Reinfección por SARS-CoV-2 en pacientes con antecedentes de MIS-C. Presentación de dos casos / MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases

El síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés) es una enfermedad rara. Se desconoce si los niños que se recuperaron del MIS-C tienen riesgo de recurrencia de MIS-C cuando presentan reinfección por SARS-CoV-2. El objetivo de este estudio es describir los casos de dos niñas que se recuperaron del MIS-C y presentaron reinfección por SARS-CoV-2 sin recurrencia de MIS-C.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARS-CoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARS-CoV-2 without recurrence of MIS-C.

COVID-19 vaccination in children: a public health priority

Abstract Objective: Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group. Sources of data: The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics. Summary of findings: Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety. Conclusions: Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.

Association between vaccination status and COVID-19-related health outcomes among community-dwelling COVID-19 patients in Nara, Japan

BACKGROUND@#Many previous studies have reported COVID-19 vaccine effectiveness, but there are few studies in Japan. This community-based, retrospective observational study investigated the association between vaccination status and COVID-19-related health outcomes in COVID-19 patients by SARS-CoV-2 variant type.@*METHODS@#The study participants were 24,314 COVID-19 patients aged 12 or older whose diagnoses were reported to the Nara Prefecture Chuwa Public Health Center from April 2021 to March 2022, during periods when the alpha, delta, and omicron variants of COVID-19 were predominant. The outcome variables were severe health consequences (SHC) (i.e., ICU admission and COVID-19-related death), hospitalization, and extension of recovery period. The explanatory variable was vaccination status at least 14 days prior to infection. Covariates included gender, age, population size, the number of risk factors for aggravation, and the number of symptoms at diagnosis. The generalized estimating equations of the multivariable Poisson regression models were used to estimate the adjusted incidence proportion (AIP) and 95% confidence interval (CI) for each health outcome. We performed stratified analyses by SARS-CoV-2 variant type, but the association between vaccination status and COVID-19-related health outcomes was stratified only for the delta and omicron variants due to the small number of vaccinated patients during the alpha variant.@*RESULTS@#Of the 24,314 participants, 255 (1.0%) had SHC; of the 24,059 participants without SHC, 2,102 (8.7%) were hospitalized; and of the 19,603 participants without SHC, hospitalization, and missing data on recovery period, 2,960 (15.1%) had extension of recovery period. Multivariable Poisson regression models showed that regardless of SARS-CoV-2 variant type or health outcome, those who received two or more vaccine doses had significantly lower risk of health outcomes than those who did not receive the vaccine, and there was a dose-response relationship in which the AIP for health outcomes decreased with an increased number of vaccinations.@*CONCLUSION@#A higher number of vaccinations were associated with lower risk of COVID-19-related health outcomes, not only in the delta variant but also in the omicron variant. Our findings suggest that increasing the number of COVID-19 vaccine doses can prevent severe disease and lead to early recovery of patients not requiring hospitalization.

Kawasaki disease in Colombia: A systematic review and contrast with multisystem inflammatory syndrome in children associated with COVID-19

Introduction: Kawasaki disease (KD) is an acute vasculitis with multisystem involvement. Recently, the increasing incidence of a condition that closely resembles KD in many cases, named multisystem inflammatory syndrome in children (MIS-C), has set off alarms amid the current worldwide coronavirus disease-19 (COVID-19) pandemic. Hence, the aim is to conduct a systematic review of the literature about KD in Colombia and contrast it with COVID-19-related MIS-C. Materials and methods: A search was carried out in both international and Latin American electronic databases for publications concerning patients with KD in the Colombian population. Records were then screened by titles and/or abstracts, assessed for eligibility, and reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The search included studies reporting MIS-C associated with COVID-19, and compared these patients with our findings of KD in Colombia. Results: Out of 36 publications retrieved, 17 were included, representing 120 individuals. Male to female ratio was 1.6, and most patients (90.4%) were aged 5 years or less. Among the main features of KD, fever was the most frequent (96.2% of the patients), while cervical lymphadenopathy was present in only 40.6%. Intravenous immunoglobulin was administered in 91.4% cases and 6.2% were resistant. Cardiac involvement was found in around 30%, and 20% had coronary artery lesions. Comparison between MIS-C associated with COVID-19 and KD in Colombia indicates that patients affected by MIS-C were older (72.2% of MIS-C patients > 5 years), had higher rates of cardiac involvement, and required critical care more often. Conclusions: Our findings of KD in Colombia are consistent with the available descriptions of KD in the scientific literature. Given the increasing rate of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in Colombia and Latin America, our study raises awareness about MIS-C in pediatric patients with COVID-19 and its relationship with KD.

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda con compromiso multisistémico. Recientemente, la incidencia creciente de una condición que se asemeja en forma considerable a la EK en muchos casos, denominada síndrome inflamatorio multisistémico (SIMS) en niños, ha encendido las alarmas en medio de la actual pandemia mundial de la enfermedad COVID-19. Por consiguiente, nos propusimos realizar una revisión sistemática de la literatura acerca de la EK en Colombia y contrastarla con el SIMS relacionado con COVID-19 en niños. Materiales y métodos: Buscamos publicaciones respecto a pacientes con EK en población colombiana, en bases de datos electrónicas tanto internacionales como latinoamericanas. Los registros hallados fueron tamizados por títulos o resúmenes, evaluados para elegibilidad y revisados. Se siguieron las guías Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Posteriormente, buscamos estudios que reportaran SIMS temporalmente asociado con COVID-19 en niños y comparamos estos pacientes con nuestros hallazgos de EK en Colombia. Resultados: De 36 publicaciones encontradas se incluyeron 17, las cuales representaron 120 individuos. La razón hombre a mujer fue de 1,6 y la mayoría de los pacientes (90,4%) tenía 5 anos o menos. Entre las principales características de EK, la fiebre fue la más frecuente (96,2%), mientras que la linfadenopatía cervical estuvo presente solo en el 40,6%. La inmunoglobulina intravenosa se administró en el 91,4% de los casos y 6,2% presentaron resistencia. Se encontró compromiso cardiaco en alrededor del 30% de los pacientes, en tanto que el 20% tuvo lesiones de arterias coronarias. La comparación entre las características clínicas de la EK y el SIMS asociado a COVID-19 mostró que los individuos afectados por el SIMS eran mayores (72,2% con SIMS tenían más de cinco anos), tuvieron mayores índices de compromiso cardiaco y requirieron cuidado crítico con mayor frecuencia. Conclusiones: Nuestros hallazgos de EK en Colombia son consistentes con las descripciones disponibles de esta enfermedad en la literatura científica. Debido al aumento de infección por SARS-CoV-2 en Colombia y Latinoamérica, nuestro estudio busca crear conciencia sobre el SIMS en pacientes pediátricos con COVID-19 y su relación con la EK.

Abdomen agudo quirúrgico relacionado con síndrome inflamatorio multisistémico asociado a covid-19 en pediatría: reporte de caso / Acute surgical abdomen related to multisystem inflamatory syndrome associated with covid-19 in pediatrics

Resumen En el contexto de la enfermedad por el nuevo coronavirus SARS-CoV-2, se ha descrito una afección poco usual denominada síndrome inflamatorio multisistémico en niños, asociada a COVID-19, en la cual los síntomas más frecuentes son los gastrointestinales. El dolor abdominal agudo severo se presenta hasta en un 60 % de los casos, requiriendoprincipalmente un diagnóstico diferencial con la apendicitis aguda. Se reporta el caso clínico de un adolescente quién presentó dolor abdominal, distensión, fiebre y diarrea, con proteína C reactiva muy elevada y hallazgos tomográficos compatibles con apendicitis aguda, por lo que se llevó a cirugía. Fue diagnosticado posteriormente con la enfermedad mencionada, tras reconsultar con fiebre y dolor abdominal. La apendicitis aguda en este síndrome se asocia con isquemia por la vasculitis intestinal y es una complicación inmunológica potencialmente mortal que debe considerarse por riesgo de perforación intestinal.

Abstract In the context of the disease caused by the new coronavirus SARS-CoV-2, an unusual condition called multisystem inflammatory syndrome in children associated with COVID-19 has been described, and its most common symptoms are gastrointestinal. Severe acute abdominal pain occurs in up to 60% of cases, requiring mainly a differential diagnosis with acute appendicitis. It is described the clinical case of an adolescent who presented abdominal pain, bloating, fever and diarrhea, with very high C-reactive protein and tomographic findings compatible with acute appendicitis, for which he underwent surgery. He was later diagnosed with the disease, after consulting again with fever and abdominal pain. Acute appendicitis related to this syndrome is associated with ischemia due to intestinal vasculitis and is a life-threatening immunological complication due to the risk of intestinal perforation.

Reinfección por SARS-CoV-2 en un niño con antecedente de síndrome inflamatorio multisistémico: a propósito de un caso / Reinfection by SARS-CoV-2 in a child with history of multisystem inflammatory syndrome: a case report

El síndrome inflamatorio multisistémico en niños y adolescentes relacionado temporalmente con la COVID-19 (SIM-C) es una entidad poco frecuente en pediatría, que emerge en relación con la pandemia por el coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y fue descripto por primera vez en mayo de 2020. Debido al escaso tiempo de evolución de esta enfermedad, hay aspectos sobre su fisiopatología, pronóstico y posibilidad de recurrencia, que aún se desconocen. Se presenta el caso clínico de un paciente de 12 años que cursó un cuadro compatible con SIM-C en enero de 2021, con buena evolución clínica posterior. Luego presentó una reinfección por SARS-CoV-2 a los 5 meses de la infección inicial (junio de 2021), con síntomas leves y sin recurrencia del SIM-C.

The multisystem inflammatory syndrome in children temporally related to COVID-19 (MIS-C) is a rare disease in pediatrics, which emerges related to the SARS-CoV-2 pandemic and was initially described in May 2020. Given the short time of evolution of this disease, little is known about the pathophysiology, prognosis, and the possibility of recurrence. We present a clinical case of a 12-year-old patient who presented symptoms compatible with MIS-C in January 2021, with good subsequent clinical evolution. He developed reinfection by SARS-CoV-2 at five months later (June 2021), with mild symptoms and without recurrence of MIS-C

SARS-CoV-2 Infection in Filipino Children: An interim report from the SALVACION registry

Background@#The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. @*Methods@#This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. @*Results@#As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. @*Conclusion@#Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.

Asociación de comorbilidades con infección sintomática y síndrome inflamatorio multisistémico por SARS-CoV-2 en niños / Association of comorbidities and symptomatic infection and multisystemic inflammatory syndrome due to SARS-CoV-2 in children

INTRODUCCIÓN: En niños, la infección por el nuevo coronavirus (SARS-CoV-2) habitualmente cursa asintomática o con síntomas leves; sólo una proporción menor presenta síntomas graves o un conjunto de signos y síntomas postinfecciosos descritos como síndrome inflamatorio multisistémico pediátrico (SIMP). OBJETIVO: Describir la asociación de comorbilidades con la infección sintomática y SIMP por SARS-CoV-2 en niños. PACIENTES Y MÉTODOS: Estudio transversal analítico, se incluyeron pacientes pediátricos hospitalizados. Mediante reacción de la polimerasa en cadena y/o pruebas antigénicas se diagnosticó la infección activa y con la definición propuesta por la Organización Mundial de la Salud se identificaron pacientes con SIMP. RESULTADOS: Se estudiaron 375 pacientes, la mediana de edad fue de 3,8 años. El 47,7% (n: 179) presentó comorbilidades, siendo las más frecuentes: neoplasias sólidas y/o enfermedades hematológicas 17,1% (n: 64), obesidad 13,3% (n: 48) y neumopatías crónicas 9,3% (n: 35). Presentaron infección por SARS-CoV-2 el 16,5% (n: 62/375) y SIMP el 10,4% (n. 39/375). Los niños con obesidad mostraron mayor riesgo de infección sintomática (OR 2,21, IC 95% 1,05-4,6) y en aquellos con cáncer (OR 0,15, IC 95% 0,03-0,68) el riesgo de SIMP fue menor. CONCLUSIONES: La presencia de comorbilidades modifica el riesgo de infección por SARS-CoV-2 y SIMP.

BACKGROUND: In children, infection by the new coronavirus (SARS-CoV-2) usually occurs asymptomatic or with mild clinical data, only a minor proportion have severe symptoms or a set of post-infectious signs and symptoms described as Pediatric Inflammatory Multisystemic Syndrome (PIMS). AIM: To describe the association of comorbidities with symptomatic infection and PIMS due to SARS-CoV-2 in children. METHODS: Analytical cross-sectional study, pediatric patients hospitalized were included. Active infection was diagnosed by polymerase chain reaction and/or antigenic tests. Patients with PIMS were identified by the definition proposed by the World Health Organization. RESULTS: 375 patients were studied, the median age was 3.8 years. 47.7% (n: 179) had comorbidities, the most frequent were: solid neoplasms and/or hematological diseases 17.1% (n: 64), obesity 13.3% (n: 48) and chronic pneumopathies 9, 3% (n: 35). SARS-CoV-2 infection was present in 16.5% (n: 62/375) and PIMS in 10.4% (n. 39/375). Children with obesity showed a higher risk of infection (OR 2.21, 95% CI 1.05-4.6) and in those with cancer (OR 0.15, 95% CI 0.03-0.68) the PIMS risk was lower. CONCLUSIONS: The presence of comorbidities modifies the risk of infection by SARS-CoV-2 and PIMS.

Estudio transversal analítico de las características y desenlaces clínicos de niños hospitalizados con COVID-19 en Lima, Perú / Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

Introducción La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales. Objetivos Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020. Métodos Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19. Resultados Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008). Conclusiones Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19.

Introduction Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.

Relationship between COVID-19 stress and social adaptation： the mediating role of patience and social support / 四川精神卫生

ObjectiveTo explore the impact of COVID-19-related stress on the social adaptation of college students， and to analyze and compare the mediating effects of patience and social support. MethodsStratified cluster sampling method was applied to enroll 3 219 college students， and they were assessed using the COVID-19-related Stress Questionnaire， Social Adaptation Inventory （SAI）， Patience Questionnaire （PQ） and Social Support Rating Scale （SSRS）， thereafter， the mediating effect was assessed via the SPSS Process macro. ResultsCollege students' COVID-19-related Stress Questionnaire score were positively correlated with the scores of PQ and SSRS （r=0.297， 0.229， P<0.01）， and negative correlated with SAI score （r=-0.430， P<0.01）. PQ and SSRS scores were positively correlated with SAI score （r=0.374， 0.283， P<0.01）. PQ score was positively correlated with SSRS score （r=0.271， P<0.01）. Patience partially mediated the relationship between COVID-19-related stress and social adaptation （β=0.049， 95% CI： 0.039~0.062）. Meanwhile， social support also partially mediated the relationship between COVID-19-related stress and social adaptation （β=0.016， 95% CI： 0.009~0.025）. ConclusionCOVID-19-related stress exerts a negative impact on college students' social adaptation ability， while the impact is mediated by patience and social support， and the mediation effect of patience is more significant.