接触者管理
世界卫生组织将接触者定义为可能或确诊病例症状发作前 2 天和症状发作后 14 天发生以下任一暴露者:[531]World Health Organization. Home care for patients with suspected or confirmed COVID-19 and management of their contacts: interim guidance. 2020 [internet publication].
https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
美国疾病预防控制中心将密切接触定义为症状发作前 2 天(或无症状患者接受检测前 2 天内),24 小时内在距感染者 2 米(6 英尺)范围内停留时间总计达 15 分钟以上者。[185]Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): contact tracing. 2020 [internet publication].
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/contact-tracing.html
从可能与感染者产生接触的最近一天起,接触者应居家隔离,监测健康状况,持续 14 天。应遵循当地监测指南。
旅行者筛查
边境仍然开放的国家可能建议进行出入境检查,特别是从疫区遣返国民时。疫区返回的旅行者应自我监测症状 14 天,并遵守接收国当地规程。某些国家可能要求旅行者在指定地点(例如酒店)进行强制隔离。建议出现症状的旅行者联系当地医疗卫生机构,最好使用电话联络。[532]World Health Organization. Updated WHO recommendations for international traffic in relation to COVID-19 outbreak. 2020 [internet publication].
https://www.who.int/ith/2019-nCoV_advice_for_international_traffic-rev/en/
一项对 566 名从武汉市撤离的日本国民展开的研究发现,基于症状的筛查并不满意,症状前和无症状病例均出现漏诊。这凸显了检测和随访的必要。[533]Arima Y, Shimada T, Suzuki M, et al. Severe acute respiratory syndrome coronavirus 2 infection among returnees to Japan from Wuhan, China, 2020. Emerg Infect Dis. 2020 Apr 10;26(7).
https://wwwnc.cdc.gov/eid/article/26/7/20-0994_article
http://www.ncbi.nlm.nih.gov/pubmed/32275498?tool=bestpractice.com
不离车筛查中心
某些国家建立了不离车筛查中心,以实现更安全、更高效的筛查。受检测者在整个过程中都不离开车辆,包括注册和问卷调查、检查、标本采集,以及后续指导。这种方法优点是使得检测能力提升,并防止侯检区域受检者之间发生交叉感染。[534]Kwon KT, Ko JH, Shin H, et al. Drive-through screening center for COVID-19: a safe and efficient screening system against massive community outbreak. J Korean Med Sci. 2020 Mar 23;35(11):e123.
https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e123
http://www.ncbi.nlm.nih.gov/pubmed/32193904?tool=bestpractice.com
体温筛查
几乎无科学证据支持使用热像仪或体温筛查设备进行体温筛查,作为 COVID-19 或所有其他发热性疾病的可靠检查方法,尤其是将其用作主要检查方法。[535]Medicines and Healthcare products Regulatory Agency. Don’t rely on temperature screening products for detection of coronavirus (COVID-19), says MHRA. 2020 [internet publication].
https://www.gov.uk/government/news/dont-rely-on-temperature-screening-products-for-detection-of-coronavirus-covid-19-says-mhra
非接触式红外温度计通常对于发热具有合理的敏感性和特异性;但是,其性能在不同环境中各有所异。环境因素(例如绝对温度、温度变化、相对湿度)在结果准确性中发挥重要作用。在目标检测区域涂抹化妆品者,或大量出汗者,可能呈现假阴性。妊娠、行经或进行激素替代治疗者,或近期饮酒或摄入热饮料者,或进行剧烈运动者,则可能呈现假阳性。同样,无症状或症状前患者不出现发热,有症状者也可能并不出现发热,从而意味着被感染者可能会遭到遗漏。[536]Aggarwal N, Garg M, Dwarakanathan V, et al. Diagnostic accuracy of non-contact infrared thermometers and thermal scanners: a systematic review and meta-analysis. J Travel Med. 2020 Oct 10 [Epub ahead of print].
https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm/taaa193/5920642
http://www.ncbi.nlm.nih.gov/pubmed/33043363?tool=bestpractice.com
尽管前额是最易于进行检查的部位,但却被认为更易随生理和环境变化产生波动,而手腕可能是更好的选择,因为它可以在不同情况下提供更为稳定的检查结果。[537]Chen G, Xie J, Dai G, et al; medRxiv. Validity of wrist and forehead temperature in temperature screening in the general population during the outbreak of 2019 novel coronavirus: a prospective real-world study. 2020 [internet publication].
https://www.medrxiv.org/content/10.1101/2020.03.02.20030148v1
非接触式红外温度计对于不同人群的准确性各异,与颞动脉温度计相比,且对成人 >37.5℃(>99.5℉)的体温,敏感性较低。因此,他们可能不是大流行期间大规模发热筛查的准确度最高装置。[538]Khan DS, Saultry MB, Adams DS, et al. Comparative accuracy testing of non-contact infrared thermometers and temporal artery thermometers in an adult hospital setting. Am J Infect Control. 2020 Oct 2 [Epub ahead of print].
https://www.ajicjournal.org/article/S0196-6553(20)30892-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33017627?tool=bestpractice.com