Background: Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa. Objective: To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal. Methods: Retrospective multicenter study of children (0–13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C. Results: Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP ( P = 0.01), ferritin ( P < 0.001), troponin-T ( P = 0.02), B-type natriuretic peptide (BNP) ( P = 0.01), and lower platelets ( P = 0.01). Acute kidney injury ( P = 0.01), cardiac involvement ( P = 0.02), and altered levels of consciousness ( P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7–19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069–1650) ng/mL versus 540 (IQR 181–1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7–191.5; P = 0.005). Conclusions: Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.

We have a long way to go to achieve decreased attrition at each step of the cascade and retain patients in care. Recent improvements in each step of the cascade are bringing us closer to achieving treatment success.

Background: Hospital acquired infections are on the increase worldwide. A possible source for transmission is the presence of microorganisms on mobile phones which are carried by increasing numbers of medical and nursing staff, students, and caregivers.Methods: A cross-sectional study was performed. Samples were obtained from medical and nursing staff, students, and caregivers from the paediatric wards (85 beds), and the neonatal unit (40 beds) at King Edward VIII Hospital (KEH), Durban. Mobile phones of participants were sampled, with sterile swabs, without prior warning. The swabs were transported promptly to the laboratory and cultured onto colistin, nalidixic acid agar and MacConkey agar plates. All positive cultures were identified using standard laboratory tests.Results: Of the 100 mobile phones sampled, 30 were contaminated with bacteria. Gram-positive microorganisms were more frequently cultured than Gram-negative microorganisms (29 vs. 7). Significantly more caregivers had contaminated phones (54.17% vs. 22.37%, p value = 0.003). Caregivers’ phones were predominantly contaminated with Staphylococcus spp. (41.67%). More phones in the general wards (37.5%) and nursery (32.5%) were contaminated compared to the gastroenteritis ward (10%).Conclusions: Our results indicate that one third of the mobile phones carried in the paediatric wards are contaminated. Caregivers had the highest likelihood of carrying mobile phones that were contaminated, with the lowest rate among the nursing staff. Caregivers’ phones were also more likely to have multiple microorganisms. The lowest rate of contamination was found in the gastroenteritis ward, possibly due to a heightened awareness of the need for handwashing.

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Coovadia (2017) The presence and spectrum of bacteria colonising mobile phones of staff and caregivers in high disease burden paediatric and neonatal wards in an urban teaching hospital in