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Should Coronavirus Disease 2019–Associated Inflammatory Syndromes in Children Affect Social Reintegration?

Educational Objective
To understand whether COVID-19 associated inflammatory syndrome among children should affect social reintegration
1 Credit CME

Recent reports in several medical journals, including JAMA, and the general media have highlighted the emergence of coronavirus disease 2019 (COVID-19)–associated inflammatory syndromes in children.13 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to induce this new condition, which has been called pediatric multisystem inflammatory syndrome (PIMS) or pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and described in detail by investigators in Europe and New York, New York.14 Additionally, investigators in Italy have reported5 a dramatic surge in Kawasaki disease (KD), often associated with positive serological test results for COVID-19. As of May 31, 2020, the New York State Department of Health is investigating 188 reported hospitalized cases and 3 deaths of children, predominantly school-aged, who experienced symptoms similar to KD and toxic shock–like syndrome that were possibly linked to COVID-19.6 Similarly, more than 200 cases have been reported to the European Centre for Disease Prevention and Control. The US Centers for Disease Control and Prevention has also issued a statement and case reports for the emerging condition, now also termed multisystem inflammatory syndrome of childhood (MIS-C), which is currently under investigation.7 Simultaneously, sporadic cases of MIS-C, KD, and/or Kawasaki shock syndrome have appeared in public health reports and the media, particularly in Washington and other West Coast states.

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Article Information

Corresponding Author: Michael A. Portman, MD, Seattle Children’s Research Institute, University of Washington, 1900 9th Ave, Seattle WA 98101 (michael.portman@seattlechildrens.org).

Published Online: July 20, 2020. doi:10.1001/jamapediatrics.2020.2810

Conflict of Interest Disclosures: None reported.

References
1.
Whittaker  E , Bamford  A , Kenny  J ,  et al.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. Published online June 8, 2020. doi:10.1001/jama.2020.10369 Google Scholar
2.
Cheung  EW , Zachariah  P , Gorelik  M ,  et al.  Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City.   JAMA. Published online June 8, 2020. doi:10.1001/jama.2020.10374 PubMedGoogle Scholar
3.
Riphagen  S , Gomez  X , Gonzalez-Martinez  C , Wilkinson  N , Theocharis  P .  Hyperinflammatory shock in children during COVID-19 pandemic.   Lancet. 2020;395(10237):1607-1608. doi:10.1016/S0140-6736(20)31094-1 PubMedGoogle ScholarCrossref
4.
Belhadjer  Z , Méot  M , Bajolle  F ,  et al.  Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic.   Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.048360 PubMedGoogle Scholar
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Verdoni  L , Mazza  A , Gervasoni  A ,  et al.  An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.   Lancet. 2020;395(10239):1771-1778. doi:10.1016/S0140-6736(20)31103-X PubMedGoogle ScholarCrossref
6.
New York State. Novel coronavirus. Published 2020. Accessed June 11, 2020. http://coronavirus.health.ny.gov
7.
US Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Published 2020. Accessed June 11, 2020. https://emergency.cdc.gov/han/2020/han00432.asp
8.
Skochko  SM , Jain  S , Sun  X ,  et al.  Kawasaki disease outcomes and response to therapy in a multiethnic community: a 10-year experience.   J Pediatr. 2018;203:408-415.e3. doi:10.1016/j.jpeds.2018.07.090 PubMedGoogle ScholarCrossref
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European Centre for Disease Prevention and Control. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. Published May 15, 2020. Accessed June 11, 2020. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf
10.
Freking  K , Colvin  J . Trump presses for schools to reopen, takes dig at Fauci. Published May 13, 2020. Accessed June 11, 2020. https://www.nbcnewyork.com/news/coronavirus/trump-presses-schools-reopen-makes-dig-fauci/2416011/?_osource=db_npd_nbc_wnbc_eml_shr
11.
Washington State Department of Health. Two cases of multisystem inflammatory syndrome in children (MIS-C) in Washington state. Published May 22, 2020. Accessed June 11, 2020. https://www.doh.wa.gov/Newsroom/Articles/ID/1195/Two-cases-of-Multisystem-Inflammatory-Syndrome-in-Children-MIS-C-in-Washington-state
12.
McCrindle  BW , Rowley  AH , Newburger  JW ,  et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention.  Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association.   Circulation. 2017;135(17):e927-e999. doi:10.1161/CIR.0000000000000484 PubMedGoogle ScholarCrossref
13.
Cimaz  R , Fanti  E , Mauro  A , Voller  F , Rusconi  F .  Epidemiology of Kawasaki disease in Italy: surveillance from national hospitalization records.   Eur J Pediatr. 2017;176(8):1061-1065. doi:10.1007/s00431-017-2947-3 PubMedGoogle ScholarCrossref
14.
Tulloh  RMR , Mayon-White  R , Harnden  A ,  et al.  Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015.   Arch Dis Child. 2019;104(7):640-646. doi:10.1136/archdischild-2018-315087 PubMedGoogle ScholarCrossref
15.
Esposito  S , Principi  N .  School closure during the coronavirus disease 2019 (COVID-19) pandemic: an effective intervention at the global level?   JAMA Pediatr. Published online May 13, 2020. doi:10.1001/jamapediatrics.2020.1892PubMedGoogle Scholar
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