Adults over the age of 40 with Down syndrome are about three times more likely to die of COVID-19 than other populations, indicating that this group should be prioritized for coronavirus vaccination. Survey Published yesterday Lancet Clinical medicine I found.
From April to November 2020, a team led by researchers at Emory University conducted an international online survey of 1,046 clinicians or caregivers with Down syndrome diagnosed with COVID-19.
The results were compared to the UK survey of 59,025 hospitalized COVID-19 patients, 109 of whom had Down syndrome, from February to July 2020. It was included in the survey.
Researchers have found a sharp increase in the mortality rate of Down’s syndrome patients who have been hospitalized since the age of 40 (relative risk). [RR], 3.5 vs. UK 2.9), increased mortality in patients aged 60 years without genetic status. After adjusting for known COVID-19 mortality risk factors, the RR for death in Down syndrome patients was 2.5.
Thirteen percent of 1,046 COVID-19 patients with Down syndrome died on average at age 51 years. The mortality rate of hospitalized Down’s syndrome patients under the age of 40 was low, but still high compared to the general population mortality rate (7% vs. 3%).
Other COVID complications
Clinicians asked about medical complications reported that 60% of Down’s syndrome patients developed COVID-19 complications, especially lung problems, which were associated with higher mortality.
The most common complications include viral pneumonia (36%), acute respiratory distress syndrome (ARDS, 34%), secondary bacterial pneumonia (17%), and septic shock (11%). I did. Patients with Down’s syndrome with coronavirus-related pneumonia were more likely to die of viral pneumonia than controls (57% vs. 23%).
The average age of Down’s syndrome patients in an international survey was 29 years (standard deviation, 18 years). Most came from Europe, America, Latin America, and India.
The most common signs and symptoms of COVID-19 in Down’s syndrome patients, like other coronavirus patients, included fever, cough, and shortness of breath. Joint and muscle pain, nausea, and vomiting were less common in patients with Down syndrome, but changes in consciousness and confusion were more common, especially over the age of 40.
About half (56%) of Down’s syndrome patients were hospitalized, 50% were hospitalized in the intensive care unit and 29% needed mechanical ventilation. In addition to the risk factors for hospitalization and death that are also found in the general population, congenital heart disease has made COVID-19 patients with Down syndrome more likely to require hospitalization.
Prioritization of vaccination
The weakened and pro-inflammatory profiles associated with Down’s syndrome may make these patients more susceptible to more serious viral illnesses, the study authors said. Other risk factors such as obesity, conditions associated with premature aging (eg Alzheimer’s disease), diabetes, craniofacial abnormalities, and other comorbidities can contribute to an increased risk of respiratory tract infections.
In addition, Americans and Europeans over the age of 40 with Down Syndrome often live in group homes, other living support facilities, or nursing homes, increasing the risk of infection from other residents and staff. Those are saying. An important factor in the increase in coronavirus mortality in their study.
Dr. Anke Huels, lead author at Emory University, said at Case Western Reserve University: Press release This study shows that patients with Down syndrome often present with more severe symptoms on admission and are more susceptible to pulmonary complications associated with an increased risk of death from COVID-19. “These results affect the prophylactic and clinical management of patients with COVID-19 with Down syndrome and emphasize the need to prioritize individuals with Down syndrome for vaccination,” she said.
Case Western Co-author Albert Costa, MD, said the US Centers for Disease Control and Prevention reported Down Syndrome, partly based on research findings. High risk condition It should be prioritized in COVID-19 vaccination. “Similar decisions have been made in the UK and Spain, and we hope other countries will continue soon,” he said.
United Kingdom Survey October 21, 2020, Annual report of internal medicine Adults with Down syndrome were found to be nearly five times more likely to be infected with COVID-19 and ten times more likely to be associated with death. Huels et al. Stated that the study may underestimate cases with Down syndrome, as there were only mild cases at the peak of the first pandemic and may not have access to a primary care physician. It was.
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