Analysis of National Surveillance Data to Support Case Definition Revisions for Multisystem Inflammatory Syndrome in Children (MIS-C), United States, February 2020-April 2022

Background. Classification of MIS-C, COVID-19, and other pediatric inflammatory conditions is challenged by phenotypic overlap and absence of diagnostic laboratory evidence. Due to public health need and based on limited data from early cases, CDC developed a necessarily broad MIS-C surveillance case definition in May 2020. Studies have since shown that some criteria do not distinguish between MIS-C and other conditions and may contribute to misclassification. To inform planned revision to the CDC definition, we evaluated the impact of narrowing these criteria on case inclusion in national MIS-C surveillance. Methods. Of state and local health-department reported cases meeting the current MIS-C case definition as of 04/14/2022, we describe the proportion that met revised criteria under consideration including fever duration, C-reactive protein (CRP) elevation using a defined cutoff, and organ involvement represented by specific criteria. We also evaluated cases identified using potential combinations of revised criteria. Results. Of 8,096 MIS-C cases fulfilling the original case definition, 6,332 (78%) had sufficient data for evaluation of criteria. Of these, 96% had fever for >=2 days and 94% had a CRP >= 3.0 mg/dL (Table 1). Cardiac involvement defined by key features of MIS-C was present in 84% of cases (62% if BNP/proBNP elevation was excluded);43% had shock. Dermatologic, gastrointestinal (GI) and hematologic involvement were present in 75%, 89% and 37% of cases, respectively. Neurologic (excluding headache), renal, and respiratory involvement were present in 16%, 20%, and 63% of cases, respectively. The number of cases with >= 2 of cardiac (without BNP/proBNP elevation), shock, dermatologic, GI, or hematologic involvement was 5,733 (91%). SARS-CoV-2 testing results are shown in Table 2. Conclusion. The CDC MIS-C case definition is intentionally broad. Using national surveillance data, we evaluated case inclusion under narrower criteria, prioritizing features of MIS-C that distinguish it from similar pediatric inflammatory conditions. A surveillance case definition may not capture all cases and is not intended to replace clinical judgment. We plan to assess additional criteria combinations, describe potentially excluded cases, and incorporate findings into a revised definition.

Multisystem Inflammatory Syndrome in Children (MIS-C) in Persons Fully Vaccinated with Two Doses of mRNA COVID-19 Vaccine Compared with Persons with Partial or No Vaccination Reported, U.S. National MIS-C Surveillance

Background. CDC began collecting COVID-19 vaccination status of persons with MIS-C as part of national surveillance inMay, 2021. We describe and compare MIS-C in fully vaccinated persons withMIS-C in persons with partial or no vaccination reported. Methods. We identified COVID-19 vaccine age-eligible persons meeting the CDC MIS-C case definition reported by health departments as of March 28, 2022 and divided theminto 3 groups for this analysis: 1) fully vaccinated (receipt of a 2-dosemRNAprimary vaccine series with MIS-C onset >=28 days after vaccine dose 2 to account for the delay between infection and MIS-C), 2) partially vaccinated (MIS-C onset after dose 1 or < 28 days from dose 2 or receipt of Janssen [Johnson & Johnson] vaccine and 3) no vaccination reported. We compared characteristics between the groups. Results. Of 7,880 MIS-C cases reported, 1,085 were vaccine eligible: 45 were fully vaccinated, 64 partially vaccinated, and 976 had no vaccine reported. Demographic characteristics were similar, although the Northeast had the lowest percentage of persons with vaccination not reported (Table). Though not statistically significant, fully vaccinated persons less frequently had severe cardiac involvement (67% vs 74%), shock (33% vs 44%), severe hematologic involvement (47% vs 54%), and mucocutaneous involvement (53% vs 63%) compared with those with no vaccine reported (Table). Forty-four percent of those fully vaccinated required ICU-level care vs 59% with no vaccine reported (p=0.053). Nineteen (2%) of those without vaccine reported died;no fully or partially vaccinated persons died. (Table Presented) Conclusion. Persons who acquire SARS-CoV-2 infection after being fully vaccinated can develop MIS-C, with similar clinical characteristics to those with no vaccination reported. A lower but not statistically significant percentage of fully vaccinated persons required ICU-level care compared with those without vaccination, and there were no deaths in the fully vaccinated group. These data do not account for trends in MIS-C over time, including the influence of circulating SARS-CoV-2 variants on MIS-C clinical manifestations. We will continue to evaluate these comparisons as the sample size of reported MIS-C cases increases.

A Case-Control Study Investigating Household, Community, and Clinical Risk Factors Associated with Multisystem Inflammatory Syndrome in Children (MIS-C) after SARS-CoV-2 Infection

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.

[Clinical characteristics of patients infected with 2019-nCoV Omicron variants BA.2 and BA.5 in Xi'an city, China].

Objective: To analyze the epidemiological and clinical characteristics of patients infected with different subtype of 2019-nCoV Omicron variants BA.2 and BA.5 in Xi'an city. Methods: A retrospective observational study was conducted to collect data of 168 patients infected with Omicron variant admitted to the designated hospital for COVID-19 charged by Xi'an Chest Hospital during 2022. Data were collected including epidemiological, clinical features, laboratory and viral load, and the difference between BA.2 and BA.5 subtype was analyzed. Results: A total of 168 patients were admitted, including 122 cases infected with BA.2 subtype, and 46 cases infected with BA.5 subtype. Patients infected with BA.2 subtype had a higher rate of cough than BA.5 subtype (43.44%∶23.91%; P=0.021). Compared with the Omicron variant BA.2, patients infected with BA.5 subtype had a higher proportion of asymptomatic and mild infections (89.13%∶68.85%; P<0.001), higher rate of vaccination (95.66%∶68.03%; P<0.001), shorter time to nucleic acid negative conversion (8.62; P=0.047), and a higher viral load at admission (P=0.005, P=0.017). Conclusions: The Omicron variant is extremely infectious with aggregated onset, but its clinical symptoms are mild. The vaccine, especially the booster vaccination, remains effective in preventing severe stage progression and improving prognosis in patients with Omicron variant infection.

Information availability among otolaryngology applicants: An analysis of Freida

Introduction: Otolaryngology (ORL) applicants face challenges finding information about residency programs. Due to COVID-19, the Society of University Otolaryngologists released suggestions for students to avoid away rotations and look for programs to expand and update their web presence. However, information on program websites is not always standardized or easily accessible. Many applicants use the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA), a designated, standardized resource of basic and detailed information on residency programs. However, the availability of information within FREIDA is unclear. Herein, we analyze available data within FREIDA on all 124 ORL residency programs to understand the completeness of the FREIDA database. Method: Data from all 124 otolaryngology-head and neck surgery residency programs within FREIDA was abstracted in early December 2020 and organized into 2 sections: basic information and detailed information (program details, educational features, and occupational benefits). The number of contributing programs in both sections was evaluated. Results: More than half of the programs (n = 65, 52.4%) did not provide any detailed information within FREIDA. While all 124 programs had their address, contact email, and the names of program directors available, slightly fewer had direct links to their website available (n = 113, 91.1%). Most programs (70.2%) did not include a brief 1-paragraph program description. Conclusion: Our findings suggest that FREIDA provides basic information for nearly all ORL programs, but it does not offer detailed information for most programs. As COVID-19 has negatively impacted the ability of ORL applicants to learn about programs, FREIDA is a helpful, centralized resource but is currently incomplete.