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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
5.
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
9.
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
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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