世界卫生组织疑似 COVID-19 病例定义在马来西亚聚集性和散发性 SARS-CoV-2 传播中的表现。

Hospital Umum Sarawak, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia.

Hospital Sungai Buloh, Ministry of Health Malaysia, Selangor, Malaysia.

Med J Malaysia. 2023 May;78(3):279-286.

INTRODUCTION

Cluster-associated transmission has contributed to the majority of COVID-19 cases in Malaysia. Although widely used, the performance of the World Health Organization (WHO) case definition for suspected COVID19 in environments with high numbers of such cases has not been reported.

MATERIALS AND METHODS

All suspected cases of COVID-19 that self-presented to hospitals or were cluster screened from 1st April to 31st May 2020 were included. Positive SARS-CoV-2 rRT-PCR was used as the diagnostic reference for COVID-19.

RESULTS

540 individuals with suspected COVID-19 were recruited. Two-third of patients were identified through contact screening, while the rest presented sporadically. Overall COVID-19 positivity rate was 59.4% (321/540) which was higher in the cluster screened group (85.6% vs. 11.6%, p<0.001). Overall, cluster-screened COVID-19 cases were significantly younger, had fewer comorbidities and were less likely to be symptomatic than those present sporadically. Mortality was significantly lower in the cluster-screened COVID-19 cases (0.3% vs. 4.5%, p<0.05). A third of all chest radiographs in confirmed COVID-19 cases were abnormal, with consolidation, ground-glass opacities or both predominating in the peripheral lower zones. The WHO suspected case definition for COVID-19 accurately classified 35.4% of all COVID-19 patients, a rate not improved by the addition of baseline radiographic data. Misclassification rate was higher among the cluster-associated cases (80.6%) compared to sporadic cases (35.3%).

CONCLUSION

COVID-19 cases in Malaysia identified by active tracing of community cluster outbreaks had lower mortality rate. The WHO suspected COVID-19 performed poorly in this setting even when chest radiographic information was available, a finding that has implications for future spikes of the disease in countries with similar transmission characteristics.

简介

集群相关传播导致马来西亚大部分 COVID-19 病例。尽管广泛使用，但在高数量病例环境中，世界卫生组织（WHO）对疑似 COVID19 的病例定义的性能尚未报告。

材料和方法

纳入 2020 年 4 月 1 日至 5 月 31 日期间自行就诊或通过集群筛查的所有疑似 COVID-19 病例。使用 SARS-CoV-2 rRT-PCR 阳性作为 COVID-19 的诊断参考。

结果

共招募 540 例疑似 COVID-19 患者。三分之二的患者是通过接触筛查发现的，其余患者则零星出现。总体 COVID-19 阳性率为 59.4%（321/540），集群筛查组更高（85.6%比 11.6%，p<0.001）。总体而言，集群筛查的 COVID-19 病例明显更年轻，合并症更少，症状也不那么明显。集群筛查 COVID-19 病例的死亡率明显较低（0.3%比 4.5%，p<0.05）。确诊 COVID-19 病例中有三分之一的胸部 X 光片异常，周边下区以实变、磨玻璃影或两者兼有为主。WHO 对 COVID-19 的疑似病例定义准确地分类了所有 COVID-19 患者的 35.4%，而添加基线放射学数据并不能提高这一比例。集群相关病例的误诊率（80.6%）高于零星病例（35.3%）。