该更新中有何新内容
奥密克戎变体在部分国家显示出增长优势
奥密克戎变体似乎比 δ 变体具有增长优势，并且在部分国家（包括英国）的传播速度快于 δ 变体。在群体免疫水平较高的国家，这一观察到的快速增长率是否与传播能力提升和/或免疫逃逸具有相关性，尚不得而知。需要获取更多这一新型担忧型变体（variant of concern）数据。
参阅病因学/分类章节，获取更多信息。
目前建议所有成人进行加强剂次 COVID-19 疫苗接种
英国疫苗接种和免疫联合委员会建议，所有 18 岁以上成人均应在完成疫苗基本接种时序至少 3 个月后，接受加强剂次 COVID-19 疫苗接种（辉瑞/BioNTech 疫苗和 Moderna 疫苗应受到同等推荐）。该建议的总体意图是在奥密克戎感染高峰即将到来之前，加快 COVID-19 疫苗部署。
美国疾病预防控制中心建议所有 18 岁以上成人在完成疫苗基本接种时序至少 6 个月后（mRNA 疫苗）或至少 2 个月后（杨森疫苗）接受加强剂次接种。中心亦建议，16 或 17 岁年轻成人也可接受加强剂次接种。
更多信息，参阅预防章节。
COVID-19 疫苗接种后心肌炎和心包炎临床指南发布
英国卫生安全局已制定临床指南，对 COVID-19 疫苗相关性心肌炎和心包炎临床病例的检出和管理提供支持。该指南是一份动态文件，将在获得更多数据时进行分析和更新。
如果疫苗接种 10 天内可疑出现心肌炎或心包炎，指南建议进行 12-导联心电图、炎症血液标志物和肌钙蛋白检查。
更多信息，参阅预防章节。
WHO 不建议使用恢复期血浆治疗 COVID-19
世界卫生组织（World Health Organization, WHO）已对其 COVID-19 治疗动态指南进行更新，其中包括一项新建议，即勿对非重症患者使用恢复期血浆，同时，除非是进行临床试验，否则亦勿对重症或危重患者使用恢复期血浆。
当前证据表明，恢复期血浆无法提升存活率或减少机械通气需要，但其成本却较高。
更多信息，请参阅新兴治疗章节。
sotrovimab 在英国获批用于轻中度疾病治疗
英国药品和医疗产品监管署已批准单克隆抗体 sotrovimab 用于存在出现重症高风险的轻中度疾病患者。该药物通过与 SARS-CoV-2 病毒外部刺突蛋白结合而发挥作用。这是第二个在英国获批用于该适应症的单克隆抗体。
更多信息，请参阅新兴治疗章节。
首个用于暴露前预防的单克隆抗体在美国获批
美国食品药品监督管理局已授予 tixagevimab/cilgavimab 紧急使用授权，用于中重度免疫系统受损，年龄 ≥12 岁（体重 ≥40 kg）的儿童和成人进行暴露前预防，或用于对 COVID-19 疫苗和/或疫苗成分具有严重不良反应史者。它是第一个获批使用的长效单克隆抗体混合物，也是首个同时唯一获批用于暴露前预防的单克隆抗体。
更多信息，请参阅新兴治疗章节。
WHO 建议伴有多系统炎症综合征的住院儿童使用皮质类固醇
WHO 已对其 COVID-19 临床管理生活指南进行更新，其中包括一项新的有条件建议，即对多系统炎症综合征住院儿童除给予支持性治疗外，亦可使用皮质类固醇。
更多信息，请参阅并发症章节。
小结
定义
病史和体格检查
诊断性检查
治疗流程
撰稿人
专家顾问
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H
Consultant and Emeritus Professor of Tropical and Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
利益声明
NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.
Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H
Senior Clinical Lecturer and Defence Consultant in Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
利益声明
TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.
Robert Fowler, MDCM, MS (Epi), FRCP(C)
H. Barrie Fairley Professor of Critical Care
University Health Network and Interdepartmental Division of Critical Care Medicine
Director
Clinical Epidemiology and Health Care Research
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health
University of Toronto
Chief
Tory Trauma Program
Sunnybrook Hospital
Toronto
Canada
利益声明
RF declares that he has no competing interests.
同行评议者
William A. Petri, Jr., MD, PhD
Professor
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
利益声明
WAP declares that he has no competing interests.
Xin Zhang, MD, PhD
Attending Physician
The Fifth Medical Center of PLA General Hospital
Clinical Division and Research Center of Infectious Disease
Beijing
China
利益声明
XZ declares that he has no competing interests.
Ran Nir-Paz, MD
Associate Professor in Medicine
Department of Clinical Microbiology and Infectious Diseases
Hadassah Hebrew University Medical Center
Jerusalem
Israel
利益声明
RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.
编辑
Adam Mitchell,
Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
Irene Chiwele,
Lead Section Editor, BMJ Best Practice
利益声明
IC declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
专家顾问：合并症
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
利益声明
MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).
Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP
Consultant Renal Physician
Honorary Associate Professor
Nephrology Department
Leeds Teaching Hospitals NHS Trust
Leeds
UK
利益声明
AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).
Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC
Professor of Cardiology
Imperial College London (Royal Brompton Hospital)
London
UK
利益声明
MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.
Rachael Evans, MBChB, FRCP (UK), PhD
Associate Professor (Clinical)
University of Leicester
Honorary Consultant Respiratory Physician
Glenfield Hospital
Leicester
UK
利益声明
RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).
Gerry Rayman, MD, FRCP
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
Ipswich
UK
利益声明
GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.
Sotiris Posporelis, MD, MRCPsych
Consultant Liaison Neuropsychiatrist
King’s College Hospital
South London and Maudsley NHS Foundation Trust
Honorary Senior Clinical Lecturer
Institute of Psychiatry, Psychology & Neuroscience
King’s College London
London
UK
利益声明
SP declares that he has no competing interests.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.
Matthew Jones, MD, FRCP
Consultant Neurologist
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
Manchester
UK
利益声明
AA and MJ declare that they have no competing interests.
同行评议：合并症
Martyn Patel, BMBcH, FRCP, MA
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
利益声明
MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).
Asangaedem Akpan, MPH, FRCP
Consultant Geriatrician
Liverpool University Hospitals NHS Foundation Trust
Visiting Professor
University of Cumbria
Carlisle
Honorary Clinical Associate Professor
University of Liverpool
Liverpool
UK
利益声明
AA declares that he has no competing interests.
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