CLINICAL AND EPIDEMIOLOGICAL FEATURES OF THE COURSE OF THE NEW CORONAVIRUS INFECTION IN THE STRUCTURE OF CHILDREN AND ADULT POPULATION OF THE VORONEZH REGION


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Abstract

Relevance: The Covid-19 pandemic, with each new wave, has had a significant impact on humanity and has become a serious test for every region of our planet. The territory of the Russian Federation was covered by 5 waves of a new coronavirus infection, the main peaks of which were recorded in the autumn-winter and summer periods, mainly in the form of SARS. The clinical manifestations of a new coronavirus infection are diverse and do not depend on gender and age.

Purpose: Assess the main symptoms of a new coronavirus infection.

Methods: general scientific, hygienic, epidemiological, sociological using questionnaires.

Results: According to the results of the study, it was found that 226,004 cases of COVID-19 were recorded in the Voronezh region. The incidence was recorded throughout the year with peaks in July and from August to November. The highest growth rate was noted in June (158.69%), the largest decline in December (-67.96%). The incidence among the adult population for the analyzed period is 10746.03 per 100 thousand, among children - 1755.24 per 100 thousand of the population. A new coronavirus infection prevailed in people aged 18-44 years and children aged 7-14 years. The largest proportion of cases was registered among female representatives. It was found that the course of a new coronavirus infection prevailed in the form of SARS. Among different age groups, the course of the disease with symptoms of SARS and a laboratory-confirmed case of COVID-19 without clinical manifestations decreased with age, while the diagnosis of pneumonia, on the contrary, increased.

Conclusion: According to the data received, the new coronavirus infection is prone to uneven fluctuations with peaks in July and from August to November (839.06; 978.81; 1515.41; 2514.70 and 1056.56 per 100 thousand population). Among the sick, the adult population prevailed (93.4%), predominantly female (61.08%). It was noted that in 90.95%, regardless of gender, COVID-19 most often proceeded in the form of acute respiratory viral infections, with age the number of people diagnosed with pneumonia increased.

Full Text

RELEVANCE
The spread of the epidemic process is one of the most difficult factors for society, negatively affecting many areas of life. At the beginning of 2019, a new coronavirus infection, which quickly developed into a pandemic, had a significant impact on humanity with each wave. The following properties contributed to the rapid epidemic spread of the Covid-19 virus: pronounced virulence of the pathogen, high heterogeneity, rapid genetic variability, the most uncontrolled aerogenic transmission mechanism, and high human susceptibility [1].
According to the Ministry of Health of the Russian Federation, as of March 31, 2020, a new coronavirus infection was included in the list of dangerous diseases. The epidemic situation that has developed in the world today is one of the serious tests for each region of the Earth, because the clinical manifestations of the infection are diverse and do not depend on gender and age. Based on data from literary sources, as of January 24, 2022, the territory of the Russian Federation was covered by 5 waves of a new coronavirus infection [2-3]. The main peaks of incidence were recorded in the autumn-winter and summer periods (July, September, October). In most cases, the disease, both among adults and children, proceeded with symptoms of acute respiratory viral infections, but there were also patients with pneumonia who needed hospitalization [4].
GOAL
Assess the main symptoms of a new coronavirus infection among different age groups of the Voronezh region for 2021.
METHODS
Study design.
Research objectives:
1. Analyze the dynamics of the incidence of the population.
2. Assess the incidence among adults and children.
3. Estimate the proportion of cases of the disease by age and gender.
4. Establish the predominant form of the course of pathology among different age groups.
Materials and methods
To solve the tasks set, a single-center cross-sectional sample study of data obtained at the Center for Hygiene and Epidemiology in the Voronezh Region (1C MS MedAngel Diagnostic Center program) for the period from January to December 2021 was carried out. Materials of emergency notifications included a section confirmed by COVID-19, according to which patients were divided into 4 groups: “Persons diagnosed with pneumonia”, “Persons with symptoms of SARS”, “Laboratory confirmed case of COVID-19, without clinical manifestations” “COVID-PNEUMONIA ". Adults are divided by sex and age into 5 categories: young population, age (18-44 years), middle-aged people (45-59 years), elderly (60-74 years) and senile (75-90 years) age and centenarians (90 and more years) [5]. Children are also divided into 5 groups: up to 1 year old, 1-2 years old, 3-6 years old, 7-14 years old and 15-17 years old.
The sample consisted of 226004 people, age range from 0 to 100 years (mean age 48.35±0.04 years), of which 210507 adults (mean age 51.16±0.04 years) and 15497 children (mean age 9.54 ±0.03 years). It was established that the number of sick women was 138032 people (mean age 49.95±0.05 years), men - 87972 people (mean age 45.87±0.07 years).
The incidence was calculated per 100 thousand population. The intra-annual trend was assessed by the growth rate, the rate of decline in the total population and the description of age groups. Statistical analysis of the data was carried out using the Microsoft-Excel 2010 software product. Mean (M) and relative values, standard error (m), and significance of differences were calculated using the Student's t-test. Differences were considered statistically significant at a significance level of p <0.05.
RESULTS
Analyzing the data obtained, 226,004 cases of COVID-19 were recorded in the Voronezh region, which amounted to 9,539.28 per 100,000 people. The incidence was recorded throughout the year with rises in the autumn and summer periods. The highest level of registration was observed in July and from August to November (839.06; 978.81; 1515.41; 2514.70 and 1056.56 per 100 thousand population, respectively). The highest rate of increase in incidence was observed in June - 158.69%, in
July - 87.11% and September - 80.61%, the highest rate of decline in December (-67.96%), November (-57.98%) and February (-48.04%).
The incidence of the adult population during the study period was 10,746.03 per 100,000 population. Assessing the incidence of adult population of different ages, it was found that the highest incidence of COVID-19 was recorded in young people - 4240.65 per 100 thousand of the population, in the elderly group - 2829.41 per 100 thousand of the population and in people 45-59 years old - 2723.95 per 100 thousand population. Among people aged 75-90 years and centenarians, the incidence rate is lower and amounted to 888.62 and 63.40 per 100 thousand population, respectively.
The incidence rate of a new coronavirus infection among children under 17 is 3,777.91 per 100,000 children. The frequency of registration of cases of the disease in school-age children is 1755.24 per 100 thousand of the population, among adolescents - 794.98 per 100 thousand of the population, in the group of preschool children (3–6 years old) - 785.47 per 1
00 thousand population, for children 1-2 years old - 435.88 per 100 thousand population. The lowest incidence rate was recorded in the group of children under 1 year old (6.34 per 100,000 population).
Significantly more often, the incidence was registered among the adult population (10746.03 per 100 thousand population; p <0.05; CI 10700.126 -10791.937) females (10860.61 per 100 thousand population; p <0.05; CI 10803.3-10917.9).
Of the number of registered emergency notifications, with a confirmed diagnosis of Covid-19 - 93.14% of the adult population. In the structure of the adult population, women accounted for 61.08%, and men for 38.92%. The largest proportion of cases in the structure of the adult population was noted among young people (39.46%).
The proportion of children among the sick was 6.86%. The first ranking place fell on the age group of 7-14 years (46.46%), the second place belonged to teenagers (21.04%), the third place was for children of preschool age (20.74%).
In the analysis of the clinical forms of the disease, the largest share fell on the diagnosis of ARVI - 205550 cases (90.95%); pneumonia was diagnosed in 16152 cases (7.15%), a laboratory confirmed case of COVID-19 without clinical manifestations in 4137 people (1.83%) and people with COVID pneumonia 165 (0.07%).
The main clinical manifestation of the disease was an acute respiratory viral infection (10492.64 per 100 thousand population; CI 10310.07-10675.20) without significant differences among all age and gender groups. The diagnosis of acute respiratory viral infections in men and women was 91.03% and 90.90%, respectively, the proportion of pneumonia was 7.04% in men and 7.21% in women, COVID-19 without clinical manifestations among the male population was 1.84%, in women - 1.82%, COVID-pneumonia - 0.06% in men and 0.09% in women.
Among different age groups, the registration of a disease with symptoms of SARS and a laboratory-confirmed case of COVID-19 without clinical manifestations decreased with age, and the diagnosis of pneumonia, on the contrary, increased from 2.17% among young people to 17.55% in people over the age of 75. years old. The difference in the structure of childhood and adult morbidity is the absence of a diagnosis of COVID pneumonia in children.
DISCUSSION
The pandemic had a significant impact on the structure of infectious diseases in the population of the Voronezh region. The main properties of the Covid-19 virus (virulence, rapid genetic variability, high heterogeneity, the least controlled transmission mechanism) contributed to its rapid spread among the population. The largest number of cases (68.10%) was registered in the autumn and summer periods. Assessing the monthly dynamics, we can conclude that the incidence is subject to irregular fluctuations. With the onset of the cold season, the risk of contracting respiratory infections increases, due to lower humidity, which allows viruses to remain in the air longer, as well as lack of sunlight, which adversely affects the immune system during the cold months. Morbidity in summer may increase due to tourist migration [6].
The largest share among the child population falls on organized children of preschool and school age, which may be associated with neurohormonal changes in puberty and social factors [7].
Assessing the age and sex structure, women get sick more often, while there were no significant differences between the manifestations of infection among both sexes. The largest proportion of cases fell on the age of 18–44 years (39.46%), possibly with their greater social activity. Significantly more often, the main clinical form of the manifestation of the disease among the studied individuals was ARVI, in relation to other manifestations of the disease (pneumonia, COVID - pneumonia, laboratory-confirmed diagnosis).
CONCLUSION
Findings:
1. When analyzing the annual dynamics of the incidence, a new coronavirus infection is subject to uneven fluctuations. The peak incidence was observed in July and from August to November (839.06; 978.81; 1515.41; 2514.70 and 1056.56
per 100 thousand population, respectively). The highest growth rate in June - 158.69%, in July - 87.11% and September - 80.61%, the highest rate of decline in December (-67.96%), November (-57.98%) and February ( -48.04%).
2. An increase in the incidence of COVID-19 among the adult population was recorded in the age group of 18–44 years - 4240.65 per 100 thousand of the population, among children among schoolchildren - 1755.24 per 100 thousand of the population.
3. Significantly more often the incidence was registered among women (10860.61 per 100 thousand population).
4. The structure was dominated by the adult population (93.4%), females (61.08%).
5. The predominant form of the disease was ARVI, regardless of gender (90.95%). Among the adult population, the registration of a disease with symptoms of SARS and a laboratory-confirmed case of COVID-19 without clinical manifestations decreased with age, and the diagnosis of pneumonia increased (from 2.17% to 17.55%). There was no diagnosis of COVID pneumonia in childre 
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About the authors

Margarita Mikhailovna Bulgakova

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: litochka1203@gmail.com
ORCID iD: 0000-0002-3354-0340
SPIN-code: 2608-8439

Student

Russian Federation, 10 Studentskaya str.,Voronezh,394036,Russia

Maria Alexandrovna Pobezhimova

Voronezh State Medical University named after N.N. Burdenko

Email: pobezhimova.2000@mail.ru
ORCID iD: 0000-0001-9112-7100
SPIN-code: 4940-3167

Student

Russian Federation, 10 Studentskaya str.,Voronezh,394036,Russia

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