Shalom Ben-Shimol1,2, Gilat Livni3, Orli Megged4, David Greenberg1,2, Dana Danino1,2, Ilan Youngster5,6, Yael Shachor-Meyouhas7, Halima Dabaja-Younis7, Oded Scheuerman8, Meirav Mor6,9, Eli Somekh6,10, Husam Yakub Hanna6,10, Noga Givon-Lavi1,2, Alex Guri11,12, Eugene Leibovitz1,2, Yoav Alkan13, Daniel Grupel14, Uri Rubinstein15, Zohar Steinberg Ben Zeev16, Ellen Bamberger17, Amir Asher Kuperman18,19, Galia Grisaru-Soen20, Diana Tasher21, Giora Gottesman22, Daniel Glikman23,24, Michal Stein25,26. 1. The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel. 2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 3. Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel. 4. Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel. 5. Pediatric Infectious Diseases Unit, Shamir Medical Center, Zerifin, Israel. 6. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 7. Pediatric Infectious Disease Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. 8. Department of Pediatrics B, Schneider Children's Medical Center, Petah Tikva, Israel. 9. Infection Control Unit and Emergency Department, Schneider Children's Medical Center, Petach Tikva, Israel. 10. Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel. 11. Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel. 12. School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel. 13. Clalit Health Services, Sharon Shomron District, Israel. 14. Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel. 15. Department of Pediatrics, Laniado Medical Center, Netanya, Israel. 16. Department of Pediatrics, Emek Medical Center, Afula, Israel. 17. Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel. 18. Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. 19. Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel. 20. Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 21. Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel. 22. Pediatric Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel. 23. Infectious Diseases Unit, The Baruch Padeh Medical Center, Poriya, Israel. 24. Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. 25. Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel. 26. Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel.
Abstract
BACKGROUND: Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS: An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS: Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS: At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
BACKGROUND: Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS: An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS: Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS: At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.