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Multicenter Study
. 2021 Aug 1;175(8):837-845.
doi: 10.1001/jamapediatrics.2021.0630.

Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic

Ermias D Belay  1 , Joseph Abrams  1 , Matthew E Oster  1 , Jennifer Giovanni  1 , Timmy Pierce  1   2 , Lu Meng  1   3 , Emily Prezzato  1 , Neha Balachandran  1 , John J Openshaw  4 , Hilary E Rosen  4 , Moon Kim  5 , Gillian Richardson  6 , Julie Hand  6 , Melissa Tobin-D'Angelo  7 , Siri Wilson  7 , Amanda Hartley  8 , Cassandra Jones  8 , Jonathan Kolsin  9 , Hani Mohamed  10 , Zachary Colles  11 , Teresa Hammett  1 , Pragna Patel  1 , Bryan Stierman  1   12 , Angela P Campbell  1 , Shana Godfred-Cato  1
Affiliations
Multicenter Study

Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic

Ermias D Belay et al. JAMA Pediatr. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jones reports grants from the US Centers of Disease Control and Prevention Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Daily Number of Patients With MIS-C and COVID-19 by 7-Day Moving Averages, United States, March 2020 to January 2021
The grayed-out area on the right side represents the most recent 6 weeks of data, for which multisystem inflammatory syndrome in children (MIS-C) case reports are likely incomplete.
Figure 2.
Figure 2.. Multisystem Inflammatory Syndrome in Children (MIS-C) Cumulative Incidence per 100 000 Children and Pediatric COVID-19 Cumulative Incidence per 1000 Children Younger Than 21 Years, United States
Figure 3.
Figure 3.. Proportion of Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Cases by Urban-Rural Categories and 2 Time Periods, United States
See this image and copyright information in PMC

Comment in

References

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