SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

Abstract

A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection. Epidemiologic data and case studies have indicated that children are less susceptible to more severe clinical features of SARS-CoV-2 infection, a finding that may be due to differences in the cytokine response generated by the innate immune system, high amounts of ACE-2 which maintain homeostatic functions by preventing inflammation, and trained immunity acquired from regular vaccinations. Despite these protective mechanisms, children are still susceptible to severe complications, such as MIS-C. The racial disparities seen in MIS-C are extremely apparent, and certain populations are more affected. Most specifically, 33% of MIS-C patients are Hispanic/Latino, and 30% Black. Current studies published on MIS-C do not detail whether certain symptoms are more present in certain racial/ethnic groups. Knowledge of these disparities could assist health care professionals with devising appropriate strategies for post-acute SARS-CoV-2 infection follow-up in children as well as vaccine distribution in specific communities to help slow the spread of SARS-CoV-2 infection, and ultimately reduce the potential for complications such as MIS-C.

Global Research Trends in Pediatric COVID-19: A Bibliometric Analysis

“…Initially, the clinical manifestations of pediatric COVID-19 were unknown; therefore, manifestation and diagnosis were the most important keywords. The morbidity and mortality of COVID-19 disease in children were low, but MIS-C and Kawasaki disease are more serious diseases which occur as a result of SARS-CoV-2 infection ( 7 , 8 ). Kawasaki-like disease associated with COVID-19 has been increasingly reported.…”

“…Pediatric COVID-19 typically presents with mild symptoms, such as cough, fever, sore throat, and diarrhea. However, some children, especially those with underlying diseases, may present with severe clinical manifestations such as hyperinflammatory syndrome ( 4 , 5 ), increased severity of childhood-onset type 1 diabetes ( 6 ), and multisystem inflammatory syndrome ( 7 ). Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease have also emerged as severe pediatric diseases after SARS-CoV-2 infection ( 4 , 8 ).…”

Neurological manifestations found in children with multisystem inflammatory syndrome

“…In children, the therapeutic effect of plasmapheresis remains unclear. All the patients with MIS-C who received intravenous immunoglobulin and/or methylprednisolone fully recovered without neurological sequelae (21).…”

“…All 17 patients had increased levels of inflammatory markers, the majority having lymphopenia, and all were positive for SARS-CoV-2 infection. There were no deaths among the patients and they were all released (21).…”

“…There have been documented differences in disease outcomes across races and ethnic groups following SARS-CoV-2 infection, with individuals of African descent (21), African Americans (22), Hispanics (23), and individuals from Latin America (24) experiencing more severe sickness, hospitalizations, and fatalities. The lineage of COVID-associated MIS-C patients demonstrated the essential nature of preventing viral transmission in this age range.…”