COVID inflammatory syndrome in kids ranges from mild to life-threatening
An international survey of 183 pediatric patients with the rare but serious COVID-19–related multisystem inflammatory syndrome in children (MIS-C) shows broad clinical presentations, from mild illness featuring fever and inflammation to life-threatening shock similar to that of Kawasaki disease (KD).
The study, led by researchers at Royal Brompton Hospital in London and published today in Pediatrics, was a retrospective case series of children younger than 18 years diagnosed as having MIS-C who were released from the hospital or died from Mar 1 to Jun 15, 2020, from 33 hospitals in American, Asian, and European countries.
Of the 183 patients, 114 (62.3%) had evidence of severe COVID-19. All had fever, 117 (63.9%) had gastrointestinal symptoms, and 79 (43.2%) had shock. Shock was linked to black race, higher levels of inflammation, and abnormal imaging findings.
Twenty-seven of 183 children (14.7%) met the criteria for KD. They were younger, did not experience shock, and had fewer cardiorespiratory, gastrointestinal, and neurologic symptoms. The remaining patients primarily had fever and inflammation.
The 78 patients (42.6%) with shock were older than their counterparts and significantly more likely to have positive antibody test results. Black children had substantially higher rates of cardiorespiratory, gastrointestinal, and neurologic symptoms.
Children hospitalized sooner rather than later after they developed symptoms were linked to worse outcomes and were more likely to need extracorporeal membrane oxygenation (ECMO, or oxygen added to the blood outside the body) (72.3% higher risk per day reduction) and to die (63.3% higher risk per day reduction).
Seventy-two patients (39.3%) required drugs to strengthen their heartbeats, 43 (23.5%) received mechanical ventilation, and 4 (2.2%) needed ECMO. Three children (1.6%) died. Mean patient age was 7.0 years, 30.6% were black, and 26.2% were obese.
"MIS-C has emerged with a wide clinical spectrum at presentation, including KD-like, life-threatening shock and milder forms with mainly fever and inflammation," the authors concluded. "The risk for worse outcome (ECMO and/or death) is associated with a short time interval between the onset of symptoms and admission. More studies encompassing larger numbers of patients are needed to better describe this new disease, its optimal treatment, and long-term monitoring."
Jan 29 Pediatrics study
Rates of screening for cervical cancer drop during COVID
During California's 3-month stay-at-home order, cervical screening rates dropped 80% per 100 person-months compared with the 2019 baseline, according to a study today in Morbidity and Mortality Weekly Report. The researchers write that rates returned almost to baseline by Sep 30, 2020.
The study pulled from 2019 and 2020 health records from the Kaiser Permanente Southern California network, which recommends Pap tests every 3 years for women 21 to 29 years of age and human papillomavirus (HPV) tests every 5 years for women 30 to 65. More than 1,455,200 women were included per year in the study after the researchers excluded women who had complete hysterectomies or who had histories of precancer or cervical cancer.
Before the stay-at-home order started on Mar 19, 2020, younger women had 8% less screenings per 100 person-months, 82% less during the order, and then 24% less after it was lifted Jun 12, 2020, in comparison to 2019. Older women had a 3% decrease, 89% decrease, and then 29% decrease, respectively, when compared with the 2019 baseline.
The researchers note that it is unknown whether women who missed screenings during the stay-at-home-order came back after it was lifted.
"During a pandemic, bringing populations at higher risk back to screening first, such as those with abnormal results or increased risk for precancers and cancers, is important," they write. The researchers recommend enhanced outreach with prioritized targets as well as additional resources such as telemedicine or the development of tests involving HPV self-collected samples.
Jan 29 MMWR study