type of human trafficking to multi-type comparisons of missing persons. (6) Regarding measures and suggestions: Combined with the existing research knowledge and current crime trends, this study presents overall strategies and specific paths for dealing with the crime of human trafficking and assisting the abducted and their relatives. © Starobulgarska Literatura 2022.
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Stimulator of interferon genes, namely STING, an adaptor protein located in the endoplasmic reticulum, has been recognized as a shining target for cancer and infection research. However, STING agonists cyclic dinucleotides (CDNs) have shown almost zero efficacy in phase I clinical trials as a monotherapy, likely due to poor cellular permeability and rapid diffusion despite intratumoral injection. These deficiencies further affect other applications of CDNs, such as pandemic SARS-CoV-2 prevention and therapy. Here, we rationally design a supramolecular cytosolic delivery system based on controllable recognition of calixarene, namely CASTING (CAlixarene-STING), to improve CDN druggability, including degradation stability, cellular permeability, and tissue retention. CASTING efficiently enhances the immunostimulatory potency of CDG(SF) [a chemically modified cyclic di-GMP (CDG)] to generate an immunogenic microenvironment for melanoma regression, anti-PD-1 response rate increase, and durable memory formation against tumor recurrence. More importantly, CASTING displays a superior adjuvant activity on SARS-CoV-2 recombinant spike/receptor binding domain vaccines, inducing robust and coordinated T-cell and antibody responses against SARS-CoV-2 infection in vivo. Collectively, the CASTING design represents an innovative advancement to facilitate the clinical translational capability of STING agonists. [GRAPHICS] .
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Objective To explore the impact of Coronavirus disease 2019 (COVID-19) epidemic on career choosing perspective among medical students and to analyze the related factors. Methods Semi-structured telephone interviews were conducted during March 1-25 2020 among 19 medical students of 8-year program from Peking Union Medical College. The grounded theory and thematic analysis were applied to code the data and identify categories and factors. Results Among the 19 respondents aged 19-26 years, 9 were males and 10 were female;10 were at the clinical stage, and 9 were at the premedical stage;3 respondents had family members involved in medical profession. Thematic analysis identified 6 main categories that affect the variability of medical students' career prospects under the COVID-19 pandemic. The 6 themes were individual characteristics of students;occupational characteristics;systemic factors;COVID-19 events;stressors of physicians and influence of job satisfaction. The outbreak affected everyone's mind of future career to varying degrees. The participants had been exposed to more negative aspects, while only one participant changed her career intention. There were conflicting views on whether to choose some specialties in future, such as respiratory medicine, infectious disease and critical care medicine. The participants feel more pressure as a doctor from the attitude of the public. Almost all participants mentioned feeling unsafe due to the high risk of occupational exposure and doctor-patient relationships. Most valued the support from their family, faculty, classmates, and volunteers. Many participants expressed their hope to improve the medical policies and systems. Conclusions The influence of COVID-19 outbreak on medical students' career choosing can be positive as well as negative in different degrees. However, we found no evidence that it altered their perspectives substantially. © 2022 Chinese Journal of Psychiatry. All rights reserved.
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Objective This study is conducted against a case of positive nucleic acid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of environmental samples in a medical institution in Chengdu. Epidemiological investigation methods and laboratory tests are used to investigate the source and analyze the cause of the case, to explore the nucleic acid monitoring mode and the disposal scheme of abnormal conditions of SARS-CoV-2 in the medical institution environment. Methods Chengdu and Shuangliu district CDC jointly investigate A Medical Institution (A refers to a specific anonymous medical institute). Epidemiological surveys were conducted though related influencing factors of the medical institution. SARS-CoV-2 nucleic acid detection kits were used for detection. Sequencing was carried out on a second-generation sequencing platform. Results From Jan.18th 2021 to Jan.20th 2021, a total of 62 smear samples of environment and articles were collected, among which 30 samples were positive for SARS-CoV-2 nucleic acid. 30 positive samples were divided into Gongwei building (9) and Zhonghe building (21) according to the sampling location. The samples' Ct values of ORF1ab gene in Gongwei building were lower than that in Zhonghe building, and the difference was statistically significant (t=2.452, P=0.036). According to the nature of the specimens, they were divided into external environment smear samples (24 samples) and cleaning tool smear samples (6 samples). The N gene Ct values of external environment smear samples were lower than that of cleaning tools, and the difference was statistically significant (Z=-2.204, P=0.028). Through gene sequencing analysis, the sequence of SARS-CoV-2 nucleic acid positive environmental samples detected this time is highly homologous with SARS-CoV-2 vaccine (> 99.9%). Conclusions The positive environmental samples of SARS-CoV-2 nucleic acid in the medical institution are caused by the damage and leakage of COVID-19 vaccine ampoules in the process of vaccination, which led to the contamination of the vaccination room of public health building, and then transmit to the hospital environment of fever clinic and complex building through cleaning tools by cleaning workers. With the progress of COVID-19 vaccine vaccination, there is a high probability of environmental pollution of vaccine liquid in the vaccination area of medical institutions. Therefore, it is necessary in combination with the current normalization monitoring requirements of domestic COVID-19 epidemic situation to refine the specific implementation plan, conduct vaccination in a scientific and orderly manner, and reduce the social impact. © 2022, Publication Centre of Anhui Medical University. All rights reserved.
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Left unmitigated, climate change poses a catastrophic risk to human health, demanding an urgent and concerted response from every country. The 2015 Lancet Commission on Health and Climate Change and The Lancet Countdown: Tracking Progress on Health and Climate Change have been initiated to map out the impacts of climate change and the necessary policy responses. To meet these challenges, Tsinghua University, partnering with the University College London and 17 Chinese and international institutions, has prepared the Chinese Lancet Countdown report, which has a national focus and builds on the work of the global Lancet Countdown: Tracking Progress on Health and Climate Change. Drawing on international methodologies and frameworks, this report aims to deepen the understanding of the links between public health and climate change at the national level and track them with 23 indicators. This work is part of the Lancet's Countdown broader efforts to develop regional expertise on this topic, and coincides with the launch of the Lancet Countdown Regional Centre in Asia, based at Tsinghua University. The data and results of this report are presented at the provincial level, where possible, to facilitate targeted response strategies for local decision-makers. Based on the data and findings of the 2020 Chinese Lancet Countdown report, five recommendations are proposed to key stakeholders in health and climate change in China: (1) Enhance inter-departmental cooperation. Climate change is a challenge that demands an integrated response from all sectors, urgently requiring substantial inter-departmental cooperation among health, environment, energy, economic, financial, and education authorities. (2) Strengthen health emergency preparedness. Knowledge and findings on current and future climate-related health threats still lack the required attention and should be fully integrated into the emergency preparedness and response system. (3) Support research and raise awareness. Additional financial support should be allocated to health and climate change research in China to enhance health system adaptation, mitigation measures, and their health benefits. At the same time, media and academia should be fully motivated to raise the public and politicians' awareness of this topic. (4) Increase climate change mitigation. Speeding up the phasing out of coal is necessary to be consistent with China's pledge to be carbon neutral by 2060 and to continue to reduce air pollution. Fossil fuel subsidies must also be phased out. (5) Ensure the recovery from COVID-19 to protect health now and in the future. China's efforts to recover from COVID-19 will shape public health for years to come. Climate change should be a priority in these interventions. © 2021, Science Press. All right reserved.
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An epidemiological investigation was carried out on a local cluster of outbreak caused by imported cases of Coronavirus Disease 2019 (COVID-19) in rural areas of Chengdu in December 2020, to find out the source of infection and the chain of transmission. According to Prevention and Control Protocol for COVID-19 (Version 7), field epidemiological investigation was adopted, combined with big data technology, video image investigation, gene sequencing and other methods to carry out investigation into COVID-19 cases and infections source tracing, analyze the epidemiological association, and map the chain of transmission. From December 7 to 17, 2020, 13 local COVID-19 confirmed cases and 1 asymptomatic case were diagnosed in Chengdu, of which 12 cases (85.71%) had a history of residence and activity in the village courtyard of Taiping (TP), Pidu (P) District, Chengdu. From November 8, 2020 to November 28, 2020, a group of inbound people form Nepal were transferred to the designated entry personnel quarantine hotel of P District which was adjacent to the TP village. During quarantine, there were 5 cases who tested positive for COVID-19. Through gene sequencing alignment, genes of local cases and Nepalese imported cases from the same period are homologous, all belong to the lineage of L2.2.3 (B.1.36 according to Pangolin lineage typing method). According to the results of field epidemiological investigation and gene sequencing analysis, the index case was most likely infected by contact with household waste of quarantine site. Under the situation of normalization prevention and control of COVID-19, sentinel monitoring of fever clinics in primary medical institutions is the key to early detection of the epidemic. The multi-department joint epidemiological investigation and the application of gene technology are the core links of the investigation and traceability of modern infectious diseases. The allocation of public health resources in rural areas needs to be strengthened. We need to improve the capacity for early surveillance and early warning of the epidemic in rural areas.
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COVID-19 , Epidemics , Disease Outbreaks , Humans , Quarantine , SARS-CoV-2ABSTRACT
Objective: To analyze the epidemiological and clinical characteristics of imported COVID-19 cases after SARS-CoV-2 vaccination and to provide evidence for the prevention and control of COVID-19. Methods: The imported COVID-19 cases in Chengdu as of April 15, 2021 were divided into the vaccinated group and unvaccinated group according to the history of SARS-CoV-2 vaccination. The epidemiological and clinical data of the cases were collected retrospectively, and the differences in epidemiological and clinical characteristics of the two groups were compared. Laboratory tests consisted of nucleic acid test, clinical index test, serum antibody test and lymphocyte test. Software WPS2019 was used for data management and software R 4.0.3 was used for statistical analysis. Results: A total of 75 COVID-19 cases were included in the analysis, in which 20 had received SARS-CoV-2 vaccination and only 4 with clinical symptoms, 55 patients did not receive SARS-CoV-2 vaccination, and 16 had clinical symptoms. In vaccinated group, the first injection time of vaccination ranged from July to November 2020, and 10 cases received two doses of vaccine simultaneously and 10 cases received two doses of vaccine at intervals of 14-57 days. The intervals between the completion of vaccination and the onset ranged from 87 days to 224 days. The differences in classification and clinical type between the two groups were significant. Significant differences were observed in case classification and clinical type between vaccinated group and unvaccinated group (P<0.05). The vaccinated group had a relatively high proportion of asymptomatic infections (40.00%, 8/20), while mild infections were mainly observed in the unvaccinated group(76.36%,42/55). The differences in Ct values (ORF1ab gene and N gene) at the diagnosis were not significant between vaccinated group and unvaccinated group (P>0.05), similar results were also observed in lymphocyte subtypes, procalcitonin and C-reactive protein level comparisons. Serum amyloid A level was higher in unvaccinated group than in vaccinated group (P<0.05). However, the SARS-CoV-2 related serum antibody of IgM, IgG and total antibody levels were significantly higher in vaccinated group (P<0.05). Conclusions: Risk of infection still exists with SARS-CoV-2 after vaccination, which can facilitate the production of specific serum antibody of IgM and IgG when people are exposed to the virus. It has a certain protective effect on SARS-CoV-2 infected persons. Vaccination can reduce the clinical symptoms and mitigate disease severity.
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COVID-19 Vaccines/administration & dosage , COVID-19 , Antibodies, Viral/blood , COVID-19/epidemiology , China/epidemiology , Humans , Retrospective Studies , VaccinationABSTRACT
Along with the spread of Covid-19, many countries are locked down, and people cannot go out for exercises as they were before. Additionally, along with the spread of streaming media, people are spending more and more time on TVs, and Internet Media, leaving less time for exercise, which is an essential factor in promoting healthy life. Current indoor exercising devices are either not fully integrated with the household environment or cannot let people exercise while watching TV. Thus, this paper introduces an electric arm training apparatus, including a housing, an arms training drive structure, an assembly matching structure and a microprocessor, said housing having an arms training drive structure mounted inside, and an assembly matching structure fixed to a lower end face of the housing, said housing having an operating structure at one end, and a mobile phone paired code at one side of the surface of the operating structure, and a voice broadcast being set above the mobile phone paired code. The device is equipped with a training drive structure that allows the user to rewind the connecting rope and handle. The training drive structure allows the user to reel in the stretched cord and handle, thus ensuring that the trainer's arm is contracted and stretched in a cyclic manner, and the assembly and matching structure allows the device to be easily interfaced with the customizable external mounting bracket - the ability to increase the diversity of device assemblies. © 2021 IEEE.
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OBJECTIVES: Although a number of cases of importation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, there are still no data available concerning the characteristics in the coronavirus disease 2019 (COVID-19) cluster of charter flight importation. Here, we provide an analysis of COVID-19 cases and their close contacts who worked for the same company on a project in Karbala, Iraq, and returned back to Chengdu, China, by a charter flight. METHODS: The data of imported COVID-19 cases and their close contacts were obtained from National Notifiable Disease Report System of Chinese Center for Disease Control and Prevention and field epidemiological investigation reports by Centers for Disease Control and Prevention (CDCs) in Chengdu. The information of general characteristics and laboratory findings of this cluster were collected and summarized. RESULTS: One hundred and six (66.67%) of 159 charter flight passengers tested positive for COVID-19 before entry. Through treatment, all 159 people tested negative and meet the requirements of taking flights bound for China before boarding. However, there has been still 36 (22.64%) of them tested positive after entry. The median time from entry to confirmation was 1.0 day (Interquartile Range (IQR): 0-4.3). The Cycle threshold value (Ct value) of 36 patients' positive samples are all above 30 and most values are above 35. CONCLUSIONS: In conclusion, there is still a risk that a number of COVID-19 cases can be imported through charter flight. However, the infectivity of confirmed patients of the charter flight was considered to be low.
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COVID-19 , China/epidemiology , Humans , Iraq/epidemiology , SARS-CoV-2 , Surveys and Questionnaires , United StatesABSTRACT
Introduction: COVID-19 is associated with characteristic lung CT findings, such as rounded ground-glass opacities in certain distributions. Diagnosing COVID-19 is a particular concern in oncology care, since cancer patients are a vulnerable population who receive treatment in close proximity to other patients and staff. Radiotherapy patients routinely undergo CT simulation before starting therapy. We hypothesized that simulation CT scans obtained on patients treated during the pandemic would reveal characteristic COVID-19 findings and represent a tool to identify patients with asymptomatic COVID-19. Methods: We reviewed patients undergoing CT simulation during a six-week period (March 1 to April 13, 2020) at a major tertiary cancer center located in an early epicenter of the COVID-19 pandemic in the United States. Most scans were done under free-breathing conditions, with slice thickness ≤3mm and without IV contrast. All scans were reviewed according to the RSNA classification of COVID-19 lung CT findings (“typical,” “indeterminate,” “atypical,” or “negative” for COVID-19 pneumonia) by radiation oncologists who had been trained by a diagnostic radiologist. All “typical” or “indeterminate” scans were considered suspicious and re-reviewed by a board-certified diagnostic radiologist. Radiographic classifications were then compared with available COVID-19 PCR test results. A one-tailed T test was used to compare the rate of positive COVID-19 tests in the radiographically suspicious vs. non-suspicious groups. Results: 414 CT simulation scans that included the lungs were performed on 400 patients during the study period. 119 patients (corresponding to 130 scans, or 31.4%) had COVID-19 PCR test results available. The most common cancer types were breast (37%), lung/thoracic (23%), and spine (21%). On initial review by radiation oncologists, 17 scans (4.1%), were deemed “typical” for COVID-19 pneumonia, 54 (13%) were “indeterminate,” 85 (21%) were “atypical,” and 258 (62.3%) were “negative.” Of the 71 suspicious (typical or indeterminate) scans, 23 had corresponding COVID-19 test results, of which 3 (15.7%) were positive for infection. 107 non-suspicious (atypical or negative) scans had corresponding COVID-19 test results, and 9 were positive (8.4%). This difference in COVID-19 positivity between radiographically suspicious and non-suspicious groups was not statistically significant (p=0.23). Upon re-review by a diagnostic radiologist, 25 (35%) of the suspicious scans were still deemed suspicious while the majority (n=46, or 65%) were deemed “atypical.” Conclusion: Simulation CT scans obtained for radiation treatment planning can be reviewed for signs of COVID-19 pneumonia. About 17% of patients simulated in our metropolitan pandemic epicenter demonstrated findings suspicious for COVID-19 when reviewed by radiation oncologists according to consensus criteria. However, few of these patients proved to have COVID-19 infections based on PCR testing, and there was no significant correlation between radiographically suspicious simulation CT scans and COVID-19 positivity in this study. Analysis was limited by the lack of available COVID-19 test results in many patients. The concordance between radiographic classification by radiation oncologists vs. diagnostic radiologists was also low. These results suggest that routine review of radiotherapy simulation CT scans is of limited value in identifying asymptomatic COVID-19 infection. Keywords: COVID-19, radiotherapy, CT
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Objectives To systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection. Methods The clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis. Results A total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection. Conclusions The clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.
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Objectives To systematically review the clinical characteristics of pregnant females and juveniles (<18 years) with Middle East Respiratory Syndrome (MERS), so as to provide evidence for epidemic prevention and treatment of COVID-19. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on clinical characteristics of pregnant females and juveniles with MERS from inception to February 15th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed. Results A total of 12 studies involving 12 pregnant females, and 21 juveniles with MERS were included. The results of studies showed that the male to female ratio of juveniles patients was 1 to 1.63 and the age ranged from 9 months to 16 years. The primary transmission route of juveniles cases was family contact infection, accounting for 57.1% (12/21). Asymptomatic juveniles accounted for 57.1% (12/21), and the most common symptoms were fever, cough and shortness of breath. Some patients exhibited gastrointestinal symptoms such as vomiting and diarrhea. The positive rate of MERS-CoV RCT test was 100.0% (21/21). As for chest radiograph, 73.7% (14/19) cases showed no obvious lesions, and juveniles with lesions were mainly bilateral. 3 patients with underlying diseases developed severe cases, the mortality was 9.5% (2/21). The age range of pregnant women was 27 to 39, with the gestational age from 6 to 38 weeks. The primary transmission route for pregnant women was nosocomial infection, accounting for 57.1% (4/7). Fever, cough, shortness of breath were common manifestations, while abdominal pain occurred in two female patients. The positive rate of MERS-CoV RCT test was 100.0% (11/11). The chest radiograph findings were mainly bilateral lesions, accounting for 55.6% (5/9). 80.0% of whole pregnant females were severe cases (8/10), 4 of them died, with the 50.0% (4/8) mortality in severe pregnant cases. Among the infective pregnant women, 2 were stillborn and 10 were delivered, of which 1 died due to premature delivery. The remaining 9 surviving newborns were not infected with MERS-CoV and there was no evidence of mother-to-child transmission. Conclusions The clinical symptoms of MERS in juveniles are similar to those in adults, however, considerably milder. Severe case rate is higher in patients with underlying diseases. However, maternal infections could be much severe with higher mortality. It is particularly important to strengthen the management of pregnant females, especially prevent hospital infection. There is still no evidence of MERS-CoV mother-to-child transmission.