Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): Prospective, national surveillance, United Kingdom and Ireland, 2020

Abstract

Background Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), first identified in April 2020, shares features of both Kawasaki disease (KD) and toxic shock syndrome (TSS). The surveillance describes the epidemiology and clinical characteristics of PIMS-TS in the United Kingdom and Ireland. Methods Public Health England initiated prospective national surveillance of PIMS-TS through the British Paediatric Surveillance Unit. Paediatricians were contacted monthly to report PIMS-TS, KD and TSS cases electronically and complete a detailed clinical questionnaire. Cases with symptom onset between 01 March and 15 June 2020 were included. Findings There were 216 cases with features of PIMS-TS alone, 13 with features of both PIMS-TS and KD, 28 with features of PIMS-TS and TSS and 11 with features of PIMS-TS, KD and TSS, with differences in age, ethnicity, clinical presentation and disease severity between the phenotypic groups. There was a strong geographical and temporal association between SARS-CoV-2 infection rates and PIMS-TS cases. Of those tested, 14.8% (39/264) children had a positive SARS-CoV-2 RT-PCR, and 63.6% (75/118) were positive for SARS-CoV-2 antibodies. In total 44·0% (118/268) required intensive care, which was more common in cases with a TSS phenotype. Three of five children with cardiac arrest had TSS phenotype. Three children (1·1%) died. Interpretation The strong association between SARS-CoV-2 infection and PIMS-TS emphasises the importance of maintaining low community infection rates to reduce the risk of this rare but severe complication in children and adolescents. Close follow-up will be important to monitor long-term complications in children with PIMS-TS. Funding

Which children and young people are at higher risk of severe disease and death after SARS-CoV-2 infection: a systematic review and individual patient meta-analysis

“…Our ndings relate to risk factors for severe disease rather than risk factors for infection, as we included only hospitalised children. It is likely that our ndings may over-estimate risks of critical care and death for CYP in high income countries, as the mortality rate in our analyses (2.1% of children with COVID and 7.41% of those with PIMS-TS/MIS-C) are very much higher than national mortality rates reported from these settings (21)(22)(23). This likely re ects inclusion of studies from LMIC and publication bias towards more severe cases.…”

Children develop robust and sustained cross-reactive spike-specific immune responses following SARS-CoV-2 infection

“…Public Health England (PHE) initiated prospective SARS-CoV-2 surveillance in primary schools across the UK after they reopened following the easing of national lockdown in June 2020. The protocol for the COVID-19 Surveillance in School KIDs (sKIDs) is available online (https://www.gov.uk/guidance/covid-19-paediatric-surveillance) (Ladhani, Baawuah et al 2021). Surveillance comprised two arms, one involving weekly swabbing of primary school students and staff for SARS-CoV-2 infection (from June to mid-July 2020) and the other comprising swabbing and blood sampling taken in 3 rounds: beginning (1-19 June) and end (3-23 July) of the summer half-term when primary schools were partially re-opened, and after full reopening of all schools in September 2020, at the end of the autumn term (23 November-18 December).…”

“…Studies of SARS-CoV-2-specific immunity in children have been limited to date but initial findings have reported reduced magnitude of both antibody and cellular responses in comparison to adults, and an absence of nucleocapsid-specific antibody responses during or early post-infection (Pierce, Preston-Hurlburt et al 2020, Tosif, Neeland et al 2020, Weisberg, Connors et al 2021). One unique feature of SARS-CoV-2 infection in children is the development of a rare complication, known as Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) also known as paediatric multisystem inflammatory syndrome (MIS-C), which shares features with Kawasaki disease, toxic shock syndrome or both (Consiglio, Cotugno et al 2020, Flood, Shingleton et al 2021). MIS-C develops approximately 2-6 weeks after infection with median age at 9 years of age (Hoang, Chorath et al 2020).…”

“…It is, therefore, imperative to understand the baseline profile of SARS-CoV-2 specific immune responses in children to inform vaccination strategy. Here we provide a comprehensive characterisation of the convalescent humoral and cellular immune response in a cohort of 92 primary school-aged children compared with 155 adults taking part in SARS-CoV-2 surveillance in the schools (sKIDs) study (Ladhani, Baawuah et al 2021). We demonstrate a markedly different profile of immune response after SARS-CoV-2 infection in children compared to adults.…”

Should we be vaccinating children against COVID-19 in high-income countries?

“…16% required invasive mechanical ventilation, however, the median paediatric intensive care stay was 3 days with an overall mortality rate of 1.1%. Similarly, in surveillance data from the US, 4018 cases meeting the CDC case definition of MIS-C were reported, with 36 associated deaths [10]. The pathogenesis of PIMS-TS is not understood and so neither safety nor efficacy of vaccines in its causation and prevention, respectively, are known.…”