Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020–February 2021

Abstract

Background: Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi. Methods: Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population. Results: Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections. Conclusions: From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.

Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis

“…A summary of the methodology, characteristics of findings, presence of racial disparity, quality appraisal, and country of study is presented in Table 3 . All of the reviewed studies employed a quantitative methodology [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and used surveillance data collected from electronic health record systems. The studies were conducted from January 2016 to December 2022.…”

“…Nineteen studies (95%) identified the presence of racial disparities in the occurrence rate of common infectious respiratory diseases, such as SARS-CoV-2 (COVID-19), SARS-CoV-2 (COVID-19)-related illnesses, influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), streptococcus, staphylococcus aureus, and rhinovirus [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], among children in the United States. One study conducted by Perez et al [ 13 ] identified the presence of racial disparities in the occurrence rate of infectious respiratory diseases, such as influenza, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and SARS-CoV-2 (COVID-19), with Blacks or African Americans and Hispanics/Latinos carrying the majority (59%) of the burden of infection.…”

“…A study by Zambrano et al [ 22 ] established that Black children have a higher likelihood of experiencing severe SARS-CoV-2 (COVID-19) outcomes. A study conducted in Mississippi by Hobbs et al [ 23 ] revealed that Black children constituted 66% of sudden SARS-CoV-2 (COVID-19) hospitalizations from March 2020 to February 2021 at the University of Mississippi Medical Center.…”

“…Chronic diseases represent another major factor identified in this review in understanding racial differences in the occurrence of common respiratory infectious diseases. Black and Hispanic children have higher rates of asthma and obesity than non-minority groups, which contribute to increased occurrence of infectious respiratory infections among these groups of children [ 21 , 23 , 26 , 27 ]. Other studies have also shown links between vulnerability to respiratory infections and chronic conditions such as asthma and obesity in adults and children [ 34 , 35 ].…”

“… Mean, standard deviation, and heterogeneity of reviewed studies [ 15 , 16 , 17 , 18 , 19 , 21 , 23 , 25 , 26 , 33 ]. …”