CHAPTER ONE
INTRODUCTION
1.1 Background to the study
In December, 2019, a cluster of pneumonia cases, who were later proven to be caused by a novel coronavirus (named as “2019-nCoV”), emerged in Wuhan City, Hubei Province, China. By January 30, 2020, 9692 confirmed cases and 15,238 suspected cases have been reported around 31 prov- inces and cities in China. Among the confirmed cases, 1527 were severe cases, 171 had recovered and been discharged at home, and 213 died. Twenty-eight confirmed cases aged from 1 month to 17 years had been reported in China.
Coronavirus (CoV) belongs to the Coronaviridae family, Nidovirales order. CoVs are divided into four genera: α-, β-, γ-, and δ-coronavirus. α- and β-coronaviruses only infect mammals, whereas γ- and δ-coronaviruses mainly infect birds, with a few infecting mammals. Human CoVs include α-coronaviruses (229E and NL63), β-coronaviruses (OC43 and HKU1), the Middle East respiratory syndrome-related coronavirus (MERS-CoV), severe acute respiratory syndrome-related coronavirus (SARS-CoV), and 2019-nCoV. The 2019-nCoV belongs to the β-coronavirus genus, which includes bat-SARS-like (SL)-CoVZC45, bat- SL-CoVZXC21, SARS-CoV, MERS-CoV, and 2019-nCoV.
Current studies have revealed that 2019-nCoV may originate from wild animals, but the exact origin remains unclear.
2019-nCoV infected patients are the main infection sources. However, we also should attach importance to asymptomatic cases which may play a critical role in the transmission process. Respiratory droplets and contact are the main transmission routes. Close contact with symptomatic cases and asymptomatic cases with silent infection are the main transmission routes of 2019-nCoV infection in children. People of all ages are susceptible to 2019-nCoV. The elderly and those with underlying chronic diseases are more likely to become severe cases. Thus far, all pediatric cases with laboratory-confirmed 2019-nCoV infection were mild cases, and no deaths had been reported.
For standardizing the prevention and treament of 2019- nCoV infections in children, we called up an experts’ com- mittee to formulate this consensus statement. This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections.
Based on the current epidemiological data, the incubation period of 2019-nCoV infections ranges from 1 to 14 days, mostly ranging from 3 to 7 days. Current reported data of pediatric cases revealed that the age of disease onset ranged from 1.5 months to 17 years, most of whom had a close contact with infected cases or were family cluster cases. Infected children might appear asymptomatic or present with fever, dry cough, and fatigue, and few have upper respiratory symptoms including nasal congestion and running nose; some patients presented with gastrointestinal symptoms including abdominal discomfort, nausea, vomiting, abdominal pain, and diarrhea.
Most infected children have mild clinical manifestations. They have no fever or symptoms of pneumonia with a good prognosis. Most of them recover within 1–2 weeks after disease onset. Few may progress to lower respiratory infections. No newborns delivered by 2019-nCoV infected mothers have been detected positive; and no newborn cases have been reported yet. It should be noted that clinical manifestations in pediatric patients should be further defined after collecting more pediat- ric case data. Furthermore, the number of confirmed infected cases will increase after a wide use of pathogen analysis.