Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS): prospective, national surveillance, United Kingdom and Ireland, 2020
Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS): prospective, national surveillance, United Kingdom and Ireland, 2020
Background: Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), first identified in April 2020, shares features of both Kawasaki disease (KD) and toxic shock syndrome (TSS). The surveillance describes the epidemiology and clinical characteristics of PIMS-TS in the United Kingdom and Ireland.
Methods: Public Health England initiated prospective national surveillance of PIMS-TS through the British Paediatric Surveillance Unit. Paediatricians were contacted monthly to report PIMS-TS, KD and TSS cases electronically and complete a detailed clinical questionnaire. Cases with symptom onset between 01 March and 15 June 2020 were included.
Findings: there were 216 cases with features of PIMS-TS alone, 13 with features of both PIMS-TS and KD, 28 with features of PIMS-TS and TSS and 11 with features of PIMS-TS, KD and TSS, with differences in age, ethnicity, clinical presentation and disease severity between the phenotypic groups. There was a strong geographical and temporal association between SARS-CoV-2 infection rates and PIMS-TS cases. Of those tested, 14.8% (39/264) children had a positive SARS-CoV-2 RT-PCR, and 63.6% (75/118) were positive for SARS-CoV-2 serology. In total 44·0% (118/268) required intensive care, which was more common in cases with a TSS phenotype. Three of five children with cardiac arrest had TSS phenotype. Three children (1·1%) died.
Interpretation: the strong association between SARS-CoV-2 infection and PIMS-TS emphasises the importance of maintaining low community infection rates to reduce the risk of this rare but severe complication in children and adolescents. Close follow-up will be important to monitor long-term complications in children with PIMS-TS.
Funding: PHE
Flood, Jessica
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Shingleton, Joseph
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Bennett, Emma
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Walker, Brodie
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Amin-Chowdhury, Zahin
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Oligbu, Godwin
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Avis, Jacob
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Lynn, Richard
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Davis, Peter
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Bharucha, Tara
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Pain, Clare E.
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Jyothish, Deepthi
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Whittaker, Elizabeth
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Dwarakanathan, Buvana
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Wood, Rachael
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Williams, Christopher
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Swann, Olivia
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Semple, Malcolm G.
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Ramsay, Mary E.
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Jones, Christine E
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Ramanan, Athimalaipet V.
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Gent, Nick
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Ladhani, Shamez N.
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Flood, Jessica
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Shingleton, Joseph
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Bennett, Emma
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Walker, Brodie
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Amin-Chowdhury, Zahin
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Oligbu, Godwin
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Avis, Jacob
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Lynn, Richard
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Davis, Peter
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Bharucha, Tara
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Pain, Clare E.
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Jyothish, Deepthi
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Whittaker, Elizabeth
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Dwarakanathan, Buvana
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Wood, Rachael
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Williams, Christopher
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Swann, Olivia
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Semple, Malcolm G.
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Ramsay, Mary E.
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Jones, Christine E
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Ramanan, Athimalaipet V.
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Gent, Nick
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Ladhani, Shamez N.
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Flood, Jessica, Shingleton, Joseph, Bennett, Emma, Walker, Brodie, Amin-Chowdhury, Zahin, Oligbu, Godwin, Avis, Jacob, Lynn, Richard, Davis, Peter, Bharucha, Tara, Pain, Clare E., Jyothish, Deepthi, Whittaker, Elizabeth, Dwarakanathan, Buvana, Wood, Rachael, Williams, Christopher, Swann, Olivia, Semple, Malcolm G., Ramsay, Mary E., Jones, Christine E, Ramanan, Athimalaipet V., Gent, Nick and Ladhani, Shamez N.
(2021)
Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS): prospective, national surveillance, United Kingdom and Ireland, 2020.
The Lancet Regional Health – Europe, 3, [100075].
(doi:10.1016/j.lanepe.2021.100075).
Abstract
Background: Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), first identified in April 2020, shares features of both Kawasaki disease (KD) and toxic shock syndrome (TSS). The surveillance describes the epidemiology and clinical characteristics of PIMS-TS in the United Kingdom and Ireland.
Methods: Public Health England initiated prospective national surveillance of PIMS-TS through the British Paediatric Surveillance Unit. Paediatricians were contacted monthly to report PIMS-TS, KD and TSS cases electronically and complete a detailed clinical questionnaire. Cases with symptom onset between 01 March and 15 June 2020 were included.
Findings: there were 216 cases with features of PIMS-TS alone, 13 with features of both PIMS-TS and KD, 28 with features of PIMS-TS and TSS and 11 with features of PIMS-TS, KD and TSS, with differences in age, ethnicity, clinical presentation and disease severity between the phenotypic groups. There was a strong geographical and temporal association between SARS-CoV-2 infection rates and PIMS-TS cases. Of those tested, 14.8% (39/264) children had a positive SARS-CoV-2 RT-PCR, and 63.6% (75/118) were positive for SARS-CoV-2 serology. In total 44·0% (118/268) required intensive care, which was more common in cases with a TSS phenotype. Three of five children with cardiac arrest had TSS phenotype. Three children (1·1%) died.
Interpretation: the strong association between SARS-CoV-2 infection and PIMS-TS emphasises the importance of maintaining low community infection rates to reduce the risk of this rare but severe complication in children and adolescents. Close follow-up will be important to monitor long-term complications in children with PIMS-TS.
Funding: PHE
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Accepted/In Press date: 2 March 2021
e-pub ahead of print date: 22 March 2021
Additional Information:
Declaration of InterestsProf. Semple reports grants from DHSC National Institute ofHealth Research UK, grants from Medical Research Council UK, grantsfrom Health Protection Research Unit in Emerging & Zoonotic Infec-tions, University of Liverpool, during the conduct of the study; otherfrom Integrum Scientific LLC, Greensboro, NC, USA, outside the sub-mitted work. Dr. Ramanan reports personal fees from EliLilly, per-sonal fees from Roche, personal fees from SOBI, personal fees fromUCB, personal fees from Abbvie, personal fees from Novartis, outsidethe submitted work.AcknowledgementsPHE, BPSU and the authors would like to thank all the paediatri-cians across the UK and the Republic of Ireland for their unendingsupport with this and all other BPSU studies.Table 3Characteristics of classes identified in the latent class analysis.Class 1 (N= 75) Class 2 (N= 88) Class 3 (N= 105) P valuePositive SARS-CoV-2 PCR test (N= 39)6 (8¢0%)4 (4¢5%)29 (27¢6%)<0¢01Positive SARS-CoV-2 serology test (N= 75)8 (10¢7%)22 (25¢0%)45 (42¢9%)<0¢01Median Age (IQR) in years7¢8(3¢1�11¢2) 4¢5(1¢5�7¢5)11¢2(8¢4�13¢9)Median Hospital Stay (IQR) in days5 (4�8)6 (4�11)9¢5(8�13)Weight 2 SDs above mean for age/sex11 (14¢7%)4 (4¢5%)21 (20¢0%)<0¢01EthnicityWhite45 (60¢0%)41 (46¢6%)28 (26¢7%)<0¢01Black/ African/ Caribbean/ Black British10 (13¢3%)14 (15¢9%)36 (34¢3%)<0¢01Asian/ Asian British13 (17¢3%)23 (26¢1%)27 (25¢7%)<0¢01Mixed/ multiple ethnic groups3 (4¢0%)5 (5¢7%)3 (2¢9%)<0¢01Other ethnic groups1(1¢3%)3 (3¢4%)6 (5¢7%)<0¢01Cardiovascular InvolvementAny cardiac arrest orfindings on ECG/Echo18 (24¢0%)39 (44¢3%)83 (79¢1%)<0¢01Hypotension14 (18¢7%)16 (18¢2%)84 (80¢0%)<0¢01Dermatological InvolvementKawasaki-type rash (widespread, polymorphous, not vesicular)3 (4¢0%)74 (84¢1%)40 (38¢1%)<0¢01Other rash6(8¢0%)21 (23¢9%)22 (21¢0%)0¢06Conjunctivitis (bilateral, bulbar, non-suppurative)5 (6¢7%)74 (84¢1%)56 (53¢3%)<0¢01Kawasaki lips and mucosa (red cracked lips, strawberry tongue, erythematous oral cavity) 2 (2¢7%)67 (76¢1%)20 (19¢0%)<0¢01Gastrointestinal InvolvementVomiting/diarrhoea49 (65¢3%)60 (68¢2%)87 (82¢9%)0¢01Abdominal pain45 (60¢0%)29 (33¢0%)78 (74¢3%)<0¢01Low albumin50 (66¢7%)78 (88¢6%)104 (99¢1%)<0¢01Raised ALT10 (13¢3%)22 (25¢0%)57 (54¢3%)<0¢01RaisedD-dimers41 (54¢7%)46 (52¢3%)96 (91¢4%)<0¢01Haematological InvolvementLow platelets (<100£109/L)7 (9¢3%)9 (10¢2%)38 (36¢2%)<0¢01Neurological InvolvementHeadache16 (21¢3%)13 (15¢3%)32 (30¢5%)0¢03Seizure1(1¢3%)02 (1¢9%)0¢45Confusion1(1¢3%)1 (1¢1%)11 (10¢5%)<0¢01Drowsiness7(9¢3%)10 (11¢4%)19 (18¢1%)0¢10Renal involvementRaised creatinine01(1¢1%)19 (18¢1%)<0¢01Acute Kidney Disease03(3¢4%)25 (23¢8%)<0¢01Respiratory InvolvementCough11 (14¢7%)30 (34¢1%)28 (26¢7%)0¢02Tachypnoea19 (25¢3%)21 (23¢9%)48 (45¢7%)<0¢01CPAP /ventilation / high frequency oscillation03 (3¢4%)45 (42¢9%)<0¢01Phenotype classTSS (N= 39)015 (17¢0%)24 (22¢9%)<0¢01KD (N= 24)016 (18¢2%)8 (7¢6%)<0¢01PIMS-TS only (N= 216)75 (100¢0%)63 (71¢6%)78 (74¢3%)<0¢01PIMS-TS/KD (N= 13)010 (11¢4%)3 (2¢9%)<0¢01PIMS-TS/TSS (N= 28)09 (10¢2%)19 (18¢1%)<0¢01PIMS-TS/Kawasaki/TSS (N= 11)06 (6¢8%)5 (4¢8%)<0¢01ALT Alanine transaminase; CPAP Continuous positive airway pressure; IQR Interquartile Range; KD Kawasaki disease; PCR Polymerase chain reaction;PIMS-TS Paedi-atric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2; TSS Toxic shock syndrome.10J. Flood et al. / The Lancet Regional Health - Europe 3 (2021) 100075
FundingThis surveillance was internally funded by PHE and did notreceive any specific grant funding from agencies in the public, com-mercial or not-for-profit sectors.
Identifiers
Local EPrints ID: 447706
URI: http://eprints.soton.ac.uk/id/eprint/447706
ISSN: 2666-7762
PURE UUID: e6b3b28b-f384-4fc1-b151-eb6f99d50fbe
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Date deposited: 18 Mar 2021 17:52
Last modified: 17 Mar 2024 06:24
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Contributors
Author:
Jessica Flood
Author:
Joseph Shingleton
Author:
Emma Bennett
Author:
Brodie Walker
Author:
Zahin Amin-Chowdhury
Author:
Godwin Oligbu
Author:
Jacob Avis
Author:
Richard Lynn
Author:
Peter Davis
Author:
Tara Bharucha
Author:
Clare E. Pain
Author:
Deepthi Jyothish
Author:
Elizabeth Whittaker
Author:
Buvana Dwarakanathan
Author:
Rachael Wood
Author:
Christopher Williams
Author:
Olivia Swann
Author:
Malcolm G. Semple
Author:
Mary E. Ramsay
Author:
Athimalaipet V. Ramanan
Author:
Nick Gent
Author:
Shamez N. Ladhani
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