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Lee S, Erdem G, Yasuhara J. Multisystem inflammatory syndrome in children associated with COVID-19: from pathophysiology to clinical management and outcomes. Minerva Pediatr (Torino) 2024; 76:268-280. [PMID: 37284807 DOI: 10.23736/s2724-5276.23.07205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome (PIMS), is a new postinfectious illness associated with COVID-19, affecting children after SARS-CoV-2 exposure. The hallmarks of this disorder are hyperinflammation and multisystem involvement, with gastrointestinal, cardiac, mucocutaneous, and hematologic disturbances seen most commonly. Cardiovascular involvement includes cardiogenic shock, ventricular dysfunction, coronary artery abnormalities, and myocarditis. Now entering the fourth year of the pandemic, clinicians have gained some familiarity with the clinical presentation, initial diagnosis, cardiac evaluation, and treatment of MIS-C. This has led to an updated definition from the Centers for Disease Control and Prevention in the USA driven by increased experience and clinical expertise. Furthermore, the available evidence established expert consensus treatment recommendations supporting a combination of immunoglobulin and steroids. However, the pathophysiology of the disorder and answers to what causes this remain under investigation. Fortunately, long-term outcomes continue to look promising, although continued follow-up is still needed. Recently, COVID-19 mRNA vaccination is reported to be associated with reduced risk of MIS-C, while further studies are warranted to understand the impact of COVID-19 vaccines on MIS-C. We review the findings and current literature on MIS-C, including pathophysiology, clinical features, evaluation, management, and medium- to long-term follow-up outcomes.
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Affiliation(s)
- Simon Lee
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guliz Erdem
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jun Yasuhara
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA -
- Center for Cardiovascular Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiology, Royal Children's Hospital, Parkville, Australia
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Shmueli M, Lendner I, Ben-Shimol S. Effect of the COVID-19 pandemic on the pediatric infectious disease landscape. Eur J Pediatr 2024; 183:1001-1009. [PMID: 37726566 DOI: 10.1007/s00431-023-05210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription. Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: • COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. • The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: • Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. • The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).
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Affiliation(s)
- Moshe Shmueli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Idan Lendner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Department B, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel.
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3
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Rao S, Jing N, Liu X, Lorman V, Maltenfort M, Schuchard J, Wu Q, Tong J, Razzaghi H, Mejias A, Lee GM, Pajor NM, Schulert GS, Thacker D, Jhaveri R, Christakis DA, Bailey LC, Forrest CB, Chen Y. Spectrum of severity of multisystem inflammatory syndrome in children: an EHR-based cohort study from the RECOVER program. Sci Rep 2023; 13:21005. [PMID: 38017007 PMCID: PMC10684592 DOI: 10.1038/s41598-023-47655-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
Multi-system inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection in children, and there is a critical need to unfold its highly heterogeneous disease patterns. Our objective was to characterize the illness spectrum of MIS-C for improved recognition and management. We conducted a retrospective cohort study using data from March 1, 2020-September 30, 2022, in 8 pediatric medical centers from PEDSnet. We included 1139 children hospitalized with MIS-C and used their demographics, symptoms, conditions, laboratory values, and medications for analyses. We applied heterogeneity-adaptive latent class analyses and identified three latent classes. We further characterized the sociodemographic and clinical characteristics of the latent classes and evaluated their temporal patterns. Class 1 (47.9%) represented children with the most severe presentation, with more admission to the ICU, higher inflammatory markers, hypotension/shock/dehydration, cardiac involvement, acute kidney injury and respiratory involvement. Class 2 (23.3%) represented a moderate presentation, with 4-6 organ systems involved, and some overlapping features with acute COVID-19. Class 3 (28.8%) represented a mild presentation. Our results indicated that MIS-C has a spectrum of clinical severity ranging from mild to severe and the proportion of severe or critical MIS-C decreased over time.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, 13123 E 16th Ave Box 090, Aurora, CO, 80045, USA.
| | - Naimin Jing
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall 602, Philadelphia, PA, 19104, USA
- Biostatistics and Research Decision Sciences, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Xiaokang Liu
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall 602, Philadelphia, PA, 19104, USA
| | - Vitaly Lorman
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mitchell Maltenfort
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julia Schuchard
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Qiong Wu
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall 602, Philadelphia, PA, 19104, USA
| | - Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall 602, Philadelphia, PA, 19104, USA
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Grace M Lee
- Department of Pediatrics (Infectious Diseases), Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan M Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deepika Thacker
- Division of Cardiology, Nemours Children's Health, Wilmington, DE, USA
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dimitri A Christakis
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, USA
| | - L Charles Bailey
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall 602, Philadelphia, PA, 19104, USA.
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Rush M, Hyman C, Yonts A, Szeles R, Boogaard C. Pediatric COVID-19 Vaccination in the Inpatient Setting. Hosp Pediatr 2023; 13:e329-e332. [PMID: 37807862 DOI: 10.1542/hpeds.2022-006804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The inpatient setting is often underutilized as a venue for providing pediatric vaccines. During the 2019 novel coronavirus (COVID-19) pandemic, our hospital began a vaccination program to provide access to COVID-19 vaccines for eligible pediatric inpatients. Our objective was to describe the establishment and assess the impact of a COVID-19 vaccination program for pediatric inpatients. METHODS All admitted patients were screened for eligibility and interest in inpatient COVID-19 vaccination upon admission from April 27, 2021 until February 12, 2022. For those eligible for vaccination, their interest was recorded and shared with the clinical team. The clinical team completed education and/or vaccination depending on individual case. Interest in inpatient vaccination and ultimate receipt of a vaccine was recorded and analyzed. RESULTS During the study period, 1615 patients were eligible for inpatient vaccination and 1601 had their interest recorded on hospital admission. Twenty-one percent of these patients were interested, 50% declined, and 28% were unsure. Twenty-nine percent of those initially interested were given vaccine by the clinical team before discharge. Six percent of patients who were unsure and 2% of those who declined vaccine on admission were vaccinated before discharge. CONCLUSIONS The inpatient setting can be an important venue to allow for education and discussion regarding pediatric COVID-19 vaccine and to improve access to vaccination for a traditionally under-vaccinated population. Challenges remain with consistent vaccine administration even for interested pediatric inpatients.
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Affiliation(s)
| | - Cleopatra Hyman
- Department of Case Management and Revenue Cycle, Children's National Hospital, Washington, District of Columbia
| | | | - Rosemary Szeles
- Children's National Hospital, Washington, District of Columbia
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Lee RE, Todd M, Oh H, Han S, Santana M, Aguilar-Troncoso J, Bruening M, Kramer JL, León T, Murugan V, Valdez H, Villegas-Gold M. Acceptability and Feasibility of Saliva-delivered PCR Coronavirus 2019 Tests for Young Children. Pediatrics 2023; 152:e2022060352D. [PMID: 37394507 PMCID: PMC10312283 DOI: 10.1542/peds.2022-060352d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Access to readily available, reliable, and easy-to-use coronavirus disease 2019 (COVID-19) tests remains critical, despite great vaccination progress. Universal back-to-school testing offered at early care and education ([ECE]; ie, preschool) sites to screen for positive cases may help preschoolers safely return to, and stay in, ECE. We examined the acceptability and feasibility of using a quantitative polymerase chain reaction COVID-19 saliva test for young children (n = 227, 54.0% girls: mean age = 52.3 ± 8.1 months) and their caregivers (n = 70 teachers: mean = 36.6 ± 14.7 years; n = 227 parents: mean = 35.5 ± 9.1 years) to mitigate the spread of COVID-19 and reduce days of school and work missed for households with children who test positive. METHODS Participants were recruited at ECE sites serving low-income communities as part of the Rapid Acceleration of Diagnostic Testing-Underserved Populations Back to Early Care and Education Safely with Sustainability via Active Garden Education project (NCT05178290). RESULTS Surveys in English or Spanish administered at testing events to children and caregivers at ECE sites showed child and adult acceptability and feasibility ratings were generally high. More favorable child and parent ratings were positively associated with child age and whether the child was able to produce a saliva sample. Language preference was not associated with any outcomes. CONCLUSIONS Saliva sampling for COVID-19 at ECE sites is an acceptable strategy as an additional layer of protection for 4- and 5-year-olds; however, alternate testing strategies may be needed for younger children.
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Affiliation(s)
- Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation
| | | | - Hyunsung Oh
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, Arizona
| | | | - Michelle Santana
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation
| | | | - Meg Bruening
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania
| | - Joanna L. Kramer
- Phoenix Children’s Hospital, Division of Primary, Complex, and Adolescent Medicine, Phoenix, Arizona
| | - Tomás León
- Equality Health Foundation, Phoenix, Arizona
| | - Vel Murugan
- Center for Personalized Diagnostics, ASU Biodesign Clinical Testing Laboratory, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Hector Valdez
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation
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Rao S, Jing N, Liu X, Lorman V, Maltenfort M, Schuchard J, Wu Q, Tong J, Razzaghi H, Mejias A, Lee GM, Pajor NM, Schulert GS, Thacker D, Jhaveri R, Christakis DA, Bailey LC, Forrest CB, Chen Y. Clinical Subphenotypes of Multisystem Inflammatory Syndrome in Children: An EHR-based cohort study from the RECOVER program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.09.26.22280364. [PMID: 36203555 PMCID: PMC9536089 DOI: 10.1101/2022.09.26.22280364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Multi-system inflammatory syndrome in children (MIS-C) represents one of the most severe post-acute sequelae of SARS-CoV-2 infection in children, and there is a critical need to characterize its disease patterns for improved recognition and management. Our objective was to characterize subphenotypes of MIS-C based on presentation, demographics and laboratory parameters. Methods We conducted a retrospective cohort study of children with MIS-C from March 1, 2020 - April 30, 2022 and cared for in 8 pediatric medical centers that participate in PEDSnet. We included demographics, symptoms, conditions, laboratory values, medications and outcomes (ICU admission, death), and grouped variables into eight categories according to organ system involvement. We used a heterogeneity-adaptive latent class analysis model to identify three clinically-relevant subphenotypes. We further characterized the sociodemographic and clinical characteristics of each subphenotype, and evaluated their temporal patterns. Findings We identified 1186 children hospitalized with MIS-C. The highest proportion of children (44·4%) were aged between 5-11 years, with a male predominance (61.0%), and non- Hispanic white ethnicity (40·2%). Most (67·8%) children did not have a chronic condition. Class 1 represented children with a severe clinical phenotype, with 72·5% admitted to the ICU, higher inflammatory markers, hypotension/shock/dehydration, cardiac involvement, acute kidney injury and respiratory involvement. Class 2 represented a moderate presentation, with 4-6 organ systems involved, and some overlapping features with acute COVID-19. Class 3 represented a mild presentation, with fewer organ systems involved, lower CRP, troponin values and less cardiac involvement. Class 1 initially represented 51·1% of children early in the pandemic, which decreased to 33·9% from the pre-delta period to the omicron period. Interpretation MIS-C has a spectrum of clinical severity, with degree of laboratory abnormalities rather than the number of organ systems involved providing more useful indicators of severity. The proportion of severe/critical MIS-C decreased over time. Research in context Evidence before this study: We searched PubMed and preprint articles from December 2019, to July 2022, for studies published in English that investigated the clinical subphenotypes of MIS-C using the terms "multi-system inflammatory syndrome in children" or "pediatric inflammatory multisystem syndrome" and "phenotypes". Most previous research described the symptoms, clinical characteristics and risk factors associated with MIS-C and how these differ from acute COVID-19, Kawasaki Disease and Toxic Shock Syndrome. One single-center study of 63 patients conducted in 2020 divided patients into Kawasaki and non-Kawasaki disease subphenotypes. Another CDC study evaluated 3 subclasses of MIS-C in 570 children, with one class representing the highest number of organ systems, a second class with predominant respiratory system involvement, and a third class with features overlapping with Kawasaki Disease. However, this study evaluated cases from March to July 2020, during the early phase of the pandemic when misclassification of cases as Kawasaki disease or acute COVID-19 may have occurred. Therefore, it is not known from the existing literature whether the presentation of MIS-C has changed with newer variants such as delta and omicron.Added value of this study: PEDSnet provides one of the largest MIS-C cohorts described so far, providing sufficient power for detailed analyses on MIS-C subphenotypes. Our analyses span the entire length of the pandemic, including the more recent omicron wave, and provide an update on the presentations of MIS-C and its temporal dynamics. We found that children have a spectrum of illness that can be characterized as mild (lower inflammatory markers, fewer organ systems involved), moderate (4-6 organ involvement with clinical overlap with acute COVID-19) and severe (higher inflammatory markers, critically ill, more likely to have cardiac involvement, with hypotension/shock and need for vasopressors).Implications of all the available evidence: These results provide an update to the subphenotypes of MIS-C including the more recent delta and omicron periods and aid in the understanding of the various presentations of MIS-C. These and other findings provide a useful framework for clinicians in the recognition of MIS-C, identify factors associated with children at risk for increased severity, including the importance of laboratory parameters, for risk stratification, and to facilitate early evaluation, diagnosis and treatment.
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7
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Sullivan AL. Overcoming Disaster Through Critical Consciousness and Ideological Change. SCHOOL PSYCHOLOGY REVIEW 2022. [DOI: 10.1080/2372966x.2022.2093127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tartof SY, Frankland TB, Slezak JM, Puzniak L, Hong V, Xie F, Ackerson BK, Valluri SR, Jodar L, McLaughlin JM. Effectiveness Associated With BNT162b2 Vaccine Against Emergency Department and Urgent Care Encounters for Delta and Omicron SARS-CoV-2 Infection Among Adolescents Aged 12 to 17 Years. JAMA Netw Open 2022; 5:e2225162. [PMID: 35921109 PMCID: PMC9350713 DOI: 10.1001/jamanetworkopen.2022.25162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/17/2022] [Indexed: 01/05/2023] Open
Abstract
Importance Data about the duration of protection of 2 and 3 doses of BNT162b2 in children and adolescents are needed to help inform recommendations for boosters in this age group. Objective To evaluate vaccine effectiveness (VE) and durability associated with 2 doses of BNT162b2 against Delta- and Omicron-related emergency department (ED) and urgent care (UC) encounters among adolescents aged 12 to 17 years and to estimate VE associated with 3 doses against these same outcomes. Design, Setting, and Participants This test-negative case-control study was conducted at Kaiser Permanente Southern California, an integrated health care system using electronic health records in the US. Participants included Kaiser Permanente Southern California members ages 12 to 17 years with an ED or UC encounter from November 1, 2021, through March 18, 2022, for acute respiratory infection who were tested for SARS-CoV-2 via a reverse transction-polymerase chain reaction test. Analyses were conducted from March 21 to June 22, 2022. Exposures BNT162b2 vaccination status ascertained from electronic health records and state registry data. Main Outcomes and Measures The main outcome was VE associated with BNT162b2 against ED and UC encounters related to Delta or Omicron variant SARS-CoV-2 infection. Results Analyses were conducted among 3168 adolescents, including 1004 with ED visits and 2164 with UC visits. Median (IQR) age was 15 (13-16) years, and 1461 (46.1%) were boys. In adjusted analyses, VE associated with 2 doses of BNT162b2 against ED or UC encounters was highest within the first 2 months for both Delta (89% [95% CI, 69% to 96%]) and Omicron (73% [95% CI, 54% to 84%]) variants but waned to 49% (95% CI, 27% to 65%) for the Delta variant and 16% (95% CI, -7% to 34%) for the Omicron variant at 6 months and beyond. A third dose of BNT162b2 was associated with improved protection against the Omicron variant (87% [95% CI, 72% to 94%]) after a median (IQR) of 19 (9-32) days after dose 3. Conclusions and Relevance These findings suggest that 2 doses of the BNT162b2 COVID-19 vaccine were associated with high levels of protection against ED and UC encounters related to the Delta and Omicron variants of SARS-CoV-2 in the first few months after vaccination. However, effectiveness waned over time, especially against Omicron. A third dose of BNT162b2 was associated with improved protection against Omicron beyond that seen initially after 2 doses, underscoring the importance of boosters for adolescents aged 12 to 17 years.
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Affiliation(s)
- Sara Y. Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Jeff M. Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Vennis Hong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Fagen Xie
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
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Abstract
Pediatricians and other primary care clinicians are responsible for the screening of numerous health issues. As the coronavirus disease 2019 (COVID-19) pandemic persists, the adverse mental health effects on patients, their families, and the community at large are evident. Therefore, pediatricians are tasked with assessing, triaging, and initiating treatment for common mental health concerns such as anxiety and depression. Complicating the picture is long-COVID. This article reviews the epidemiology of pediatric and adolescent anxiety and depression and data about pediatric long-COVID. Additionally, strategies and tools for pediatricians and their office staff to address the mental health needs of their patients are outlined. [Pediatr Ann. 2022;51(4):e154-e160.].
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Cinteză E, Voicu C, Filip C, Ioniță M, Popescu M, Bălgrădean M, Nicolescu A, Mahmoud H. Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis. Diagnostics (Basel) 2022; 12:diagnostics12040884. [PMID: 35453932 PMCID: PMC9025069 DOI: 10.3390/diagnostics12040884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/19/2022] Open
Abstract
Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.
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Affiliation(s)
- Eliza Cinteză
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristiana Voicu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristina Filip
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihnea Ioniță
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Monica Popescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihaela Bălgrădean
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Alin Nicolescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Hiyam Mahmoud
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Royal Brompton Hospital, London SW3 6NP, UK
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11
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Poddighe D, Ziaee V, Kasapcopur O. Editorial: COVID-19 and hyper inflammation syndrome: Different presentation and management. Front Pediatr 2022; 10:1022701. [PMID: 36160806 PMCID: PMC9501999 DOI: 10.3389/fped.2022.1022701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Pediatrics, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.,Children's Medical Center, Pediatric Center of Excellence, Tehran, Iran
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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