RESUMO
Abstract Objective: To estimate temporary changes in the incidence of SARS-CoV-2-confirmed hospitalizations (by date of symptom onset) by age group during and after the national lockdown. Materials and methods: For each age group g, we computed the proportion E(g) of individuals in that age group among all cases aged 10-59y during the early lockdown period (April 20-May 3, 2020), and the corresponding proportion L(g) during the late lockdown (May 18-31, 2020) and post-lockdown (June 15-28, 2020) periods and computed the prevalence ratio: PR(g)=L(g)/E(g). Results: For the late lockdown and post-lockdown periods, the highest PR values were found in age groups 15-19y (late: PR=1.69, 95%CI 1.05,2.72; post-lockdown: PR=2.05, 1.30,3.24) and 20-24y (late: PR=1.43, 1.10,1.86; post-lockdown: PR=1.49, 1.15,1.93). These estimates were higher in individuals 15-24y compared to those ≥30y. Conclusions: Adolescents and younger adults had an increased relative incidence of SARS-CoV-2 during late lockdown and post-lockdown periods. The role of these age groups should be considered when implementing future pandemic response efforts.
Resumen Objetivo: Estimar los cambios temporales en la incidencia de hospitalizaciones confirmadas por SARS-CoV-2 (por fecha de inicio de los síntomas) por grupo de edad durante y después del cierre nacional. Material y métodos: Para cada grupo de edad g, calculamos la proporción E(g) de individuos en ese grupo de edad entre todos los casos de 10 a 59 años durante el periodo de cierre temprano (del 20 de abril al 3 de mayo de 2020) y la proporción correspondiente L(g) durante los periodos de cierre tardío (18-31 de mayo de 2020) y posterior al cierre (15-28 de junio de 2020), y se calculó la razón de prevalencia: RP(g)=L(g)/E(g). Resultados: Para los periodos de cierre tardío y posterior al cierre, los valores de RP más altos se dieron en los grupos de edad de 15 a 19 años (tardío: RP=1.69, IC95% 1.05,2.72; después del cierre: RP=2.05, 1.30,3.24) y 20-24 años (tardío: RP=1.43, 1.10,1.86; después del cierre: RP=1.49, 1.15,1.93). Estas estimaciones fueron más altas en personas de 15 a 24 años en comparación con las de ≥ 30 años Conclusiones: Los adolescentes y los adultos jóvenes tuvieron una mayor incidencia relativa de SARS-CoV-2 durante los periodos de cierre tardío y posteriores al cierre. El papel de estos grupos de edad en la transmisión de la enfermedad debe tenerse en cuenta al implementar futuros esfuerzos de respuesta a una pandemia.
RESUMO
OBJECTIVE: To estimate temporary changes in the inciden-ce of SARS-CoV-2-confirmed hospitalizations (by date of symptom onset) by age group during and after the national lockdown. MATERIALS AND METHODS: For each age group g, we computed the proportion E(g) of individuals in that age group among all cases aged 10-59y during the early lock-down period (April 20-May 3, 2020), and the corresponding proportion L(g) during the late lockdown (May 18-31, 2020) and post-lockdown (June 15-28, 2020) periods and computed the prevalence ratio: PR(g)=L(g)/E(g). RESULTS: For the late lockdown and post-lockdown periods, the highest PR values were found in age groups 15-19y (late: PR=1.69, 95%CI 1.05,2.72; post-lockdown: PR=2.05, 1.30,3.24) and 20-24y (late: PR=1.43, 1.10,1.86; post-lockdown: PR=1.49, 1.15,1.93). These estimates were higher in individuals 15-24y compared to those ≥30y. CONCLUSIONS: Adolescents and younger adults had an increased relative incidence of SARS-CoV-2 during late lockdown and post-lockdown periods. The role of these age groups should be considered when implementing future pandemic response efforts.
Assuntos
COVID-19/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Hospitalização/estatística & dados numéricos , Humanos , Incidência , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
Background: During the first months of the SARS-CoV-2 pandemic, Mexico implemented a national lockdown followed by post-lockdown mitigation. Methods: We used daily number of SARS-CoV-2-confirmed hospitalizations (by date of symptom onset) to assess the changes in the incidence of individuals between the age of 10-59 years during the epidemic in Mexico. For each age group g, we computed the proportion E(g) of individuals in that age group among all cases aged 10-59y during the early lockdown period (April 20-May 3, 2020), and the corresponding proportion L(g) during the late lockdown period (May 18-31, 2020) and post-lockdown mitigation (June 15-28, 2020). For each later period (late lockdown or post-lockdown), we computed the proportion ratios relative to the early lockdown period PR(g)=L(g)/E(g). For each pair of age groups g1,g2, PR(g1)> PR(g2) is interpreted as a relative increase in SARS-CoV-2 infections in the age group g1 compared to g2 for the late lockdown and post-lockdown periods vs. the early lockdown period. Results: For the late lockdown period, the highest PR estimates belong to persons aged 15-19y (PR=1.69(95%CI(1.05, 2.72))) and 20-24y (PR=1.43(1.10,1.86)). For the post-lockdown period, the highest PR estimates were also in age groups 15-19y (PR=2.05(1.30, 3.24)) and 20-24y (PR=1.49(1.15,1.93)). These estimates were higher in persons 15-24y compared to those ≥30y. Conclusions: Our results suggest that adolescents and younger adults had an increased relative incidence during late lockdown and the post-lockdown mitigation periods. The role of these age groups during the epidemic should be considered when implementing future pandemic response efforts.
RESUMO
BACKGROUND: Tuberculosis (TB) often occurs among household contacts of people with active TB. It is unclear whether clustering of cases represents household transmission or shared household risk factors for TB. METHODS: We used cross-sectional data from 764 households in Lima, Peru, to estimate the relative contributions of household and community transmission, the average time between cases, and the immunity afforded by a previous TB infection. RESULTS: The distribution of cases per household suggests that almost 7 of 10 nonindex household cases were infected in the community rather than in the household. The average interval between household cases was 3.5 years. We observed a saturation effect in the number of cases per household and estimated that protective immunity conferred up to 35% reduction in the risk of disease. CONCLUSIONS: Cross-sectional household data can elucidate the natural history and transmission dynamics of TB. In this high-incidence setting, we found that the majority of cases were attributable to community transmission and that household contacts of case patients derive some immunity from household exposures. Screening of household contacts may be an effective method of detecting new TB cases if carried out over several years.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/transmissão , Estudos Transversais , Características da Família , Humanos , Lactente , Pessoa de Meia-Idade , Modelos Teóricos , Peru/epidemiologia , Fatores de Risco , Fatores de Tempo , Tuberculose/transmissãoRESUMO
BACKGROUND: An accurate estimate of the total number of cases and severity of illness of an emerging infectious disease is required both to define the burden of the epidemic and to determine the severity of disease. When a novel pathogen first appears, affected individuals with severe symptoms are more likely to be diagnosed. Accordingly, the total number of cases will be underestimated and disease severity overestimated. This problem is manifest in the current epidemic of novel influenza A/H1N1. METHODS AND RESULTS: We used a simple approach to leverage measures of incident influenza A/H1N1 among a relatively small and well observed group of US, UK, Spanish and Canadian travelers who had visited Mexico to estimate the incidence among a much larger and less well surveyed population of Mexican residents. We estimate that a minimum of 113,000 to 375,000 cases of novel influenza A/H1N1 have occurred in Mexicans during the month of April, 2009. Such an estimate serves as a lower bound because it does not account for underreporting of cases in travelers or for nonrandom mixing between Mexican residents and visitors, which together could increase the estimates by more than an order of magnitude. CONCLUSIONS: We find that the number of cases in Mexican residents may exceed the number of confirmed cases by two to three orders of magnitude. While the extent of disease spread is greater than previously appreciated, our estimate suggests that severe disease is uncommon since the total number of cases is likely to be much larger than those of confirmed cases.
Assuntos
Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/epidemiologia , Influenza Humana/virologia , Canadá , Surtos de Doenças , Saúde Global , Humanos , Incidência , Tempo de Internação , México , Vigilância da População , Espanha , Viagem , Reino Unido , Estados UnidosRESUMO
OBJECTIVES: To document the attainment of developmental milestones in children with Duchenne's muscular dystrophy (DMD) and to determine whether early delays are associated with later performance on measures of cognition. STUDY DESIGN: Retrospective parental report was utilized to document the acquisition of 10 common developmental milestones in children with DMD (n = 130) and their unaffected siblings (n = 59). Children completed tests of cognitive functioning. RESULTS: Parents rated children with DMD as delayed on achieving both language and motor milestones more frequently than their unaffected siblings. Furthermore, those children with DMD who were rated as late talkers or late walkers performed more poorly on tests of cognitive function than their on-time peers. CONCLUSIONS: In addition to the commonly reported delays in motor milestones, the current study documents delays in the acquisition of language milestones as well. These early delays are associated with significant impairments in later cognitive functioning.