ABSTRACT
Background. Risk factors for MIS-C, a rare but serious hyperinflammatory syndrome associated with SARS-CoV-2 infection, remain unclear. We evaluated household, clinical, and environmental risk factors potentially associated with MIS-C. Methods. This investigation included MIS-C cases hospitalized in 14 US pediatric hospitals in 2021. Outpatient controls were frequency-matched to case-patients by age group and site and had a positive SARS-CoV-2 viral test within 3 months of the admission of their matched MIS-C case (Figure 1). We conducted telephone surveys with caregivers and evaluated potential risk factors using mixed effects multivariable logistic regression, including site as a random effect. We queried regarding exposures within the month before hospitalization for MIS-C cases or the month after a positive COVID-19 test for controls. Enrollment scheme for MIS-C case-patients and SARS-CoV-2-positive outpatient controls. MIS-C case-patients were identified through hospital electronic medical records, while two outpatient controls per case were identified through registries of outpatient SARS-CoV-2 testing logs at facilities affiliated with that medical center. Caregivers of outpatient controls were interviewed at least four weeks after their positive test to ensure they did not develop MIS-C after their infection. Results. We compared 275 MIS-C case-patients with 494 outpatient SARS-CoV-2-positive controls. Race, ethnicity and social vulnerability indices were similar. MIS-C was more likely among persons who resided in households with >1 resident per room (aOR=1.6, 95% CI: 1.1-2.2), attended a large (>=10 people) event with little to no mask-wearing (aOR=2.2, 95% CI: 1.4-3.5), used public transportation (aOR=1.6, 95% CI: 1.2-2.1), attended school >2 days per week with little to no mask wearing (aOR=2.1, 95% CI: 1.0-4.4), or had a household member test positive for COVID-19 (aOR=2.1, 95% CI: 1.3-3.3). MIS-C was less likely among children with comorbidities (aOR=0.5, 95% CI: 0.3-0.9) and in those who had >1 positive SARS-CoV-2 test at least 1 month apart (aOR=0.4, 95% CI: 0.2-0.6). MIS-C was not associated with a medical history of recurrent infections or family history of underlying rheumatologic disease. Conclusion. Household crowding, limited masking at large indoor events or schools and use of public transportation were associated with increased likelihood of developing MIS-C after SARS-CoV-2 infection. In contrast, decreased likelihood of MIS-C was associated with having >1 SARS-CoV-2 positive test separated by at least a month. Our data suggest that additional studies are needed to determine if viral load, and/or recurrent infections in the month prior to MIS-C contribute to MIS-C risk. Medical and family history were not associated with MIS-C in our analysis.
ABSTRACT
Background: COVID-19 testing data in children from different backgrounds such as race/ethnicity can guide the strategies for controlling the pandemic. In this study, we aimed to characterize the percent positivity of real time reverse transcriptase polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children with different race/ethnicity in Mississippi, a state with historic racial health disparity. Methods: We performed a retrospective study using a deidentified COVID- 19 registry abstracted from the electronic health record at the University of Mississippi Medical Center, the only academic institution in the state encompassing the main university hospitals and ambulatory sites statewide. Children aged 18 years or younger who underwent RT-PCR for SARS-CoV-2 between 11 March 2020 and 31 May 2020 were included in the study. The primary outcome of interest was positive SARS-CoV-2 RT-PCR test, and the primary exposure of interest was race/ethnicity. Multivariable analysis was performed by developing a logistic regression model. Results: Of 1838 children who underwent SARS-CoV-2 RT-PCR testing, 162 tested positive, corresponding to percent positivity of 8.8%. Non-Hispanic white children had percent positivity of 2.4%, which was substantially lower than that of non-white children (9.7%, 28.6%, and 11.5% for non-Hispanic black, Hispanic, and other race/ethnicity children, respectively) (Table). Older children (particularly those aged 10-18 years) also had higher percent positivity (Table, Figure). The risks associated with non-white race/ethnicity remained substantial after adjusting for insurance status, which was used as a surrogate for socioeconomic status (Figure). Conclusion: We found a striking difference in percent positivity by race/ethnicity among children, suggesting inadequate allocation of testing resources to this population. Higher percent positivity among school age children may also have particular public health implications, considering their school attendance. We argue that minority children should not be left behind in data analysis, research, targeted testing and transmission reduction measures. (Table Presented).