Importance: Multiple inflammatory syndrome in children (MIS-C) occurs in association with the COVID-19 pandemic. Objective: To describe the clinical characteristics and geographic and temporal distribution of the largest cohort of patients with MIS-C in the United States to date. Design, Setting, and Participants: Cross-sectional analysis was conducted on clinical and laboratory data collected from patients with MIS-C. The analysis included patients with illness onset from March 2020 to January 2021 and met MIS-C case definition. Main Outcomes and Measures: Geographic and temporal distribution of MIS-C was compared with that of COVID-19 nationally, by region, and level of urbanicity by county. Clinical and laboratory findings and changes over time were described by age group and by presence or absence of preceding COVID-19. Results: A total of 1733 patients with MIS-C were identified; 994 (57.6%) were male and 1117 (71.3%) were Hispanic or non-Hispanic Black. Gastrointestinal symptoms, rash, and conjunctival hyperemia were reported by 53% (n = 931) to 67% (n = 1153) of patients. A total of 937 patients (54%) had hypotension or shock, and 1009 (58.2%) were admitted for intensive care. Cardiac dysfunction was reported in 484 patients (31.0%), pericardial effusion in 365 (23.4%), myocarditis in 300 (17.3%), and coronary artery dilatation or aneurysms in 258 (16.5%). Patients aged 0 to 4 years had the lowest proportion of severe manifestations, although 171 patients (38.4%) had hypotension or shock and 197 (44.3%) were admitted for intensive care. Patients aged 18 to 20 years had the highest proportions with myocarditis (17 [30.9%]), pneumonia (20 [36.4%]), acute respiratory distress syndrome (10 [18.2%]), and polymerase chain reaction positivity (39 [70.9%]). These older adolescents also had the highest proportion reporting preceding COVID-19-like illness (63%). Nationally, the first 2 MIS-C peaks followed the COVID-19 peaks by 2 to 5 weeks. The cumulative MIS-C incidence per 100 000 persons younger than 21 years was 2.1 and varied from 0.2 to 6.3 by state. Twenty-four patients (1.4%) died. Conclusions and Relevance: In this cross-sectional study of a large cohort of patients with MIS-C, 2 peaks that followed COVID-19 peaks by 2 to 5 weeks were identified. The geographic and temporal association of MIS-C with the COVID-19 pandemic suggested that MIS-C resulted from delayed immunologic responses to SARS-CoV-2 infection. The clinical manifestations varied by age and by presence or absence of preceding COVID-19.
Importance: Multiple inflammatory syndrome in children (MIS-C) occurs in association with the COVID-19 pandemic. Objective: To describe the clinical characteristics and geographic and temporal distribution of the largest cohort of patients with MIS-C in the United States to date. Design, Setting, and Participants: Cross-sectional analysis was conducted on clinical and laboratory data collected from patients with MIS-C. The analysis included patients with illness onset from March 2020 to January 2021 and met MIS-C case definition. Main Outcomes and Measures: Geographic and temporal distribution of MIS-C was compared with that of COVID-19 nationally, by region, and level of urbanicity by county. Clinical and laboratory findings and changes over time were described by age group and by presence or absence of preceding COVID-19. Results: A total of 1733 patients with MIS-C were identified; 994 (57.6%) were male and 1117 (71.3%) were Hispanic or non-Hispanic Black. Gastrointestinal symptoms, rash, and conjunctival hyperemia were reported by 53% (n = 931) to 67% (n = 1153) of patients. A total of 937 patients (54%) had hypotension or shock, and 1009 (58.2%) were admitted for intensive care. Cardiac dysfunction was reported in 484 patients (31.0%), pericardial effusion in 365 (23.4%), myocarditis in 300 (17.3%), and coronary artery dilatation or aneurysms in 258 (16.5%). Patients aged 0 to 4 years had the lowest proportion of severe manifestations, although 171 patients (38.4%) had hypotension or shock and 197 (44.3%) were admitted for intensive care. Patients aged 18 to 20 years had the highest proportions with myocarditis (17 [30.9%]), pneumonia (20 [36.4%]), acute respiratory distress syndrome (10 [18.2%]), and polymerase chain reaction positivity (39 [70.9%]). These older adolescents also had the highest proportion reporting preceding COVID-19-like illness (63%). Nationally, the first 2 MIS-C peaks followed the COVID-19 peaks by 2 to 5 weeks. The cumulative MIS-C incidence per 100 000 persons younger than 21 years was 2.1 and varied from 0.2 to 6.3 by state. Twenty-four patients (1.4%) died. Conclusions and Relevance: In this cross-sectional study of a large cohort of patients with MIS-C, 2 peaks that followed COVID-19 peaks by 2 to 5 weeks were identified. The geographic and temporal association of MIS-C with the COVID-19 pandemic suggested that MIS-C resulted from delayed immunologic responses to SARS-CoV-2 infection. The clinical manifestations varied by age and by presence or absence of preceding COVID-19.
Authors: Meghan Laverty; Marina Salvadori; Susan G Squires; May Ahmed; Lisa Eisenbeis; Santina Lee; Annick Des Cormiers; Y Anita Li Journal: Can Commun Dis Rep Date: 2021-11-10
Authors: Amanda B Payne; Zunera Gilani; Shana Godfred-Cato; Ermias D Belay; Leora R Feldstein; Manish M Patel; Adrienne G Randolph; Margaret Newhams; Deepam Thomas; Reed Magleby; Katherine Hsu; Meagan Burns; Elizabeth Dufort; Angie Maxted; Michael Pietrowski; Allison Longenberger; Sally Bidol; Justin Henderson; Lynn Sosa; Alexandra Edmundson; Melissa Tobin-D'Angelo; Laura Edison; Sabrina Heidemann; Aalok R Singh; John S Giuliano; Lawrence C Kleinman; Keiko M Tarquinio; Rowan F Walsh; Julie C Fitzgerald; Katharine N Clouser; Shira J Gertz; Ryan W Carroll; Christopher L Carroll; Brooke E Hoots; Carrie Reed; F Scott Dahlgren; Matthew E Oster; Timmy J Pierce; Aaron T Curns; Gayle E Langley; Angela P Campbell; Neha Balachandran; Thomas S Murray; Cole Burkholder; Troy Brancard; Jenna Lifshitz; Dylan Leach; Ian Charpie; Cory Tice; Susan E Coffin; Dana Perella; Kaitlin Jones; Kimberly L Marohn; Phoebe H Yager; Neil D Fernandes; Heidi R Flori; Monica L Koncicki; Karen S Walker; Maria Cecilia Di Pentima; Simon Li; Steven M Horwitz; Sunanda Gaur; Dennis C Coffey; Ilana Harwayne-Gidansky; Saul R Hymes; Neal J Thomas; Kate G Ackerman; Jill M Cholette Journal: JAMA Netw Open Date: 2021-06-01
Authors: Hyemin Chung; Hyeonji Seo; Sunghee Park; Haein Kim; Jiwon Jung; Yong Pil Chong; Sung Han Kim; Sang Oh Lee; Sang Ho Choi; Yang Soo Kim; Min Jae Kim Journal: J Korean Med Sci Date: 2021-06-28 Impact factor: 2.153