Human respiratory syncytial virus subgroups A and B outbreak in a kindergarten in Zhejiang Province, China, 2023.

Background: In May-June 2023, an unprecedented outbreak of human respiratory syncytial virus (HRSV) infections occurred in a kindergarten, Zhejiang Province, China. National, provincial, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. Methods: We interviewed patients with the respiratory symptoms by questionnaire. Respiratory samples were screened for six respiratory pathogens by real-time quantitative polymerase chain reaction (RT-PCR). The confirmed cases were further sequenced of G gene to confirm the HRSV genotype. A phylogenetic tree was reconstructed by maximum likelihood method. Results: Of the 103 children in the kindergarten, 45 were classified as suspected cases, and 25 cases were confirmed by RT-PCR. All confirmed cases were identified from half of classes. 36% (9/25) were admitted to hospital, none died. The attack rate was 53.19%. The median ages of suspected and confirmed cases were 32.7 months and 35.8 months, respectively. Nine of 27 confirmed cases lived in one community. Only two-family clusters among 88 household contacts were HRSV positive. A total of 18 of the G gene were obtained from the confirmed cases. Phylogenetic analyses revealed that 16 of the sequences belonged to the HRSV B/BA9 genotype, and the other 2 sequences belonged to the HRSV A/ON1 genotype. The school were closed on June 9 and the outbreak ended on June 15. Conclusion: These findings suggest the need for an increased awareness of HRSV coinfections outbreak in the kindergarten, when HRSV resurges in the community after COVID-19 pandemic.

LncRNAs expression profile in a family household cluster of COVID-19 patients.

More than 3 years after the start of SARS-CoV-2 pandemic, the molecular mechanisms behind the viral pathogenesis are still not completely understood. Long non-coding RNAs (lncRNAs), well-known players in viral infections, can represent prime candidates for patients' risk stratification. The purpose of the current study was to investigate the lncRNA profile in a family cluster of COVID-19 cases with different disease progression, during the initial wave of the pandemic and to evaluate their potential as biomarkers for COVID-19 evolution. LncRNA expression was investigated in nasopharyngeal swabs routinely collected for diagnosis. Distinct expression patterns of five lncRNAs (HOTAIR, HOTAIRM1, TMEVPG1, NDM29 and snaR) were identified in all the investigated cases, and they were associated with disease severity. Additionally, a significant increase in the expression of GAS5-family and ZFAS1 lncRNAs, which target factors involved in the inflammatory response, was observed in the sample collected from the patient with the most severe disease progression. An lncRNA prognostic signature was defined, opening up novel research avenues in understanding the interactions between lncRNAs and SARS-CoV-2.

Contagion of coronavirus disease-the first family cluster of Pakistan: a case series.

Coronavirus Disease has resulted in public health crisis all over the world. We describe the case series of a family, who travelled together to a mass gathering in Iraq, toured Syria, Lebanon, and Doha and returned to Karachi. The data describes the demographic and clinical features of these six members. There were three males and three females. One developed severe disease and died. Incubation period was between 8-14 days. Four patients were symptomatic, had diabetes mellitus and hypertension; and presented with fever. They also had bilateral airspace opacifications on chest X-ray. Our study describes familial clustering of SARS-CoV-2 and its person-to-person transmission.

Clinical and psychological status analysis of children and parents infected with familial aggregation omicron variant in Shanghai in parent-child ward.

Aims: To analyze the clinical characteristics, treatment outcomes and sleep psychological problems of children and parents infected with familial aggregation Omicron variants under a parent-child ward treatment mode to provide a theoretical reference for the diagnosis and comprehensive treatment of Omicron variant strains. Methods: The clinical data of 225 children and 230 adult family members admitted were retrospectively collected and analyzed to investigate their clinical characteristics and response to treatments. Results: The proportion of infected adults and children was the same, and the proportion of children with mild disease was higher than that of adults, but the clinical symptoms were milder. The clinical symptoms of fever, nausea, vomiting and wheezing in children were significantly higher than in adults (P < 0.05). In addition, dry pharynx, pharynx itching and pharyngeal pain were lower than in adults (P < 0.05). The time of turning negative in the moderate group was longer than in the mild group, and the time of turning negative in the unvaccinated group was higher than in the vaccinated group (P < 0.05). The Cycle Threshold Value (Ct value) of Open Reading Frame 1ab (ORF1ab) and Nucleocapsid protein (N) gene of children were higher adults. The increase in the rate of Ct value of ORF1ab and N gene in adults treated with Traditional Chinese Medicine (TCM) was significantly higher than in those who underwent symptomatic treatment (P < 0.01). Based on the Children's Sleep Habits Questionnaire (CSHQ)score, we found varying levels of sleep problems in sleeping habits, latency and anxiety, night awakenings and abnormal sleep at all ages (P < 0.05). In the adult group, those with Self-Rating Scale of Sleep (SRSS) scores ≥3 accounted for more than 50% of adults with insomnia, sleep deprivation, sleep instability and early awakening. The proportion of adults with anxiety and depression was 21.3% and 16.4%. Conclusion: Infections in children and adults during this pandemic were mainly associated with familial aggregation infections, and their clinical symptoms were mainly located in the upper respiratory tract. With comprehensive treatment, children became negative faster, vaccination led to faster recovery, and although some patients experienced sleeping and psychological issues, all patients had good prognoses following comprehensive diagnosis under a parent-child ward treatment mode.

[Clinical features of children and their family members with family clusters of SARS-CoV-2 Omicron variant infection in Shanghai, China: an analysis of 380 cases]. / 上海380例家庭聚集性感染Omicronå˜å¼‚æ ªçš„å„¿ç«¥åŠå ¶å®¶å±žä¸´åºŠç‰¹å¾åˆ†æž.

OBJECTIVES: To study the clinical features and prognosis of children and their family members with family clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection under the admission mode of parent-child ward. METHODS: A retrospective analysis was performed on the medical data of 190 children and 190 family members with SARS-CoV-2 Omicron variant infection who were admitted to Shanghai Sixth People's Hospital, the designated hospital for coronavirus disease 2019 (COVID-19), April 8 to May 10, 2022. RESULTS: Both the child and adult groups were mainly mild COVID-19, and the proportion of mild cases in the child group was higher than that in the adult group (P<0.05). Respiratory symptoms were the main clinical manifestations in both groups. Compared with the adult group, the child group had higher incidence rates of fever, abdominal pain, diarrhea, and wheezing (P<0.05) and lower incidence rates of nasal obstruction, runny nose, cough, dry throat, throat itching, and throat pain (P<0.05). Compared with the child group, the adult group had higher rates of use of Chinese patent drugs, traditional Chinese medicine decoction, recombinant interferon spray, cough-relieving and phlegm-eliminating drugs, and nirmatrelvir/ritonavir tablets (P<0.05). Compared with the adult group, the child group had a lower vaccination rate of SARS-CoV-2 vaccine (30.5% vs 71.1%, P<0.001) and a shorter duration of positive SARS-CoV-2 nucleic acid (P<0.05). The patients with mild COVID-19 had a shorter duration of positive SARS-CoV-2 nucleic acid than those with common COVID-19 in both groups (P<0.05). The patients with underlying diseases had a longer duration of positive SARS-CoV-2 nucleic acid than those without such diseases in both groups (P<0.05). CONCLUSIONS: Both children and adults with family clusters of SARS-CoV-2 Omicron variant infection manifest mainly mild COVID-19. Despite lower vaccination rate of SARS-CoV-2 vaccine in children, they have rapid disease recovery, with a shorter duration of positive SARS-CoV-2 nucleic acid than adults, under the admission mode of parent-child ward.

Perceived Psychological Impact on Children and Parents of Experiencing COVID-19 Infection in One or More Family Members.

SARS-CoV-2 infection may impair behavior and mental health; we explored the psychological impact on parents and children who experienced COVID-19 within their families. A cross-sectional web-based survey was conducted on families attending the COVID-19 Follow-up Clinic at the Department for Women's and Children's Health, Padua (Italy). From April 2020 to August 2021, 75 surveys were collected from 66 families (97 parents and 129 children); almost 70% of participants had COVID-19, mostly asymptomatic/mildly symptomatic, and the median time from infection to survey compilation was 164.7 days (SD 56). Most parents (>87%) reported positive relationships with family members either before, during, or after COVID-19. More than one-third of children and adolescents were unable to adapt to isolation. Among 31 pre-school children with a median age of 3 (SD 1.7), a change of one or more functions was reported for 74.2% of cases irrespective of COVID-19 status, particularly a change in circadian rhythm (25%), in relationship with parents (42.8%), and poor emotional control (36%). Among 74 children with a median age of 10.9 years (SD 2.7), 8.1% had a score indicating a disease; however, significant impairment in attention was reported for 16.7%, along with anxiety/depression and problems with conduct in 5.6% and 6.5% of cases, respectively.

Parents as coronavirus disease-19 carriers in intrafamily settings: Cases of severe forms in a family cluster.

The outbreak of coronavirus disease-19 (COVID-19) infection that started in China in December 2019 has subsequently spread too many countries worldwide with high contagiousness. Given the spread and the current debate on the management and origin of intrafamilial clusters of COVID-19, this case highlights how essential it has become to prompt quarantine for the whole family and any contact member who may be at risk of infection. For this, the management of family clusters requires specific guidelines that need to be prepared to help clinicians and families to better face the disease, especially the risk of developing severe forms. We reported a case and the management of severe forms of COVID-19 infection in an intrafamily cluster with different child and parent outcomes.

Investigation on the first family cluster of Chlamydia psittaci infection in Wuhan / 公共卫生与预防医学

Objective An epidemiological investigation was carried out on the first family cluster epidemic of psittacosis in Wuhan to provide scientific basis for the prevention and control of Chlamydia psittacosis. Methods Epidemiological data were collected by field epidemiological investigation methods, and pathogenic testing was carried out by collecting cases, suspected exposed persons, and environmental samples. Results The 2 cases in the same family stared with fever, headache and chills. The first case was treated in 5 medical institutions and hospitalized in 2 of them. The results of metagenomic next-generation sequencing in the bronchoalveolar lavage fluid of the case indicated that it was infected with Chlamydia psittaci. Thirty environmental samples from cases and 3 pigeon farmers homes, 4 throat swabs from family members of pigeon farmers were collected, and 15 environmental samples were positive by real-time fluorescence quantitative polymerase chain reaction, all of which were in the cases' home and neighbor farmers' homes, including 8 pigeon feces smearing samples, 3 pigeon drinking residual water samples, 1 sand and corn eaten by pigeons, 1 tableware surface smearing sample, and 1 sample of external environment of the patient's home. Conclusions The family cluster epidemic of psittacosis was caused by exposure to the external environment contaminated by Chlamydia psittacosis. Poultry breeding should be regulated to prevent the spread of poultry infection to the human world. At the same time, the awareness of medical staff should be raised, and pathogenic testing should be carried out to confirm the diagnosis for avoiding the occurrence of severe cases and death.

Genomic epidemiological analysis of SARS-CoV-2 household transmission.

Family clusters have contributed significantly to the onward spread of SARS-CoV-2. However, the dynamics of viral transmission in this setting remain incompletely understood. We describe the clinical and viral-phylogenetic characteristics of a family cluster of SARS-CoV-2 infections with a high attack rate, and explore how whole-genome sequencing (WGS) can inform outbreak investigations in this context. In this cluster, the first symptomatic case was a 22-month-old infant who developed rhinorrhoea and sneezing 2 days prior to attending a family gathering. Subsequently, seven family members in attendance at this event were diagnosed with SARS-CoV-2 infections, including the infant described. WGS revealed indistinguishable SARS-CoV-2 genomes recovered from the adults at the gathering, which were closely related genetically to B.1 lineage viruses circulating in the local community. However, a divergent viral sub-lineage was recovered from the infant and another child, each harbouring a distinguishing spike substitution (N30S). This suggested that the infant was unlikely to be the primary case, despite displaying symptoms first, and additional analysis of her nasopharyngeal swab revealed a picornavirus co-infection to account for her early symptoms. Our findings demonstrate how WGS can elucidate the transmission dynamics of SARS-CoV-2 infections within household clusters and provide useful information to support outbreak investigations. Additionally, our description of SARS-CoV-2 viral lineages and notable variants circulating in Ireland to date provides an important genomic-epidemiological baseline in the context of vaccine introduction.

The role of children and adolescents in the transmission of SARS-CoV-2 virus within family clusters: A large population study from Oman.

BACKGROUND: In Oman, many extended families tend to live in one household. Some families can include 20-30 individuals with the majority of them being children. This study investigates the role of children in spreading SARS-CoV-2 causing COVID-19 within family clusters in Oman. METHODS: This retrospective study includes data of 1026 SARS-CoV-2 positive children (≤18 years) collected from the national surveillance database for COVID-19 between 1 February 2020 and 30 May 2020. RESULTS: We included 1026 patients. Most, 842 were Omani (82%), 52% male, and 28.5% asymptomatic. Close to the half of symptomatic 419 (40%), patients presented with fever associated with other respiratory symptoms. Fifty pediatric patients were index cases who transmitted the virus to 107 patients in total (86 adults and 21 children) with a mode of 1. There is no statistical significance of all studied risk factors in the transmission of the SARS-CoV-2 virus including age, gender, and cycle threshold (CT) value. CONCLUSIONS: According to this study, children are not to be considered a significant driver of transmission of SARS-CoV-2 in Oman.

A familial cluster of COVID-19 infection in a northern Chinese region.

OBJECTIVE: Currently, coronavirus disease 2019 (COVID-19) has spread worldwide and become a global health concern. Here, we report a familial cluster of six patients infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) in a northern Chinese region and share our local experience with regard the control of COVID-19. METHODS: The demographic data, clinical features, laboratory examinations, and epidemiological characteristics of enrolled cases were collected and analyzed. Two family members (Cases 1 and 2) had Hubei exposure history and were admitted to the hospital with a confirmed diagnosis of COVID-19; eight familial members who had contact with them during the incubation period underwent quarantine in a hospital. We closely followed up all the family members and analyzed their clinical outcome. RESULTS: Case 3 had negative SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) results but was suspected to have COVID-19 because of radiographic abnormalities. Cases 4 and 5 developed symptomatic COVID-19. Case 6 was considered an asymptomatic carrier as his SARS-CoV-2 RT-PCR result was positive. The other four family members with close contacts to COVID-19 patients had no evidence of SARS-CoV-2 infection. CONCLUSIONS: Our findings suggest that COVID-19 has infectivity during the incubation period and preventive quarantine is effective for controlling an outbreak of COVID-19 infection.

Molecular epidemiology of SARS-CoV-2 isolated from COVID-19 family clusters.

BACKGROUND: Transmission within families and multiple spike protein mutations have been associated with the rapid transmission of SARS-CoV-2. We aimed to: (1) describe full genome characterization of SARS-CoV-2 and correlate the sequences with epidemiological data within family clusters, and (2) conduct phylogenetic analysis of all samples from Yogyakarta and Central Java, Indonesia and other countries. METHODS: The study involved 17 patients with COVID-19, including two family clusters. We determined the full-genome sequences of SARS-CoV-2 using the Illumina MiSeq next-generation sequencer. Phylogenetic analysis was performed using a dataset of 142 full-genomes of SARS-CoV-2 from different regions. RESULTS: Ninety-four SNPs were detected throughout the open reading frame (ORF) of SARS-CoV-2 samples with 58% (54/94) of the nucleic acid changes resulting in amino acid mutations. About 94% (16/17) of the virus samples showed D614G on spike protein and 56% of these (9/16) showed other various amino acid mutations on this protein, including L5F, V83L, V213A, W258R, Q677H, and N811I. The virus samples from family cluster-1 (n = 3) belong to the same clade GH, in which two were collected from deceased patients, and the other from the survived patient. All samples from this family cluster revealed a combination of spike protein mutations of D614G and V213A. Virus samples from family cluster-2 (n = 3) also belonged to the clade GH and showed other spike protein mutations of L5F alongside the D614G mutation. CONCLUSIONS: Our study is the first comprehensive report associating the full-genome sequences of SARS-CoV-2 with the epidemiological data within family clusters. Phylogenetic analysis revealed that the three viruses from family cluster-1 formed a monophyletic group, whereas viruses from family cluster-2 formed a polyphyletic group indicating there is the possibility of different sources of infection. This study highlights how the same spike protein mutations among members of the same family might show different disease outcomes.

Virology features of a family cluster of SARS-CoV-2 infections in Shanghai, China.

The global spread of SARS-CoV-2 is currently continuing, and the World Health Organization has announced the risk assessment of the viruses as high. In this study, we analyzed virology features of SARS-CoV-2 causing a family cluster outbreak. Among the six family members, five have been laboratory-confirmed infection of SARS-CoV-2 viruses. A total of five SARS-CoV-2 viruses have been isolated from the nasopharyngeal swabs. The complete genome of the viruses exhibited 100% nucleotide identity with each other. Only two nucleotide differences have been observed between genomes of the isolated viruses and the HCoV/Wuhan/ IVDC-HB-01/2019 strain. Therefore, SARS-CoV-2 has been confirmed as the causation of the family cluster infections.

Serological Profile of Children and Young Adults with at Least One SARS-CoV-2 Positive Cohabitant: An Observational Study.

At the end of 2019, a new disease caused by the novel coronavirus SARS-CoV-2 appeared in Wuhan Province in China. Children seemed to be infected less frequently than adults, and family clusters seemed to play an important role in the spread of the pandemic. The aim of this study is to evaluate the serological profile of children and young adults between 4 and 16 years of age in order to assess the transmission patterns of COVID-19 between cohabitants. The subjects lived with at least one cohabitant who tested positive for the disease using a nasopharyngeal swab. To avoid contact with the disease, families were interviewed by telephone. Forty-nine children and adolescents with a mean age of 11 years were then subjected to a rapid lateral flow chromatographic test. Of them, seven (14.3%) were immunoglobulin G (IgG)-positive, and four (8.2%) were immunoglobulin M (IgM)-positive. In total, 16.3% of the tested sample had antibodies against SARS-CoV-2: this may confirm the lower vulnerability of children to COVID-19, despite the small sample size. The time from the negativization of the cohabitant until the test day may have influenced the results, especially when this timeframe is wide.

Epidemiological investigation of a COVID-19 family cluster outbreak transmitted by a 3-month-old infant.

OBJECTIVE: To investigate the clinical characteristics, epidemiological characteristics, and transmissibility of coronavirus disease 2019 (COVID-19) in a family cluster outbreak transmitted by a 3-month-old confirmed positive infant. METHODS: Field-based epidemiological methods were used to investigate cases and their close contacts. Real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) was used to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for all collected specimens. Serum SARS-CoV-2 IgM and IgG antibodies were detected by Chemiluminescence and Gold immnnochromatography (GICA). RESULTS: The outbreak was a family cluster with an attack rate of 80% (4/5). The first case in this family was a 3-month-old infant. The transmission chain was confirmed from infant to adults (her father, mother and grandmother). Fecal tests for SARS-CoV-2 RNA remained positive for 37 days after the infant was discharged. The infant's grandmother was confirmed to be positive 2 days after the infant was discharged from hospital. Patients A (3-month-old female), B (patient A's father), C (patient A's grandmother), and D (patient A's mother) had positive serum IgG and negative IgM, but patients A's grandfather serum IgG and IgM were negative. CONCLUSION: SARS-CoV-2 has strong transmissibility within family settings and presence of viral RNA in stool raises concern for possible fecal-oral transmission. Hospital follow-up and close contact tracing are necessary for those diagnosed with COVID-19.

Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.

Alert for non-respiratory symptoms of coronavirus disease 2019 patients in epidemic period: A case report of familial cluster with three asymptomatic COVID-19 patients.

At present, coronavirus disease 2019 (COVID-19) is rampaging around the world. However, asymptomatic carriers intensified the difficulty of prevention and management. Here we reported the screening, clinical features, and treatment process of a family cluster involving three COVID-19 patients. The discovery of the first asymptomatic carrier in this family cluster depends on the repeated and comprehensive epidemiological investigation by disease control experts. In addition, the combination of multiple detection methods can help clinicians find asymptomatic carriers as early as possible. In conclusion, the prevention and control experience of this family cluster showed that comprehensive rigorous epidemiological investigation and combination of multiple detection methods were of great value for the detection of hidden asymptomatic carriers.

Features of family clusters of COVID-19 patients: A retrospective study.

BACKGROUND: To investigate and compare the clinical and imaging features among family members infected with COVID-19. METHODS: We retrospectively collected a total of 34 COVID-19 cases (15 male, 19 female, aged 48 ± 16 years, ranging from 10 to 81 years) from 13 families from January 17, 2020 through February 15, 2020. Patients were divided into two groups: Group 1 - part of the family members (first-generation) who had exposure history and others (second-generation) infected through them, and Group 2 - patients from the same family having identical exposure history. We collected clinical symptoms, laboratory findings, and high-resolution computed tomography (HRCT) features for each patient. Comparison tests were performed between the first- and second-generation patients in Group 1. RESULTS: In total there were 21 patients in Group 1 and 20 patients in Group 2. For Group 1, first-generation patients had significantly higher white blood cell count (6.5 × 109/L (interquartile range (IQR): 4.9-9.2 × 109/L) vs 4.5 × 109/L (IQR: 3.7-5.3 × 109/L); P = 0.0265), higher neutrophil count (4.9 × 109/L (IQR: 3.6-7.3 × 109/L) vs 2.9 × 109/L (IQR: 2.1-3.3 × 109/L); P = 0.0111), and higher severity scores on HRCT (3.9 ± 2.4 vs 2.0 ± 1.3, P = 0.0362) than the second-generation patients. Associated underlying diseases (odds ratio, 8.0, 95% confidence interval: 3.4-18.7, P = 0.0013) were significantly correlated with radiologic severity scores in second-generation patients. CONCLUSION: Analysis of the family cluster cases suggests that COVID-19 had no age or sex predominance. Secondarily infected patients in a family tended to develop milder illness, but this was not true for those with existing comorbidities.

Epidemiological and clinical characteristics of 35 children with COVID-19 in Beijing, China.

IMPORTANCE: Within the coronavirus disease 2019 (COVID-19) global pandemic, more attention is warranted for whether this new infectious disease has unique manifestations in children. OBJECTIVE: To retrospectively determine the epidemiological and clinical characteristics of 35 children with COVID-19 in Beijing, China. METHODS: We collected data for 35 children diagnosed with COVID-19 who were admitted to Beijing Ditan Hospital from January 2020 to June 2020, and analyzed their epidemiological characteristics, clinical manifestations, laboratory examinations, chest imaging findings, treatments, and outcomes. RESULTS: The children comprised 18 boys (51.4%) and 17 girls (48.6%) aged 6 months to 15 years. All patients had clear epidemiological history, with family clusters accounting for 28 cases (80.0%) and clear tracing of exposure to high epidemic areas in the remaining 7 cases (20.0%). Four (11.4%) patients were classified as asymptomatic, 17 (48.6%) as acute upper respiratory infection, and 14 (40.0%) as mild pneumonia, with no severe or critical cases. Clinical manifestations were mild, including fever in 18 (51.4%), cough in 14 (40.0%), and nausea and diarrhea in 7 (20.0%) patients. White blood cell count was mostly normal (26 cases, 74.3%) or decreased (7 cases, 20.0%); lymphocyte percentage was increased in 24 (68.7%); neutrophil percentage was decreased in 25 (71.4%); alanine aminotransferase was increased in 3 (8.6%); and serum potassium was decreased in 4 (11.4%). Time to negative viral nucleic acid testing was 2-42 days (mean: 14.0 ± 9.4 days). Chest imaging examination revealed that 20 patients (57.1%) had different forms of lung inflammation. Treatment was mainly isolation and nutritional support. Eleven patients were treated with interferon atomization inhalation. No patients required oxygen therapy. All 35 children were cured and discharged. Length of hospital stay was 9-54 days (mean: 25.4 ± 13.8 days). During regular follow-up after discharge, 5 children showed positivity again in the viral nucleic acid test and were re-hospitalized for observation and treatment. The mean length of re-hospitalization stay was 10.8 days. INTERPRETATION: Children with COVID-19 mainly become infected within their family, and children of all ages are generally susceptible. The disease in children is mostly mild and the prognosis is good. Nucleic acid tests in some patients become positive again after discharge, suggesting that it is of great significance to carry out centralized isolation medical observations and active nucleic acid tests in close contacts for early detection of patients and routine epidemic prevention and control.

Quarantine at home may not enough!-from the epidemiological data in Shaanxi Province of China.

OBJECTIVES: A pneumonia associated with 2019 novel coronavirus (2019-nCoV, subsequently named SARS-CoV2) emerged worldwide since December, 2019. We aimed to describe the epidemiological characteristics of 2019 coronavirus disease (COVID-19) in Shaanxi province of China. RESULTS: 1. Among the 245 patients, 132 (53.9%) were males and 113 (46.1%) were females. The average age was 46.15 ± 16.43 years, ranging from 3 to 89 years. 2. For the clinical type, 1.63% (4/245) patients were mild type, 84.90% (208/245) were moderate type, 7.76% (19/245) were severe type, 5.31% (13/245) were critical type and only 0.41% (1/245) was asymptomatic. 3. Of the 245 patients, 116 (47.35%) were input case, 114 (46.53%) were non-input case, and 15 (6.12%) were unknown exposure. 4. 48.57% (119/245) cases were family cluster, involving 42 families. The most common pattern of COVID-19 family cluster was between husband and wife or between parents and children.