After the throat swab became negative, the anal swab test results of 8 children were still positive, which increased the possibility of fecal-oral transmission, but how infectious is still unknown.
It is not uncommon for patients with neocoronary pneumonia to test positive for anal swab nucleic acid, but in children, the positive can last more than seven weeks.
At 17:00 on March 13, Beijing time, the clinical research team of Guangzhou Women's and Children's Medical Center published in the internationally renowned academic journal "Nature Medicine" "Epidemiological and clinical characteristics analysis of children with new coronavirus infection and evidence of continuous bowel detoxification ( Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Characteristics, the study found that the possibility of neocoronavirus transmission in feces through the feces in children's cases, as well as the long-term existence of anal swab nucleic acid test positive, intestinal detoxification time, the results of this study provide clinical diagnosis and treatment of children infected with neocoronavirus This important reference provides new ideas and directions for the diagnosis, treatment and rehabilitation observation of children's cases. The research data was shared with the World Health Organization when it was published.
In the new crown pneumonia epidemic, Guangzhou Women's and Children's Medical Center, as the designated hospital for children's cases in Guangzhou area, has treated the first confirmed case of children in Guangzhou since January 22. So far, 10 cases of confirmed children have been treated. In clinical diagnosis and treatment, The hospital found that these children presented three major clinical features. One was the presence of a positive nucleic acid test for anal swabs for a long time and the intestinal detoxification time was long; the other was that CT was more effective than X-ray examinations in the case of asymptomatic infection. Indications of pneumonia were found. Third, most cases of children were cluster-onset in families with symptoms of mild, common, or even asymptomatic infection.
Of the 10 confirmed cases, 6 were male and 4 were female, ranging in age from 2 months to 15 years. The research paper pointed out that after the throat swabs became negative, the anal swab test results of 8 children were still positive, increasing the possibility of fecal-oral transmission.
"From clinical statistical observations, the detoxification time of children with throat swabs was more than two weeks, and most of them turned negative in three to five days, but the positive test of anal swabs lasted longer, and the longest case was found. It can be more than 7 weeks. "Xu Yi, director of the infection department of Guangzhou Women's and Children's Medical Center, introduced to First Financial reporter.
The longest child with positive anal swabs mentioned by Xu Yi turned negative over 51 days later and is still under medical observation 14 days after discharge.
The above research paper also pointed out that anal swab detection may be more useful than a throat swab in judging the effect of treatment, but it has not been found whether the anal swab virus has the ability to replicate, and this is exactly what confirms the potential of fecal-oral transmission Required evidence.
Gong Sitang, deputy director of Guangzhou Women's and Children's Medical Center, told First Financial News that anal swabs have a positive nucleic acid test, which is the same as a throat swab. The diagnostic value is the same, that is, the infection status is confirmed. How strong is still unknown, and further research is needed, which is also the direction of the hospital's next focus.
In the early stage, in order to reduce the source of infection to a minimum, Guangzhou Women's and Children's Medical Center has harmlessly treated feces excreted by children and diapers of small infants.
It is worth noting that the children diagnosed above are mostly asymptomatic, light or common, but the anal swab nucleic acid test is positive for a long time. How does the mechanism behind this happen? The above paper has not yet been elaborated. In response to this clinical phenomenon, Gong Sitang also told the First Financial Journalist that he has now risen to scientific research and believes that there will be answers soon.
In the case of asymptomatic infection, CT is better than X-ray examination to detect the signs of pneumonia. Guangzhou Women and Children Medical Center also explained the discovery process.
In early February this year, Guangzhou Women's and Children's Medical Center used a bedside X-ray to take a chest radiograph to check the children's lung infections, but the results were mostly no indication of pneumonia, and they had pneumonia imaging characteristics with known suspected or confirmed cases There were discrepancies between the situation and the actual course of the child's disease. Therefore, a CT examination was proposed to further understand the lung lesions. CT examination revealed that five of the ten children had lung infections, and two of them had a large area. The lesions, and therefore the CT examination method is better than X-ray examination, which ensures that children receive timely and symptomatic treatment.
In addition, for the treatment of mild children, Guangzhou Women and Children's Medical Center currently recommends no over-treatment, mainly nutrition support, psychological intervention and so on.
Author: Albert Lam Ho Yin Yue Shu