The clinical features and estimated incidence of MIS-C in Cape Town, South Africa
Abstract Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-022-03308-z |
| _version_ | 1811307932951773184 |
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| author | Claire Butters Deepthi Raju Abraham Raphaella Stander Heidi Facey-Thomas Debbie Abrahams Ayodele Faleye Nazneen Allie Khushbu Soni Helena Rabie Christiaan Scott Liesl Zühlke Kate Webb |
| author_facet | Claire Butters Deepthi Raju Abraham Raphaella Stander Heidi Facey-Thomas Debbie Abrahams Ayodele Faleye Nazneen Allie Khushbu Soni Helena Rabie Christiaan Scott Liesl Zühlke Kate Webb |
| author_sort | Claire Butters |
| collection | DOAJ |
| description | Abstract Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. Results Sixty eight children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). Ninety seven healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p = 0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. Ninety four percent received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. Forty percent required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR = 1.523, CI 1.074, 2.16, p = 0.018). The median hospital stay duration was 7 days with no deaths. Conclusion The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment. |
| first_indexed | 2024-04-13T09:14:09Z |
| format | Article |
| id | doaj.art-2f926963a0c24345bd36cc75ce08e310 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-13T09:14:09Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-2f926963a0c24345bd36cc75ce08e3102022-12-22T02:52:47ZengBMCBMC Pediatrics1471-24312022-05-012211810.1186/s12887-022-03308-zThe clinical features and estimated incidence of MIS-C in Cape Town, South AfricaClaire Butters0Deepthi Raju Abraham1Raphaella Stander2Heidi Facey-Thomas3Debbie Abrahams4Ayodele Faleye5Nazneen Allie6Khushbu Soni7Helena Rabie8Christiaan Scott9Liesl Zühlke10Kate Webb11Red Cross War Memorial Children’s Hospital, University of Cape TownTygerberg Hospital, Stellenbosch UniversityRed Cross War Memorial Children’s Hospital, University of Cape TownRed Cross War Memorial Children’s Hospital, University of Cape TownRed Cross War Memorial Children’s Hospital, University of Cape TownLagos State University Teaching HospitalRed Cross War Memorial Children’s Hospital, University of Cape TownRed Cross War Memorial Children’s Hospital, University of Cape TownTygerberg Hospital, Stellenbosch UniversityRed Cross War Memorial Children’s Hospital, University of Cape TownRed Cross War Memorial Children’s Hospital, University of Cape TownRed Cross War Memorial Children’s Hospital, University of Cape TownAbstract Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. Results Sixty eight children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). Ninety seven healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p = 0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. Ninety four percent received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. Forty percent required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR = 1.523, CI 1.074, 2.16, p = 0.018). The median hospital stay duration was 7 days with no deaths. Conclusion The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.https://doi.org/10.1186/s12887-022-03308-zMIS-CSARS-CoV-2PaediatricsLow-middle income countriesGlobal healthEpidemiology |
| spellingShingle | Claire Butters Deepthi Raju Abraham Raphaella Stander Heidi Facey-Thomas Debbie Abrahams Ayodele Faleye Nazneen Allie Khushbu Soni Helena Rabie Christiaan Scott Liesl Zühlke Kate Webb The clinical features and estimated incidence of MIS-C in Cape Town, South Africa BMC Pediatrics MIS-C SARS-CoV-2 Paediatrics Low-middle income countries Global health Epidemiology |
| title | The clinical features and estimated incidence of MIS-C in Cape Town, South Africa |
| title_full | The clinical features and estimated incidence of MIS-C in Cape Town, South Africa |
| title_fullStr | The clinical features and estimated incidence of MIS-C in Cape Town, South Africa |
| title_full_unstemmed | The clinical features and estimated incidence of MIS-C in Cape Town, South Africa |
| title_short | The clinical features and estimated incidence of MIS-C in Cape Town, South Africa |
| title_sort | clinical features and estimated incidence of mis c in cape town south africa |
| topic | MIS-C SARS-CoV-2 Paediatrics Low-middle income countries Global health Epidemiology |
| url | https://doi.org/10.1186/s12887-022-03308-z |
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