Multisystem inflammatory syndrome in children occurred in one of four thousand children with severe acute respiratory syndrome coronavirus 2

Holm, Mette; Hartling, Ulla Birgitte; Schmidt, Lene Skytthe Kaarsberg; Glenthøj, Jonathan; Kruse, Alexandra; Rytter, Maren Johanne Heilskov; Lindhard, Morten Søndergaard; Lawaetz, Marie Cecilie; Zaharov, Tatjana; Petersen, Jens; Andersen, Rikke Møller; Lemvik, Grethe; Marciński, Paweł; Thaarup, Jesper; Jensen, Lise Heilmann; Borch, Luise; Nielsen, Allan Bybeck; Vissing, Nadja Hawwa; Schmiegelow, Kjeld; Nygaard, Ulrikka

doi:10.1111/apa.15985

Cited by 39 publications

(48 citation statements)

References 6 publications

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Section: Discussionmentioning

confidence: 99%

“…By comparison, the estimated occurrence of multisystem inflammatory syndrome in individuals aged 12-17 years is 27 per 100 000 individuals with serologically determined SARS-CoV-2 infection. 22 Given the worldwide spread of the highly contagious SARS-CoV-2 delta and omicron variants, future infection is the undesirable alternative to vaccination against SARS-CoV-2. Taken together with the potential long term sequelae of even mild SARS-CoV-2 infection, 23 and with the risk of multisystem inflammatory syndrome among adolescents (which is associated with severe morbidity), 24 our finding of a low absolute risk of myocarditis or myopericarditis with BNT162b2 or mRNA-1273 vaccination supports the overall benefits of such vaccination on an individual, societal, and global level.…”

Section: Policy Implicationsmentioning

confidence: 99%

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SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

Husby

Hansen

Fosbøl

et al. 2021

BMJ

217

209

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Objective To investigate the association between SARS-CoV-2 vaccination and myocarditis or myopericarditis. Design Population based cohort study. Setting Denmark. Participants 4 931 775 individuals aged 12 years or older, followed from 1 October 2020 to 5 October 2021. Main outcome measures The primary outcome, myocarditis or myopericarditis, was defined as a combination of a hospital diagnosis of myocarditis or pericarditis, increased troponin levels, and a hospital stay lasting more than 24 hours. Follow-up time before vaccination was compared with follow-up time 0-28 days from the day of vaccination for both first and second doses, using Cox proportional hazards regression with age as an underlying timescale to estimate hazard ratios adjusted for sex, comorbidities, and other potential confounders. Results During follow-up, 269 participants developed myocarditis or myopericarditis, of whom 108 (40%) were 12-39 years old and 196 (73%) were male. Of 3 482 295 individuals vaccinated with BNT162b2 (Pfizer-BioNTech), 48 developed myocarditis or myopericarditis within 28 days from the vaccination date compared with unvaccinated individuals (adjusted hazard ratio 1.34 (95% confidence interval 0.90 to 2.00); absolute rate 1.4 per 100 000 vaccinated individuals within 28 days of vaccination (95% confidence interval 1.0 to 1.8)). Adjusted hazard ratios among female participants only and male participants only were 3.73 (1.82 to 7.65) and 0.82 (0.50 to 1.34), respectively, with corresponding absolute rates of 1.3 (0.8 to 1.9) and 1.5 (1.0 to 2.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 1.48 (0.74 to 2.98) and the absolute rate was 1.6 (1.0 to 2.6) per 100 000 vaccinated individuals within 28 days of vaccination. Among 498 814 individuals vaccinated with mRNA-1273 (Moderna), 21 developed myocarditis or myopericarditis within 28 days from vaccination date (adjusted hazard ratio 3.92 (2.30 to 6.68); absolute rate 4.2 per 100 000 vaccinated individuals within 28 days of vaccination (2.6 to 6.4)). Adjusted hazard ratios among women only and men only were 6.33 (2.11 to 18.96) and 3.22 (1.75 to 5.93), respectively, with corresponding absolute rates of 2.0 (0.7 to 4.8) and 6.3 (3.6 to 10.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 5.24 (2.47 to 11.12) and the absolute rate was 5.7 (3.3 to 9.3) per 100 000 vaccinated individuals within 28 days of vaccination. Conclusions Vaccination with mRNA-1273 was associated with a significantly increased risk of myocarditis or myopericarditis in the Danish population, primarily driven by an increased risk among individuals aged 12-39 years, while BNT162b2 vaccination was only associated with a significantly increased risk among women. However, the absolute rate of myocarditis or myopericarditis after SARS-CoV-2 mRNA vaccination was low, even in younger age groups. The benefits of SARS-CoV-2 mRNA vaccination should be taken into account when interpreting these findings. Larger multinational studies are needed to further investigate the risks of myocarditis or myopericarditis after vaccination within smaller subgroups.

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Section: Discussionmentioning

confidence: 99%

Section: Policy Implicationsmentioning

confidence: 99%

SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

Husby

Hansen

Fosbøl

et al. 2021

BMJ

217

209

View full text Add to dashboard Cite

show abstract

“…We used WHO criteria, which might be to some extent focused on cardiac involvement, as CDC-criteria are more relevant to hyperinflammation, but all of our patients satisfied both sets of criteria ( 14 , 21 ). Fortunately, MIS-C is a rare condition, which involves one of each 4,000 children, infected with COVID-19 ( 12 ). The obtained data demonstrate similarities and differences between MIS-C and KD.…”

Section: Discussionmentioning

confidence: 99%

“…MIS-C is quite rare, and the incidence at the beginning of the pandemic in children was about 2 per 100,000 people or <1% of children with confirmed SARS-CoV-2 infection (11). However, in a more recent study, the frequency of MIS-C cases is 1:4,000 children who have suffered COVID-19 infection (12). Despite the similarities in the clinical picture, the diseases might have different outcomes and treatment approaches.…”

Section: Introductionmentioning

confidence: 99%

Distinguishing Between Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children and the Kawasaki Disease: Development of Preliminary Criteria Based on the Data of the Retrospective Multicenter Cohort Study

et al. 2021

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Objectives: Diagnostic between multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) and Kawasaki disease (KD) can make difficulties due to many similarities. Our study aimed to create a Kawasaki/MIS-C differentiation score (KMDscore) allowing discrimination of MIS-C and KD.Study design: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about MIS-C (n = 72) and KD (n = 147). The variables allowed to discriminate both conditions used to construct and validate the diagnostic score called the KMDscore.Results: Patients with MIS-C were older, had earlier admission to the hospital, had a shorter time before fever resolution, two times frequently had signs of GI and CNS involvement observed, and had more impressive thrombocytopenia, higher level of CRP, ferritin, ALT, AST, LDH, creatinine, triglycerides, troponin, and D-dimer compared to KD patients. Respiratory signs in MIS-C were presented with pleuritis, acute respiratory distress syndrome, oxygen dependency, lung infiltration, and ground-glass opacities in CT. The heart involvement with fast progression of myocarditis provided the severity of MIS-C and ICU admission due to 12 times higher arterial hypotension or shock and required cardiotonic. No differences in the frequency of CA lesions were seen in the majority of cases. Five criteria, CRP >11 mg/dl (18 points), D-dimer >607 ng/ml (27 points), age >5 years (30 points), thrombocytopenia (25 points), and GI involvement (28 points), were included in the KMDscore. The summa >55 points allowed to discriminate MIS-C from KD with a sensitivity of 87.5% and specificity of 89.1%.Conclusion: The KMDscore can be used to differentiate the diagnostic of MIS-C from KD.

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“… 1 This contrasts with MIS‐C after SARS‐CoV‐2 infection, which has been reported to occur in 1 in approximately 4000 children and adolescents. 5 …”

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confidence: 99%

Multisystem inflammatory syndrome in a male adolescent after his second Pfizer‐BioNTech COVID‐19 vaccine

et al. 2021

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Multisystem inflammatory syndrome in children occurred in one of four thousand children with severe acute respiratory syndrome coronavirus 2

Abstract: How to cite this article: Holm M, Hartling UB, Schmidt LS, et al. Multisystem inflammatory syndrome in children occurred in one of four thousand children with severe acute respiratory syndrome coronavirus 2.

Cited by 39 publications

References 6 publications

SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

Distinguishing Between Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children and the Kawasaki Disease: Development of Preliminary Criteria Based on the Data of the Retrospective Multicenter Cohort Study

Multisystem inflammatory syndrome in a male adolescent after his second Pfizer‐BioNTech COVID‐19 vaccine

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