COVID-19 Publications

22

Dec, 2020

Clinical Charateristrics of 58 Children with a Pediatric Inflmmatory Multisystem Syndrome Temporally Associated with SARS-CoV-2

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Authors: Elizabeth Whittaker, Alasdair Bamford, Julia Kenny, Myrsini Kaforou, Christine E Jones, Priyen Shah, Padmanabhan Ramnarayan, Alain Fraisse, Owen Miller, Patrick Davies, Filip Kucera, Joe Brierley, Marilyn McDougall, Michael Carter, Adriana Tremoulet, Chisato Shimizu, Jethro Herberg, Jane C Burns, Hermione Lyall, Michael Levin, PIMS-TS Study Group and EUCLIDS and PERFORM Consortia

Published in: JAMA Network

 

Abstract: Importance: In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation.

Objectives:To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders.

Design, setting, and participants:Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019.

Exposures:Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization.

Main outcomes and measures:Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders.

Results:Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively).

Conclusions and relevance:In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.

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22

Dec, 2020

Multisystem Inflammatory Syndrome in U.S Children and Adolescents

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Authors: Leora R. Feldstein, Ph.D., Erica B. Rose, Ph.D., Steven M. Horwitz, M.D.

Published in: The New England Journal of Medicine

 

Abstract: Background: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

Methods: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.

Results: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).

Conclusions: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)

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22

Dec, 2020

Multisystem Inflammatory Syndrome in Children in New York State

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Authors: Elizabeth M. Dufort, M.D., Emilia H. Koumans, M.D., M.P.H., Eric J. Chow, M.D., M.P.H., Elizabeth M. Rosenthal, M.P.H., Alison Muse, M.P.H.,  Jemma Rowlands, M.P.H., Meredith A. Barranco, M.P.H.,
Angela M. Maxted, D.V.M., Ph.D.,  Eli S. Rosenberg, Ph.D., Delia Easton, Ph.D.,  Tomoko Udo, Ph.D., et al
Jessica Kumar, D.O.,  for the New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team

Published in: NEJM

 

Abstract: Background: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome.

Methods: Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.

Results: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.

Conclusions: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

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22

Dec, 2020

Addition of Corticosteroids to Immune Globulins is Associated with Recovery of Cardiac function in Multi-inflammatory Syndrome in Children (MIS-C)

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Authors: Zahra Belhadjer, Johanne Auriau, Mathilde Méot, Sylvain Renolleau, Lucile Houyel, Damien Bonnet

Published in: AHA Journals

 

Introduction: An entity related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection associated with a multisystem inflammatory state in children (MIS-C) and acute heart failure has been described.1 Early treatment of MIS-C has mimicked that of Kawasaki disease with the use of intravenous immunoglobulin (IVIG) and other anti-inflammatory agents.1–3 This strategy seems to be effective because the outcomes are usually favorable with a very limited number of fatalities.1,3 Yet, there is no consensus or evidence for the optimal treatment strategy in MIS-C, and the effect of treatment strategies on the recovery of cardiac function has not been yet described.

We report the evolution of cardiac function in children admitted at our institution for MIS-C, defined by persistent fever (>38.5 °C) for >3 days, multiorgan involvement, evidence for coagulopathy (D-dimers>1000 ng/mL), inflammation (C-reactive protein>80 mg/L), and positive antibody assays for SARS-CoV-2 infection. Three clinical criteria among the following had to be observed to define multiorgan involvement in this series: cervical lymphadenopathy, bulbar conjunctivitis, skin rash, erythema of oral and pharyngeal mucosa, gastrointestinal symptoms, asthenia, respiratory signs, heart failure, or cardiogenic shock.

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28

Oct, 2020

PAIRED PANDEMICS: Ensuring HIV Care Continuity and Market Stability During COVID-19

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Join this webinar, hosted by CHAI, to get highlights on key trends in the HIV space in LMICs from CHAI’s 2020 HIV Market Report.

You can expect an insightful panel discussion focusing on the resiliency of national HIV programs and markets and ensuring HIV care continuity during these trying times.

Date: November 12 2020

Time: 8am – 9am EST (13 – 14 GMT)

Register to join the webinar here.

23

Oct, 2020

XIII Foresight Training Course: Challenges for Researchers and Regulators Facing The Pandemic Crisis

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Fonazione Gianni Benzi, a partner of c4c, proudly brings you this training session focusing on the proposed European Union Pharmaceutical strategy which intends to improve and accelerate patient access to medicines.

 

This training will include discussions on how the COVID-19 pandemic has changed some of the pillars of the Regulatory System and the Pharmaceutical Market in order to address patient issues and become more efficient and closer to patient needs.

 

Regulatory Agencies representatives, experts from companies, healthcare professionals, researchers and patients’ groups will also be sharing their contributions and considerations.

 

We welcome students, healthcare professionals, researchers and patients’ groups representatives to register and attend this informative training session with us.

 

For more information please click here

 

15

Oct, 2020

How European Paediatric emergency departments responded to the first wave of SARS-CoV-2 Pandemic

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Between February and May 2020, during the first wave of the COVID-19 pandemic, we sent out a survey to all European paediatric sites within the Penta ID research network. The aim of the study was to describe the implementation of SARS-CoV-2 disease (COVID-19) testing and infection control strategies, and their evolution in paediatric emergency departments in Europe.

Although infection control strategies and even discharge of patients relied heavily on receiving SARS-CoV-2 test results, most hospitals only received these after considerable delay, often more than twenty-four hours.

Shortening turnaround times for tests should be a priority. Prior to discharge, infection control measures on uninfected patients awaiting test results place a huge burden on emergency care resources.

Most departments rightly responded by discharging patients while test results were pending. This does not, however, mitigate against the public health impact of delayed result reporting on efficient contact tracing and subsequent isolation or quarantine of contacts in the community.

Children and adolescents suffer serious consequences from school closures and allowing schools to stay open has positive social, psychological and economic implications. Benefits of broader access to testing may include the ability to detect outbreaks in day care facilities and schools earlier in order to limit spread of infections while maintaining as much normality as possible for children and adolescents.

Download the full survey report here

14

Oct, 2020

SARS-CoV-2 testing and infection control strategies in European paediatric emergency departments during the first wave of the pandemic

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Published in: European Journal of Pediatrics

 

Authors: Malte Kohns Vasconcelos & Hanna Renk & Jolanta Popielska & Maggie Nyirenda Nyang’wa & Sigita Burokiene & Despoina Gkentzi & Ewelina Gowin & Daniele Donà & Sara Villanueva-Medina & Andrew Riordan & Markus Hufnagel & Sarah Eisen & Liviana Da Dalt & Carlo Giaquinto & Julia A. Bielicki1

 

Abstract: Between February and May 2020, during the first wave of the COVID-19 pandemic, paediatric emergency departments in 12 European countries were prospectively surveyed on their implementation of SARS-CoV-2 disease (COVID-19) testing and infection control strategies. All participating departments (23) implemented standardised case definitions, testing guidelines, early triage and infection control strategies early in the outbreak. Patient testing criteria initially focused on suspect cases and later began to include screening, mainly for hospital admissions. Long turnaround times for test results likely put additional strain on healthcare resources.

Conclusion: Shortening turnaround times for SARS-CoV-2 tests should be a priority. Specific paediatric testing criteria are needed.

 

Download the full article here.KohnsVasconcelos2020_Article_SARS-CoV-2TestingAndInfectionC

29

Sep, 2020

COVID-19 Online Educational Program

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This online educational program will be presented by Dr Lynne Mofenson, of the Elizabeth Glaser Pediatric AIDS Foundation, on October 13th 2020.

Dr Mofenson’s talk will focus on the effects of COVID-19 in pregnant women and possible mother to child transmission during breastfeeding.

Join us to hear important insights into the clinical characteristics and possible risks associated with COVID-19 during the pregnancy and postnatal period.

Click here for more information.

Click here to register.

2

Sep, 2020

SARS‐CoV‐2 infection in people living with HIV: a systematic review

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Background and setting Little is known about SARS‐CoV‐2 impact on some vulnerable subgroups, such as people living with HIV/AIDS (PLWHA). In our study we reviewed the current knowledge on SARS‐CoV‐2 cases in PLWHA.

Methods A systematic review was conducted by searching the MEDLINE, EMBASE and Google Scholar databases. Studies reporting data on PLWHA affected by SARS‐CoV‐2 were considered for inclusion. The aim of this study was the systematic characterization of cases of SARS‐CoV‐2 infection among PLWHA, particularly focusing on age, clinical findings at diagnosis, radiological features, therapeutic management and clinical outcomes.

Results Twenty three relevant articles were identified, which reported 164 adults with both HIV and SARS‐CoV‐2 infection. Of those, the large majority were males (120/142, 84.5%), often with one or more comorbidities. Fifteen cases needed intensive care treatment and 16 died. For each group, respectively three patients had underlying comorbidities. There were no studies on children. The included studies were mostly retrospective or case series/reports (19 studies). The overall risk of bias was moderate, due to the study types and characteristics.

Conclusion It is still unclear if HIV infection may influence SARS‐CoV‐2 infection and disease course, however some PLWHA and particularly males affected by ARV‐related complications may be at greater risk of severe Covid‐19 course.

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