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Pediatrics

Risk and Phenotype of Multisystem Inflammatory Syndrome in Vaccinated and Unvaccinated Danish Children Before and During the Omicron Wave

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JAMA Pediatrics

Published Online: June 8, 2022

Research Letter

Article Information and Disclosures

Mette Holm, PhD¹;

Laura Espenhain, MSc²;

Jonathan Glenthøj, MD³;

Lisbeth Samsø Schmidt, PhD⁴;

Sannie Brit Nordly, PhD⁵;

Ulla Birgitte Hartling, MD⁶;

Ulrikka Nygaard, MD, MPhil, PhD⁷

Author Affiliations

¹Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
²Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
³Department of Paediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hillerod, Denmark
⁴Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
⁵Department of Paediatrics and Adolescent Medicine, Hvidovre University Hospital, Copenhagen, Denmark
⁶Department of Paediatrics and Adolescent Medicine, Odense University Hospital, Odense, Denmark
⁷Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Multisystem inflammatory syndrome in children (MIS-C) is a severe manifestation of SARS-CoV-2 in children and adolescents.¹ We aimed to estimate the risk of MIS-C after SARS-CoV-2 infection in vaccinated and unvaccinated individuals during the Omicron wave. Further, we aimed to compare the risk and clinical characteristics of MIS-C with the pre-Omicron waves.

This population-based cohort study prospectively included patients aged 0 to 17 years with MIS-C from all 18 Danish pediatric departments. Patients were diagnosed from January 1, 2022, to March 15, 2022, after SARS-CoV-2 infection between January 1 and February 1, 2022, when Omicron constituted more than 95% of variants. We followed the STROBE reporting guidelines for cohort studies. We used previously reported data to compare MIS-C during Omicron with the pre-Omicron waves.¹^,2

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Article Information

Accepted for Publication: May 4, 2022.

Published Online: June 8, 2022. doi:10.1001/jamapediatrics.2022.2206

Correction: This article was corrected on August 1, 2022, to add reference citations and a multiplier to footnote a in Table 1.

Corresponding Author: Ulrikka Nygaard, MD, MPhil, PhD, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (ulrikka.nygaard@regionh.dk).

Author Contributions: Dr Nygaard and Ms Espenhain 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: Holm, Glenthoej, Schmidt, Brit Nordly, Hartling, Nygaard.

Acquisition, analysis, or interpretation of data: Holm, Espenhain, Glenthoej, Brit Nordly, Hartling, Nygaard.

Drafting of the manuscript: Holm, Espenhain, Glenthoej, Nygaard.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Holm, Espenhain, Nygaard.

Obtained funding: Nygaard.

Administrative, technical, or material support: Holm, Glenthoej, Schmidt, Nygaard.

Supervision: Brit Nordly, Hartling.

Conflict of Interest Disclosures: None reported.

Funding/Support: The study was supported by COVID-19 grant 0237-00004B from the National Ministry of Higher Education and Science and grant 0176-00020B from Innovation Fund Denmark.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

Nygaard U , Holm M , Hartling UB , et al. Incidence and clinical phenotype of multisystem inflammatory syndrome in children after infection with the SARS-CoV-2 delta variant by vaccination status: a Danish nationwide prospective cohort study. Lancet Child Adolesc Health. Published online May 5, 2022. doi:10.1016/S2352-4642(22)00100-6 PubMed Google Scholar Crossref

Holm M , Hartling UB , Schmidt LS , et al. Multisystem inflammatory syndrome in children occurred in 1 of 4000 children with severe acute respiratory syndrome coronavirus 2. Acta Paediatr. 2021;110(9):2581-2583. doi:10.1111/apa.15985 PubMed Google Scholar Crossref

Garcia-Beltran WF , St Denis KJ , Hoelzemer A , et al. mRNA-based COVID-19 vaccine boosters induce neutralizing immunity against SARS-CoV-2 Omicron variant. Cell. 2022;185(3):457-466.e4. doi:10.1016/j.cell.2021.12.033 PubMed Google Scholar Crossref

Levy M , Recher M , Hubert H , et al. Multisystem inflammatory syndrome in children by COVID-19 vaccination status of adolescents in France. JAMA. 2022;327(3):281-283. doi:10.1001/jama.2021.23262 PubMed Google Scholar Crossref

Zambrano LD , Newhams MM , Olson SM , et al; Overcoming COVID-19 Investigators. Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12 to 18 years—US, July-December 2021. MMWR Morb Mortal Wkly Rep. 2022;71(2):52-58. doi:10.15585/mmwr.mm7102e1 PubMed Google Scholar Crossref

Reese H , Iuliano AD , Patel NN , et al. Estimated incidence of coronavirus disease 2019 (COVID-19) illness and hospitalization—US, February-September 2020. Clin Infect Dis. 2021;72(12):e1010-e1017. doi:10.1093/cid/ciaa1780 PubMed Google Scholar Crossref

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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.