COVID-19 in a Subset of Hospitalized Children in Israel

Abstract

Background Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. Methods An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). Results Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. Conclusions At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.

The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases

“…The majority of children (60-70%) were admitted to intensive care units. According to that report, the prevalence of MIS-C in the United States was approximately 1:3200 of SARS-CoV-2-positive children and adolescents, similar to the reported prevalence in Israel [6].…”

“…Mortality was 1-2%. An Israeli study showed similar findings: during the first three waves of the COVID-19 pandemic, 56% of children diagnosed with MIS-C were admitted to intensive care units and 20% required mechanical ventilation [6].…”

“…A review of 1475 children from various countries who were hospitalized with acute COVID-19 reported a moderate to severe degree of illness in 615 (42%) [5]. In a prospective multicenter study in Israel [6], including 579 children hospitalized for COVID-19 or multisystem inflammatory syndrome in children (MIS-C), 103 had moderate to severe illness. Among them, 20% of those with COVID-19 and 56% of those with MIS-C were hospitalized in pediatric intensive care units, 7% and 20% of these respective groups necessitated mechanical ventilation.…”

“…The average age is 9 years and about 60% of those diagnosed are males. Worldwide reports [13][14][15] and those from Israel [6] indicate that the vast majority of patients with MIS-C do not have any background disease (including obesity).…”

Covid-19 in Children and Adolescent: Characteristics and Specificities in Immunocompetent and Oncohematological Patients

“…32,33 Among the hospitalized patients, the MIS-C rate varies between 10 to 25%. 34 Currently, no long-term follow-up studies that define with certainty the prognosis of patients with MIS-C are reported. In a systematic review including 16 studies and a total of 655 MIS-C patients, 10% of patients (68) required critical care, and the mortality rate was 1.7% (11 deaths ).…”