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Article ; Online: Notes from the Field: Surveillance for Multisystem Inflammatory Syndrome in Children - United States, 2023.

Yousaf, Anna R / Lindsey, Katherine N / Wu, Michael J / Shah, Ami B / Free, Rebecca J / Simeone, Regina M / Zambrano, Laura D / Campbell, Angela P

MMWR. Morbidity and mortality weekly report

2024 Volume 73, Issue 10, Page(s) 225–228

MeSH term(s)	Child ; Humans ; United States/epidemiology ; COVID-19/epidemiology ; COVID-19/complications ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/epidemiology
Language	English
Publishing date	2024-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7310a2
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Article ; Online: Multisystem Inflammatory Syndrome in Children Among Persons Who Completed a Two-dose COVID-19 Vaccine Primary Series Compared With Those Reporting No COVID-19 Vaccination, US National MIS-C Surveillance.

Yousaf, Anna R / Miller, Allison D / Lindsey, Katherine / Shah, Ami B / Wu, Michael J / Melgar, Michael / Zambrano, Laura D / Campbell, Angela P

The Pediatric infectious disease journal

2023 Volume 42, Issue 12, Page(s) e476–e478

Abstract: We analyzed multisystem inflammatory syndrome in children cases by reported COVID-19 vaccination status (2-dose primary series vs. no vaccination). A total of 46% vaccinated versus 58% unvaccinated persons received intensive care unit-level care ( P = 0 ... ...

Abstract	We analyzed multisystem inflammatory syndrome in children cases by reported COVID-19 vaccination status (2-dose primary series vs. no vaccination). A total of 46% vaccinated versus 58% unvaccinated persons received intensive care unit-level care ( P = 0.02); the risk of intensive care unit admission was 23% higher (adjusted relative risk: 1.23; 95% confidence interval: 1.03-1.48) among unvaccinated patients; 21 unvaccinated persons died. Multisystem inflammatory syndrome in children occurs after SARS-CoV-2 infection in vaccinated persons, but may be less severe.
MeSH term(s)	Child ; Humans ; COVID-19 Vaccines ; COVID-19/epidemiology ; COVID-19/prevention & control ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000004103
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Article: Demographic and Clinical Factors Associated With Death Among Persons <21 Years Old With Multisystem Inflammatory Syndrome in Children-United States, February 2020-March 2021.

Bowen, Anna / Miller, Allison D / Zambrano, Laura D / Wu, Michael J / Oster, Matthew E / Godfred-Cato, Shana / Belay, Ermias D / Campbell, Angela P

Open forum infectious diseases

2021 Volume 8, Issue 8, Page(s) ofab388

Abstract: Multisystem inflammatory syndrome in children (MIS-C) occurs among persons aged <21 years following severe acute respiratory syndrome coronavirus 2 infection. Among 2818 MIS-C cases, 35 (1.2%) deaths were reported, primarily affecting racial/ethnic ... ...

Abstract	Multisystem inflammatory syndrome in children (MIS-C) occurs among persons aged <21 years following severe acute respiratory syndrome coronavirus 2 infection. Among 2818 MIS-C cases, 35 (1.2%) deaths were reported, primarily affecting racial/ethnic minority persons. Being 16-20 years old or having comorbidities was associated with death. Targeting coronavirus disease 2019 prevention among these groups and their caregivers might prevent MIS-C-related deaths.
Language	English
Publishing date	2021-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofab388
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Article ; Online: Correction to: Multisystem Inflammatory Syndrome in Children-United States, February 2020-July 2021.

Miller, Allison D / Zambrano, Laura D / Yousaf, Anna R / Abrams, Joseph Y / Meng, Lu / Wu, Michael J / Melgar, Michael / Oster, Matthew E / Godfred Cato, Shana E / Belay, Ermias D / Campbell, Angela P

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022 Volume 75, Issue 1, Page(s) 186

Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Published Erratum
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac253
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Article ; Online: Trends in Treatments for Multisystem Inflammatory Syndrome in Children (MIS-C), United States, February 2020 - July 2021.

Abrams, Joseph Y / Belay, Ermias D / Godfred-Cato, Shana / Campbell, Angela P / Zambrano, Laura D / Kunkel, Amber / Miller, Allison D / Wu, Michael J / Meng, Lu / Shah, Ami B / Oster, Matthew E

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022 Volume 75, Issue 7, Page(s) 1201–1209

Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a novel severe postinfectious condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this report is to describe nationwide trends in the ...

Abstract	Background: Multisystem inflammatory syndrome in children (MIS-C) is a novel severe postinfectious condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this report is to describe nationwide trends in the evolving clinical management of MIS-C. Methods: Patients with MIS-C were reported from state and local jurisdictions to the Centers for Disease Control and Prevention's (CDC's) MIS-C national surveillance system. Patients' case reports were reviewed to ensure that they met the CDC MIS-C case definition and had sufficient data for analysis. The prevalence of use of treatments for MIS-C, temporal trends in use of these treatments, and frequency of administration of different treatment combinations were analyzed. Results: There were 4470 patients meeting the MIS-C case definition with onset dates from 19 February 2020 to 31 July 2021. The proportion of patients admitted to an intensive care unit (ICU) has declined over time, from 78.7% in April 2020 to 57.5% in June 2021 (P = .001). The most common treatments were intravenous immunoglobulin (IVIG), given to 85.6% of patients; steroids (77.7%), and antiplatelet medications (73.7%); use of each of these treatments has increased over time, particularly in patients not requiring admission to an ICU (all P < .001). Older patients and non-Hispanic Black patients were more likely to receive additional modes of therapy including vasoactive medication, noninvasive respiratory support, anticoagulation medication, and intubation/mechanical ventilation. Conclusions: IVIG, steroids, and antiplatelet medication have become increasingly utilized as standard treatment for MIS-C patients, while the use of other treatments may be contingent on the type and severity of clinical findings.
MeSH term(s)	Anticoagulants ; COVID-19/complications ; Child ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/drug therapy ; Systemic Inflammatory Response Syndrome/epidemiology ; United States/epidemiology
Chemical Substances	Anticoagulants ; Immunoglobulins, Intravenous
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac072
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Article ; Online: Multisystem Inflammatory Syndrome in Children During Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta and Omicron Variant Circulation-United States, July 2021-January 2022.

Miller, Allison D / Yousaf, Anna R / Bornstein, Ethan / Wu, Michael J / Lindsey, Katherine / Melgar, Michael / Oster, Matthew E / Zambrano, Laura D / Campbell, Angela P

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022 Volume 75, Issue Supplement_2, Page(s) S303–S307

Abstract: We describe 2116 multisystem inflammatory syndrome in children (MIS-C) cases reported to the Centers for Disease Control and Prevention during Delta and Omicron circulation from July 2021 through January 2022. Half of MIS-C patients were aged 5-11 years, ...

Abstract	We describe 2116 multisystem inflammatory syndrome in children (MIS-C) cases reported to the Centers for Disease Control and Prevention during Delta and Omicron circulation from July 2021 through January 2022. Half of MIS-C patients were aged 5-11 years, 52% received intensive care unit-level care, and 1.1% died. Only 3.0% of eligible patients were fully vaccinated prior to MIS-C onset.
MeSH term(s)	COVID-19/complications ; Child ; Connective Tissue Diseases ; Coronavirus Infections/epidemiology ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/epidemiology ; United States/epidemiology
Language	English
Publishing date	2022-06-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac471
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Article ; Online: Multisystem Inflammatory Syndrome in Children-United States, February 2020-July 2021.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2021 Volume 75, Issue 1, Page(s) e1165–e1175

Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition in persons aged <21 years associated with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Our objective was to ... ...

Abstract	Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition in persons aged <21 years associated with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Our objective was to describe MIS-C cases reported to Centers for Disease Control and Prevention's (CDC's) national surveillance since the coronavirus disease 2019 (COVID-19) pandemic began. Methods: We included patients meeting the MIS-C case definition with onset date from 19 February 2020 through 31 July 2021, using CDC's MIS-C case report form, which collects information on demographics, clinical presentation, and laboratory results. Trends over time across 3 MIS-C pandemic waves were assessed using Cochran-Armitage test for categorical and Jonckheere-Terpstra test for continuous variables. Results: Of 4901 reported cases, 4470 met inclusion criteria. Median patient age increased over time (P < .001), with a median of 9 years (interquartile range, 5-13 years) during the most recent (third) wave. Male predominance also increased (62% in third wave, P < .001). A significant (P < .001) increase in severe hematologic and gastrointestinal involvement was observed across the study period. Frequency of several cardiovascular complications (ie, cardiac dysfunction, myocarditis, and shock/vasopressor receipt) and renal failure declined (P < .001). Provision of critical care including mechanical ventilation (P < .001) and extracorporeal membrane oxygenation (ECMO; P = .046) decreased, as did duration of hospitalization and mortality (each P < .001). Conclusions: Over the first 3 pandemic waves of MIS-C in the United States, cardiovascular complications and clinical outcomes including length of hospitalization, receipt of ECMO, and death decreased over time. These data serve as a baseline for monitoring future trends associated with SARS-CoV-2 B.1.617.2 (Delta) or other variants and increased COVID-19 vaccination among children.
MeSH term(s)	COVID-19/complications ; COVID-19/epidemiology ; COVID-19/therapy ; COVID-19 Vaccines ; Child ; Connective Tissue Diseases ; Female ; Humans ; Male ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/therapy ; United States/epidemiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-12-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciab1007
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Article ; Online: Risk Factors for Multisystem Inflammatory Syndrome in Children: A Case-control Investigation.

Zambrano, Laura D / Wu, Michael J / Martin, Lora / Malloch, Lacy / Chen, Sabrina / Newhams, Margaret M / Kucukak, Suden / Son, Mary Beth / Sanders, Cameron / Patterson, Kayla / Halasa, Natasha / Fitzgerald, Julie C / Leroue, Matthew K / Hall, Mark / Irby, Katherine / Rowan, Courtney M / Wellnitz, Kari / Sahni, Leila C / Loftis, Laura /

Bradford, Tamara T / Staat, Mary / Babbitt, Christopher / Carroll, Christopher L / Pannaraj, Pia S / Kong, Michele / Schuster, Jennifer E / Chou, Janet / Patel, Manish M / Randolph, Adrienne G / Campbell, Angela P / Hobbs, Charlotte V

The Pediatric infectious disease journal

2023 Volume 42, Issue 6, Page(s) e190–e196

Abstract: Background: In a 2020 pilot case-control study using medical records, we reported that non-Hispanic Black children were more likely to develop multisystem inflammatory syndrome in children (MIS-C) after adjustment for sociodemographic factors and ... ...

Abstract	Background: In a 2020 pilot case-control study using medical records, we reported that non-Hispanic Black children were more likely to develop multisystem inflammatory syndrome in children (MIS-C) after adjustment for sociodemographic factors and underlying medical conditions. Using structured interviews, we investigated patient, household, and community factors underlying MIS-C likelihood. Methods: MIS-C case patients hospitalized in 2021 across 14 US pediatric hospitals were matched by age and site to outpatient controls testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 3 months of the admission date. Caregiver interviews queried race/ethnicity, medical history, and household and potential community exposures 1 month before MIS-C hospitalization (case-patients) or after SARS-CoV-2 infection (controls). We calculated adjusted odds ratios (aOR) using mixed-effects multivariable logistic regression. Results: Among 275 case patients and 496 controls, race/ethnicity, social vulnerability and patient or family history of autoimmune/rheumatologic disease were not associated with MIS-C. In previously healthy children, MIS-C was associated with a history of hospitalization for an infection [aOR: 4.8; 95% confidence interval (CI): 2.1-11.0]. Household crowding (aOR: 1.7; 95% CI: 1.2-2.6), large event attendance (aOR: 1.7; 95% CI: 1.3-2.1), school attendance with limited masking (aOR: 2.6; 95% CI: 1.1-6.6), public transit use (aOR: 1.8; 95% CI: 1.4-2.4) and co-resident testing positive for SARS-CoV-2 (aOR: 2.2; 95% CI: 1.3-3.7) were associated with increased MIS-C likelihood, with risk increasing with the number of these factors. Conclusions: From caregiver interviews, we clarify household and community exposures associated with MIS-C; however, we did not confirm prior associations between sociodemographic factors and MIS-C.
MeSH term(s)	Child ; Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Case-Control Studies ; Crowding ; Family Characteristics ; Systemic Inflammatory Response Syndrome/epidemiology ; Risk Factors
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003900
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Article ; Online: Influenza vaccination coverage among persons seeking outpatient medical care for acute respiratory illness in five states in the United States, 2011-2012 through 2018-2019.

Wu, Michael J / Chung, Jessie R / Kim, Sara S / Jackson, Michael L / Jackson, Lisa A / Belongia, Edward A / McLean, Huong Q / Gaglani, Manjusha / Reis, Michael / Beeram, Madhava / Martin, Emily T / Monto, Arnold S / Nowalk, Mary Patricia / Zimmerman, Richard / Santibanez, Tammy A / Singleton, James A / Patel, Manish / Flannery, Brendan

Vaccine

2021 Volume 39, Issue 12, Page(s) 1788–1796

Abstract: Background: In the United States (U.S.), annual influenza vaccination has been recommended for all persons aged ≥6 months with the Healthy People 2020 coverage target of 70%. However, vaccination coverage has remained around 42-49% during the past eight ...

Abstract	Background: In the United States (U.S.), annual influenza vaccination has been recommended for all persons aged ≥6 months with the Healthy People 2020 coverage target of 70%. However, vaccination coverage has remained around 42-49% during the past eight influenza seasons. We sought to quantify influenza vaccination coverage and factors associated with vaccination in persons seeking outpatient medical care for an acute respiratory illness (ARI). Methods: We enrolled outpatients aged ≥6 months with ARI from >50 U.S. clinics from 2011 to 2012 through 2018-2019 influenza seasons and tested for influenza with molecular assays. Vaccination status was based on documented receipt of the current season's influenza vaccine. We estimated vaccination coverage among influenza-negative study participants by study site, age, and season, and compared to state-level influenza coverage estimates in the general population based on annual immunization surveys. We used multivariable logistic regression to examine factors independently associated with receipt of influenza vaccines. Results: We enrolled 45,424 study participants with ARI who tested negative for influenza during the study period. Annual vaccination coverage among influenza-negative ARI patients and the general population in the participating states averaged 55% (range: 47-62%), and 52% (range: 46-54%), respectively. Among enrollees, coverage was highest among adults aged ≥65 years (82%; range, 80-85%) and lowest among adolescents aged 13-17 years (38%; range, 35-41%). Factors significantly associated with non-vaccination included non-White race, no college degree, exposure to cigarette smoke, absence of high-risk conditions, and not receiving prior season influenza vaccine. Conclusions: Influenza vaccination coverage over eight seasons among outpatients with non-influenza respiratory illness was slightly higher than coverage in the general population but 15% lower than national targets. Increased efforts to promote vaccination especially in groups with lower coverage are warranted to attain optimal health benefits of influenza vaccine.
MeSH term(s)	Adolescent ; Adult ; Aged, 80 and over ; Humans ; Infant ; Influenza Vaccines ; Influenza, Human/prevention & control ; Outpatients ; Population Surveillance ; Seasons ; United States ; Vaccination ; Vaccination Coverage
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2021-02-15
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2021.01.065
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Article ; Online: Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection.

Zambrano, Laura D / Ly, Kathleen N / Link-Gelles, Ruth / Newhams, Margaret M / Akande, Manzilat / Wu, Michael J / Feldstein, Leora R / Tarquinio, Keiko M / Sahni, Leila C / Riggs, Becky J / Singh, Aalok R / Fitzgerald, Julie C / Schuster, Jennifer E / Giuliano, John S / Englund, Janet A / Hume, Janet R / Hall, Mark W / Osborne, Christina M / Doymaz, Sule /

Rowan, Courtney M / Babbitt, Christopher J / Clouser, Katharine N / Horwitz, Steven M / Chou, Janet / Patel, Manish M / Hobbs, Charlotte / Randolph, Adrienne G / Campbell, Angela P

The Pediatric infectious disease journal

2022 Volume 41, Issue 11, Page(s) 891–898

Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complication that has disproportionately affected racial/ethnic minority children. We conducted a ... ...

Abstract	Background: Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities. Methods: This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk factors using mixed effects multivariable logistic regression. Results: We compared 241 MIS-C cases with 817 outpatient SARS-CoV-2-positive at-risk controls. Cases and controls had similar sex, age and U.S. census region distribution. MIS-C patients were more frequently previously healthy, non-Hispanic Black, residing in higher SVI areas, and in the 95th percentile or higher for weight-for-age. In the multivariable analysis, the likelihood of MIS-C was higher among non-Hispanic Black children [adjusted odds ratio (aOR): 2.07; 95% CI: 1.23-3.48]. Additionally, SVI in the 2nd and 3rd tertiles (aOR: 1.88; 95% CI: 1.18-2.97 and aOR: 2.03; 95% CI: 1.19-3.47, respectively) were independent factors along with being previously healthy (aOR: 1.64; 95% CI: 1.18-2.28). Conclusions: In this study, non-Hispanic Black children were more likely to develop MIS-C after adjustment for sociodemographic factors, underlying medical conditions, and weight-for-age. Investigation of the potential contribution of immunologic, environmental, and other factors is warranted.
MeSH term(s)	Adolescent ; COVID-19/complications ; COVID-19/epidemiology ; Case-Control Studies ; Child ; Ethnicity ; Humans ; Minority Groups ; Pilot Projects ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/epidemiology
Language	English
Publishing date	2022-09-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003689
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