Background

Clusters of children with multisystem inflammatory syndrome (MIS-C) linked to SARS-CoV-2 infection have been described in Europe. The syndrome shares features of Kawasaki disease, toxic shock syndrome and macrophage activation syndrome. The specific link with SARS-CoV-2 remains unclear. We aim to describe the epidemiological and clinical features of children with MIS-C in Spain.

Methods

Case series of children (0-18 years old) with MIS-C associated with SARS-CoV-2 enrolled from March 1^st to June 1^st 2020 in the Epidemiological Study of COVID-19 in Children (EPICO-AEP), a multicentre (49 hospitals) prospective registry cohort of children with SARS-CoV-2 infection in Spain.

Results

31/252 (12%) hospitalized children were diagnosed with MIS-C and/or Kawasaki disease. All but one patient (97%) had microbiological or serological evidence of SARS-CoV-2 infection: 17/31 (55%) positive RT-PCR, 10/17 (59%) positive IgM and 19/21 (90%) positive IgG. 13/31 children (45%) fulfilled complete or incomplete Kawasaki disease criteria. Table 1 summarizes the clinical, microbiological and laboratory features of the children included. One patient (3%) did not fulfilled MIS-C WHO criteria: a 12-month old girl with cardiogenic shock, chronic oral corticosteroid therapy, positive RT-PCR and human metapneumovirus coinfection but no inflammatory markers.

Conclusions

Our series support the impression that not only a temporal association exists between MIS-C and SARS-CoV-2, but also a microbiological association. SARS-CoV-2 could be a trigger for a delayed cytokine storm and inflammatory disease, with potential severe consequences. Paediatricians should be aware of this condition in children during COVID-19 epidemics. More studies are necessary to clarify the physiopathology of this syndrome.

Background

Objectives:

Characterisation of the clinical features of patients under 19 years admitted to hospital with laboratory-confirmed SARS-CoV-2 infection in the UK and factors associated with admission to critical care and development of multisystem inflammatory syndrome in children and adolescents temporarily related to covid-19 (MIS-C).

Methods

Prospective multicentre observational cohort study across 260 acute care hospitals in England, Wales, and Scotland between 17th January and 5^th June 2020, with a minimum follow-up time of two weeks (to 19^th June 2020).

451 children and young people <19 years old admitted to 116 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory-confirmed SARS-CoV-2.

Complete data were not available for all variables, hence denominators differ between analyses. Fisher's exact test, Kruskal-Wallis and Jaccard similarity coefficient.

Results

A muco-enteric symptom cluster closely mirrored the WHO MIS-C criteria (Figure).

12% of children (36/303) met the WHO MIS-C criteria. They were older, (median 10.8 years vs 2.0, p<0.001) and more likely to be of non-White ethnicity (70%(23/33) vs 43%(101/237), p=0.005). Children with MIS-C were more likely to be admitted to critical care (61%(22/36) vs 15%(40/267, p<0.001), present with headache (45%(13/29) vs 11%(19/171), p<0.001), myalgia (39%(11/28) vs 7%(12/170), p<0.001) and sore throat (37%(10/27) vs (13%(24/183), p = 0.004) and have a platelet count <150 x10⁹/L (30%(10/33) vs 10%(24/232), p=0.004).

Conclusions

Our data confirms less severe covid-19 in children and young people than in adults and we provide evidence for refining the WHO MIS-C case definition. The muco-enteric symptom cluster suggests MIS-C may be the severe end of a spectrum of disease.

Background

Spain is one of the most affected countries during COVID-19 pandemic. The spectrum and severity of the disease in children is still unclear.

Methods

The Epidemiological study of COVID-19 in Children (EPICO) is a multicenter prospective national study involving 50 hospitals aiming to shape the COVID-19 disease in Spanish children.

Results

By July 1st, 351 children under 18 years were diagnosed of COVID-19 and 291 (83%) of them were admitted: 213 (73%) due to relevant COVID-19 disease, and others due to other reasons (13%) or isolation (15%). PCR was positive in 93% and serology for SARS-CoV-2 IgM+ 9% and IgG+ 23%; 160/291(55%) were male, 52% had contact with a known COVID-19 adult patient, and 44% had comorbidities. Four (1%) patients died, all with serious comorbidities. Coinfections were detected in 54/291(19%) patients.

Diagnosis in patients admitted with COVID-19 were: pneumonia 100/291(34%); upper respiratory tract infection 41/291(14%); inflammatory multisystemic syndrome related with SARS-CoV-2 (PIMS-TS) 36/291(12%); fever without a source 30/291(10%); gastrointestinal symptoms 25/291(9%); bronchiolitis, bronchitis or asthma flare, 10/291(3%). 32%(93/291) of patients needed O2, 19%(54/291) admission in the PICU, and 7% (20/291) mechanical ventilation. Complications (93/291,32%) were cardiological (10%, only 1% coronary abnormalities), pleural effusion (5%), sepsis (5%), renal failure (4%), and pneumothorax (1%).

In the X-ray at admission of 252 patients, 22% had consolidation and 33% had infiltrates.

Risk factor for severe outcome (PICU or high flow) included pneumonia, PIMS-TS features, higher age, comorbidities, lower Hb, lymphopenia, inflammatory markers, and high urea.

Time to PCR negativization in 108 patients with follow up was 13.5 days.

Conclusions

COVID-19 in children has a wide range of features and severity. The Spanish cohort shows a significant proportion of seriously ill patients.

Clinical Trial Registration

Not apply.

Background

School closures have been important in Covid-19 containment strategies in most countries worldwide, despite a lack of knowledge on outbreak characteristics. A school SARS-CoV-2 outbreak affecting 52 people from a large school community in Santiago, Chile was identified (March 12), ten days after the first country case. We assessed the magnitude of the outbreak and the role students and staff played using a self-administered antibody detection test and survey.

Methods

The school was closed on March 13, and the entire community was placed under quarantine. After school and ethical approval, we implemented a home delivery-self-administered IgG/IgM antibody test and survey to a classroom stratified sample of students and all staff from May 4-19. We aimed to determine overall seroprevalence rates by age group, reported symptoms, contact exposure and to explore the dynamics of transmission.

Results

Antibody positivity rates were 9·9% (95%CI: 8·2-11·8) for 1,009 students and 16·6% (95%CI: 12·1-21·9) for 235 staff. Among students, positivity was associated with younger age (P=0·010), lower grade level (P=0·045), prior RT-PCR positivity (P=0·031), and history of contact with a confirmed case (P<0·001). Among staff, positivity was higher in teachers (p=0^.012) and in those previously RT-PCR positive (P<0·001). Excluding RT-PCR positive individuals, antibody positivity was associated with fever in adults and children (P=0·022; P=0·002), abdominal pain in children (P=0·001), and chest pain in adults (P=0·016). Within antibody positive individuals, 40% of students and 18% of staff reported no symptoms (P<0·014).

Conclusions

Teachers were more affected during the outbreak and younger children were at higher infection risk, most likely due to transmission from teachers and/or adult household members. Self-administered antibody testing, supervised remotely, proved to be a suitable and rapid tool. Our study provides useful information for school re-openings.

Clinical Trial Registration

This is a Clinical Study, with no direct intervention

Background

This study aims to know the clinical characteristics of infants under 90 days of age with fever without source (FWS) as the first manifestation of SARS-CoV-2 infection.

Methods

This is a case series of infants with fever without source (FWS) associated with SARS-CoV-2 infection registered in the EPICO-AEP database, a multicenter (49 hospitals) prospective cohort of children with SARS-CoV-2 infection in Spain. Results: By June 26^th, 336 children with COVID-19 had been included. A total of 67/336(20%) were under 3 months of age and 27/67(40%) presented with FWS as the first manifestation. Twenty-four (89%) were admitted to the hospital. Blood cultures were performed in 24/27(89%) children and were negative in all but

Results

one child with Swachmann-Diamond Syndrome, severe neutropenia, S.mitis bacteremia and E.cloacae in urine culture. Otherwise, urine culture was performed in 26/27(97%) and was negative in all, except in 2 patients. Cerebrospinal fluid cultures were negative when performed (0/6). Two children showed bacterial coinfection (2/27;7.4%). Median values of C-reactive protein (CRP) and procalcitonin at admission were 1.9mg/L(0.6-5) and 0.12ng/mL(0.1-0.15), respectively (figure). Six of 27(22%) children required oxygen therapy by nasal cannula. One child was admitted to the PICU because of apnea episodes. No patient required mechanical ventilation and all survived.

Conclusions

FWS is a common manifestation of SARS-CoV-2 infection in infants under 3 months of age. Children with SARS-CoV-2 and no bacterial coinfection showed low CRP and PCT values, so standardized markers to rule out bacterial infection seem to remain useful in this population.

Background

The Covid-19 pandemic poses unprecedented challenges for healthcare and has led to alterations in the medical care utilization patterns by the pediatric population. Concerns have been raised regarding the consequences for non-Covid patients due to decreased access to medical care. We aimed to describe the impact of the pandemic on children’s health, wellbeing, and access to medical care.

Methods

We conducted a retrospective cross-sectional study through an anonymous online survey via social networks. We accepted responses from parents with children and adolescents living in Portugal. The survey was organized into four sections - sociodemographic characterization; pandemic-related information, including children belonging to a risk group for Covid-19 and parental degree of concern; information regarding the utilization of healthcare services during the pandemic; and assessment of the consequences of Covid-19 on the child’s health and wellbeing.

Results

We obtained responses to the survey regarding 19,745 children. Children belonging to a risk group for Covid-19 (28.1%) did not attend an emergency department in significantly higher rates than other children but showed significantly higher rates of invasive interventions and hospitalization. 54.2% of the scheduled medical appointments were postponed by health institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children.

Conclusions

In summary, the impact of the Covid-19 pandemic on children’s health includes decreased access to care as well as relevant psychological, social and physical consequences that should not be overlooked. In view of the uncertain future course of the pandemic, further studies are necessary to fully comprehend the outcomes of the current health emergency. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority to minimize negative outcomes in the short and long-term.