tetano
Editor, Senior Moderator
J Pediatric Infect Dis Soc
. 2021 Jun 15;piab035.
doi: 10.1093/jpids/piab035. Online ahead of print.
COVID-19 in a Subset of Hospitalized Children in Israel
Shalom Ben-Shimol[SUP] 1 2 [/SUP], Gilat Livni[SUP] 3 [/SUP], Orli Megged[SUP] 4 [/SUP], David Greenberg[SUP] 1 2 [/SUP], Dana Danino[SUP] 1 2 [/SUP], Ilan Youngster[SUP] 5 6 [/SUP], Yael Shachor-Meyouhas[SUP] 7 [/SUP], Halima Dabaja-Younis[SUP] 7 [/SUP], Oded Scheuerman[SUP] 8 [/SUP], Meirav Mor[SUP] 6 9 [/SUP], Eli Somekh[SUP] 6 10 [/SUP], Husam Yakub Hanna[SUP] 6 10 [/SUP], Noga Givon-Lavi[SUP] 1 2 [/SUP], Alex Guri[SUP] 11 12 [/SUP], Eugene Leibovitz[SUP] 1 2 [/SUP], Yoav Alkan[SUP] 13 [/SUP], Daniel Grupel[SUP] 14 [/SUP], Uri Rubinstein[SUP] 15 [/SUP], Zohar Steinberg Ben Zeev[SUP] 16 [/SUP], Ellen Bamberger[SUP] 17 [/SUP], Amir Asher Kuperman[SUP] 18 19 [/SUP], Galia Grisaru-Soen[SUP] 20 [/SUP], Diana Tasher[SUP] 21 [/SUP], Giora Gottesman[SUP] 22 [/SUP], Daniel Glikman[SUP] 23 24 [/SUP], Michal Stein[SUP] 25 26 [/SUP]
Affiliations
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.
Keywords: SARS-CoV-2; children; coronavirus disease 2019 (COVID-19); multisystem inflammatory syndrome in children (MIS-C); pediatric inflammatory multisystem syndrome (PIMS).
. 2021 Jun 15;piab035.
doi: 10.1093/jpids/piab035. Online ahead of print.
COVID-19 in a Subset of Hospitalized Children in Israel
Shalom Ben-Shimol[SUP] 1 2 [/SUP], Gilat Livni[SUP] 3 [/SUP], Orli Megged[SUP] 4 [/SUP], David Greenberg[SUP] 1 2 [/SUP], Dana Danino[SUP] 1 2 [/SUP], Ilan Youngster[SUP] 5 6 [/SUP], Yael Shachor-Meyouhas[SUP] 7 [/SUP], Halima Dabaja-Younis[SUP] 7 [/SUP], Oded Scheuerman[SUP] 8 [/SUP], Meirav Mor[SUP] 6 9 [/SUP], Eli Somekh[SUP] 6 10 [/SUP], Husam Yakub Hanna[SUP] 6 10 [/SUP], Noga Givon-Lavi[SUP] 1 2 [/SUP], Alex Guri[SUP] 11 12 [/SUP], Eugene Leibovitz[SUP] 1 2 [/SUP], Yoav Alkan[SUP] 13 [/SUP], Daniel Grupel[SUP] 14 [/SUP], Uri Rubinstein[SUP] 15 [/SUP], Zohar Steinberg Ben Zeev[SUP] 16 [/SUP], Ellen Bamberger[SUP] 17 [/SUP], Amir Asher Kuperman[SUP] 18 19 [/SUP], Galia Grisaru-Soen[SUP] 20 [/SUP], Diana Tasher[SUP] 21 [/SUP], Giora Gottesman[SUP] 22 [/SUP], Daniel Glikman[SUP] 23 24 [/SUP], Michal Stein[SUP] 25 26 [/SUP]
Affiliations
- PMID: 34129032
- DOI: 10.1093/jpids/piab035
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.
Keywords: SARS-CoV-2; children; coronavirus disease 2019 (COVID-19); multisystem inflammatory syndrome in children (MIS-C); pediatric inflammatory multisystem syndrome (PIMS).