What are the clinical characteristics and geographic and temporal distribution of multisystem inflammatory syndrome in children (MIS-C) in the United States?
In this cross-sectional study, 1733 patients with MIS-C were identified with predominantly gastrointestinal, mucocutaneous, and cardiovascular manifestations, and a majority required intensive care. MIS-C peaks closely followed the peaks of COVID-19 and the spread of the pandemic from urban to rural communities.
The data are consistent with observations that MIS-C resulted from delayed immunologic responses to infection by SARS-CoV-2.
Multiple inflammatory syndrome in children (MIS-C) occurs in association with the COVID-19 pandemic.
To describe the clinical characteristics and geographic and temporal distribution of the largest cohort of patients with MIS-C in the United States to date.
Design, Setting, and Participants
Cross-sectional analysis was conducted on clinical and laboratory data collected from patients with MIS-C. The analysis included patients with illness onset from March 2020 to January 2021 and met MIS-C case definition.
Main Outcomes and Measures
Geographic and temporal distribution of MIS-C was compared with that of COVID-19 nationally, by region, and level of urbanicity by county. Clinical and laboratory findings and changes over time were described by age group and by presence or absence of preceding COVID-19.
A total of 1733 patients with MIS-C were identified; 994 (57.6%) were male and 1117 (71.3%) were Hispanic or non-Hispanic Black. Gastrointestinal symptoms, rash, and conjunctival hyperemia were reported by 53% (n = 931) to 67% (n = 1153) of patients. A total of 937 patients (54%) had hypotension or shock, and 1009 (58.2%) were admitted for intensive care. Cardiac dysfunction was reported in 484 patients (31.0%), pericardial effusion in 365 (23.4%), myocarditis in 300 (17.3%), and coronary artery dilatation or aneurysms in 258 (16.5%). Patients aged 0 to 4 years had the lowest proportion of severe manifestations, although 171 patients (38.4%) had hypotension or shock and 197 (44.3%) were admitted for intensive care. Patients aged 18 to 20 years had the highest proportions with myocarditis (17 [30.9%]), pneumonia (20 [36.4%]), acute respiratory distress syndrome (10 [18.2%]), and polymerase chain reaction positivity (39 [70.9%]). These older adolescents also had the highest proportion reporting preceding COVID-19–like illness (63%). Nationally, the first 2 MIS-C peaks followed the COVID-19 peaks by 2 to 5 weeks. The cumulative MIS-C incidence per 100 000 persons younger than 21 years was 2.1 and varied from 0.2 to 6.3 by state. Twenty-four patients (1.4%) died.
Conclusions and Relevance
In this cross-sectional study of a large cohort of patients with MIS-C, 2 peaks that followed COVID-19 peaks by 2 to 5 weeks were identified. The geographic and temporal association of MIS-C with the COVID-19 pandemic suggested that MIS-C resulted from delayed immunologic responses to SARS-CoV-2 infection. The clinical manifestations varied by age and by presence or absence of preceding COVID-19.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Ermias D. Belay, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 (firstname.lastname@example.org).
Accepted for Publication: February 10, 2021.
Published Online: April 6, 2021. doi:10.1001/jamapediatrics.2021.0630
Author Contributions: Drs Belay and Abrams had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Belay, Abrams, Oster, Giovanni, Rosen, Mohamed, Stierman, Godfred-Cato.
Acquisition, analysis, or interpretation of data: Belay, Abrams, Oster, Giovanni, Pierce, Meng, Prezzato, Balachandran, Openshaw, Kim, Richardson, Hand, Tobin-D’Angelo, Wilson, Hartley, Jones, Kolsin, Mohamed, Colles, Hammett, Patel, Stierman, Campbell.
Drafting of the manuscript: Belay, Abrams, Giovanni, Hartley, Mohamed.
Critical revision of the manuscript for important intellectual content: Belay, Abrams, Oster, Giovanni, Pierce, Meng, Prezzato, Balachandran, Openshaw, Rosen, Kim, Richardson, Hand, Tobin-D’Angelo, Wilson, Jones, Kolsin, Mohamed, Colles, Hammett, Patel, Stierman, Campbell, Godfred-Cato.
Statistical analysis: Abrams, Oster, Meng, Mohamed.
Administrative, technical, or material support: Belay, Oster, Giovanni, Balachandran, Openshaw, Rosen, Kim, Wilson, Hartley, Jones, Kolsin, Mohamed, Hammett, Patel, Godfred-Cato.
Supervision: Belay, Godfred-Cato
Conflict of Interest Disclosures: Dr Jones reports grants from the US Centers of Disease Control and Prevention Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) during the conduct of the study. No other disclosures were reported.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Additional Contributions: We thank local and state health departments for submitting reports of patients with suspected multisystem inflammatory syndrome in children to the national surveillance system.
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