The Clinical Features and Estimated Incidence of MIS-C in Cape Town, South Africa

Abstract

Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. Results 68 children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). 97 healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p=0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. 94.1% received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. 39.7% required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR=1.523, CI 1.074, 2.16, p=0.018). The median hospital stay duration was 7 days with no deaths. Conclusion The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.

Management of Multisystem Inflammatory Syndrome in Children (MIS-C) in resource limited settings: The Kenyan Experience

“…The median age was 3•98 years (range 1•71 − 7•44) and 70% of the children were male. Our colleagues in South Africa had a cohort of 68 patients with a much higher median age of 7 years (range 3•6-9•9) (15). The majority of our patients were African, re ecting the demographics of our nation.…”

“…In There are few reports of MIS-C is sub-Saharan Africa, which may lead to a presumption that this syndrome is not identi ed in these populations yet low and middle-income countries (LMICs) have the challenge of delayed vaccination, poor vaccine coverage, inadequate diagnostics, sub-optimal management options despite a relatively larger proportion of younger people in their population (15).…”

Routine SARS‐CoV‐2 vaccination for all children*

“…42 Therefore, on the global level, pediatric complications due to SARS-CoV-2 infection are most likely underreported and will continue to occur given the considerably lower vaccine coverage in LMICs. 42 In high income countries, such as the USA, the risk for MIS-C is increased in Black and Hispanic children. 30,41 This disparity could be due to socio-economic and health care access inequities, but genetic and environmental risk factors are still being explored.…”

“…Importantly, exact data on global SARS‐CoV‐2 infections in LMICs are often not available, especially when estimating pediatric cases. In fact, only recently a first study on MIS‐C was reported from South Africa 42 . Therefore, on the global level, pediatric complications due to SARS‐CoV‐2 infection are most likely underreported and will continue to occur given the considerably lower vaccine coverage in LMICs 42 .…”

“…In fact, only recently a first study on MIS‐C was reported from South Africa 42 . Therefore, on the global level, pediatric complications due to SARS‐CoV‐2 infection are most likely underreported and will continue to occur given the considerably lower vaccine coverage in LMICs 42 . In high income countries, such as the USA, the risk for MIS‐C is increased in Black and Hispanic children 30,41 .…”