AUTHOR=Berry Crista-Lee Shahine  , Melbourne-Chambers Roxanne Helene , Harrison Abigail Natalie , Anzinger Joshua James , Gordon-Johnson Kelly-Ann Maxorinthia , Deyde Varough Mohamed , Christie Celia Dana Claire 

TITLE=Hospitalized children with SARS-CoV-2 infection and MIS-C in Jamaica: A dive into the first 15 months of the novel pandemic

JOURNAL=Frontiers in Pediatrics

VOLUME=10

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.904788

DOI=10.3389/fped.2022.904788

ISSN=2296-2360

ABSTRACT=<sec><title>Objectives</title><p>COVID-19 in children was initially mild until the emergence of Multisystem Inflammatory Syndrome in Children (MIS-C). We describe pediatric COVID-19 in a developing country within the Caribbean.</p></sec><sec><title>Methods</title><p>Jamaican children who were hospitalized with SARS-CoV-2 infection, in one Caribbean regional academic referral center from April 2020 through June 2021 were included. Prospective surveillance and pediatric infectious disease consultations were performed using the CDC's MIS-C case definition. Data were extracted from patients' hospital charts using WHO's reporting form, entered into the RedCap database, and SPSS 28 was used for analysis. MIS-C and non-MIS-C patients were compared using independent sample <italic>t</italic>-tests for continuous variables and Fisher's exact test for categorical variables, <italic>p</italic> values &lt; 0.05 were statistically significant.</p></sec><sec><title>Results</title><p>Seventy-nine children with COVID-19 with/without MIS-C presented to UHWI. Thirty-eight (48%) were mild ambulatory cases. Hospitalizations occurred in 41 (52%) children, with median age of 10 <inline-formula><mml:math id="M1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mfrac><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:mfrac></mml:math></inline-formula> years. SARS-CoV-2 RT-PCR positivity was present in 26 (63%), Immunoglobulin M, or Immunoglobulin G (IgM/IgG) positivity in 8 (20%), with community exposures in 7 (17%). Eighteen (44%) MIS-C positive patients were significantly more likely than 23 MIS-C negative patients (56%) to present with fever (94% vs. 30%; <italic>p</italic> &lt; 0.001), fatigue/lethargy (41% vs. 4%; <italic>p</italic> = 0.006), lymphadenopathy (33% vs. 0%; <italic>p</italic> = 0.003), elevated neutrophils (100% vs. 87%; <italic>p</italic> = 0.024), and ESR (78% vs. 9%; <italic>p</italic> = 0.002). Involvement of <underline>&gt;</underline> two organ systems occurred more frequently in MIS-C positive cases (100% vs. 34%; <italic>p</italic> &lt; 0.001), including gastrointestinal (72% vs. 17%; <italic>p</italic> &lt; 0.001); vomiting/nausea (39% vs. 9%; <italic>p</italic> &lt; 0.028); hematological/coagulopathic (67% vs. 4%; <italic>p</italic> &lt; 0.001); dermatologic involvement (56% vs. 0%; <italic>p</italic> &lt; 0.001); and mucositis (28% vs. 0%; <italic>p</italic> = 0.001). MIS-C patients had Kawasaki syndrome (44%), cardiac involvement (17%), and pleural effusions (17%). MIS-C patients had &gt;4 abnormal inflammatory biomarkers including D-dimers, C-reactive protein, ESR, ferritin, troponins, lactate dehydrogenase, neutrophils, platelets, lymphocytes, and albumen (72%). MIS-C patients were treated with intravenous immune gamma globulin (78%), aspirin (68%), steroids (50%), and non-invasive ventilation (11%). None required inotropes/vasopressors. MIS-C negative patients received standard care. All recovered except one child who was receiving renal replacement therapy and developed myocardial complications.</p></sec><sec><title>Conclusions</title><p>In this first report of COVID-19 from the Caribbean, children and adolescents with and without MIS-C were not very severe. Critical care interventions were minimal and outcomes were excellent.</p></sec>