ABSTRACT
Összefoglaló. Bevezetés: A COVID-19-pandémia kapcsán számos tanulmány vizsgálta a tünetek gyakoriságát és a járványterjedés jellemzoit gyermekkorban, kevés azonban az alapellátás adatait összefoglaló publikáció. Közleményünkben 12 házi gyermekorvosi praxis 545 SARS-CoV-2-fertozött betegének adatait elemeztük a 2. (n = 293) és a 3. (n = 252) járványhullámban. Célkituzés: A gyermekkori fertozések tünettanának és epidemiológiai jellemzoinek összehasonlítása korcsoportok és járványhullámok között. Módszer: Valamennyi alapellátó praxis egységes retrospektív adatgyujtést végzett ugyanazon paraméterek regisztrálásával. Eredmények: A 10 év alatti betegekben a láz, a nátha és a köhögés dominált (30-50%), míg a 10 év felettiekben magas arányban regisztráltunk általános tüneteket is (30-40% fejfájás, gyengeség, szaglászavar). A 2. hullámban a 11-18 évesek (68%), a 3. hullámban a 0-10 évesek (53%) voltak többségben. A 3. hullámban szignifikánsan emelkedett a légúti tünetek elofordulása, az általános tünetek gyakorisága jelentosen csökkent, és szignifikánsan nott a családon belüli expozíció aránya (36% vs. 58%) a 2. hullámmal összehasonlítva. A gyermekrol családtagra történo továbbterjedés 24% és 16% volt a két járványhullámban, és mértékét az életkor befolyásolta. Megbeszélés: A klinikai kép az életkorral és a feltételezett vírusvariánssal mutatott összefüggést: 10 év alatt a légúti tünetek domináltak, 10 év felett szignifikánsan több általános tünetet regisztráltunk a 0-10 évesekhez képest. A 3. járványhullámban az alfa-variáns terjedésével gyakoribbá váltak a légúti tünetek, az iskolabezárások következtében megváltozott az életkori megoszlás, és megemelkedett a családi expozíció okozta fertozések aránya. A fertozés továbbadása háztartáson belül mindkét hullámban alacsony maradt. Következtetés: A COVID-19 klinikai megjelenését és terjedési jellemzoit jelentosen befolyásolta az érintett gyermekpopuláció életkori összetétele, a cirkuláló vírusvariáns és az aktuális korlátozó intézkedések. Orv Hetil. 2021; 162(44): 1751-1760. INTRODUCTION: During the COVID-19 pandemic, a large number of publications examined the frequency of symptoms and the mode of transmission in childhood but only a few community-based studies have been published. In our paper, 545 pediatric COVID-19 patients' data were collected by 12 primary care pediatricians in the second (n = 293) and third (n = 252) waves of the pandemic. OBJECTIVE: To compare the frequency of symptoms and household transmission in different age groups and between the two waves. METHOD: Patients' data and disease characteristics were recorded retrospectively in the same manner by all participating pediatricians. RESULTS: In patients of <10 years of age, fever, rhinorrhea and cough were registered the most frequently (30-50%), in contrast to patients of >10 years, where high frequency of general symptoms was found (30-40% headache, weakness, anosmia). In the third wave, the ratio of the age group 11-18 years declined from 68% to 47%, the frequency of respiratory symptoms increased significantly, while the ratio of general symptoms decreased. Household exposition was more frequent in the third wave (36% vs. 58%), while the transmission rate from children to family members was 24% and 16%, respectively, and it varied with age. DISCUSSION: Clinical manifestation showed relation to age and virus variant: the older age associated with higher frequency of general symptoms and the spread of the alpha variant led to the predominance of respiratory symptoms over general complaints. Prolonged school closures affected the age distribution and increased the frequency of household exposition. Secondary household transmission remained low. CONCLUSION: Clinical and epidemiological characteristics of pediatric COVID-19 disease were highly influenced by age, dominant virus variant and mitigation measures. Orv Hetil. 2021; 162(44): 1751-1760.
Subject(s)
COVID-19 , Adolescent , COVID-19/epidemiology , COVID-19/transmission , Child , Humans , Hungary/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2ABSTRACT
Juvenile localized scleroderma (jLS), also known as morphea, is an orphan disease. Pediatric guidelines regarding diagnosis, assessment, and management are lacking.Our objective was to develop minimum standards of care for diagnosis, assessment, and management of jLS. A systematic review was undertaken to establish the pediatric evidence for assessment and monitoring of jLS. An expert panel, including members of the Pediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based on evidence graded by the systematic review and, where evidence was lacking, consensus opinion. A nominal technique was used where 75% consensus was taken as agreement. Recommendations for diagnosis, assessment, and management were developed. Due to a lack of pediatric evidence, these were primarily consensus driven. Careful assessment for extra-cutaneous manifestations including synovitis, brain involvement, and uveitis were key features together with joint assessments between Dermatology and Rheumatology to improve and standardize care. CONCLUSION: Management of jLS is varied. These recommendations should help provide standardization of assessment and care for those with this rare and potentially debilitating condition. What is Known: ⢠Children with juvenile localized scleroderma (jLS) are managed by a number of specialties including pediatric rheumatologists and dermatologists, sometimes in shared clinics. Studies have shown that management varies considerably and that there are notable differences between specialties [1]. ⢠There is very little published guidance on management of jLS. What is new: ⢠These recommendations aim to standardize diagnosis, assessment, and management through review of pediatric evidence and consensus agreement. ⢠Joint review of patients by both pediatric rheumatologists and dermatologists is recommended.
