COVID-19 Publications

22

Dec, 2020

Multisystem Inflammatory Syndrome in Children Associated With Coronavirus Disease 2019 in a Children’s Hospital in New York City: Patient Characteristics and an Institutional Protocol for Evaluation, Management, and Follow-Up

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Authors: Brian Jonat, Mark Gorelik, Alexis Boneparth, Andrew S Geneslaw, Philip Zachariah, Amee Shah, Larisa Broglie, Juan Duran, Kimberly D Morel, Maria Zorrilla, Leanne Svoboda 9, Candace Johnson, Jennifer Cheng, Maria C Garzon , Wendy G Silver, Kara Gross Margolis, Cindy Neunert, Irene Lytrivi, Joshua Milner, Steven G Kernie, Eva W Cheung

Published in: Pediatric Critical Care Medicine

 

Abstract: Objectives: The disease caused by severe acute respiratory syndrome coronavirus 2, known as coronavirus disease 2019, has resulted in a global pandemic. Reports are emerging of a new severe hyperinflammatory syndrome related to coronavirus disease 2019 in children and adolescents. The Centers for Disease Control and Prevention has designated this disease multisystem inflammatory syndrome in children. Our objective was to develop a clinical inpatient protocol for the evaluation, management, and follow-up of patients with this syndrome.

Data Sources: The protocol was developed by a multidisciplinary team based on relevant literature related to coronavirus disease 2019, multisystem inflammatory syndrome in children, and related inflammatory syndromes, as well as our experience caring for children with multisystem inflammatory syndrome in children. Data were obtained on patients with multisystem inflammatory syndrome in children at our institution from the pre-protocol and post-protocol periods.

Data Synthesis: Our protocol was developed in order to identify cases of multisystem inflammatory syndrome in children with high sensitivity, stratify risk to guide treatment, recognize co-infectious or co-inflammatory processes, mitigate coronary artery abnormalities, and manage hyperinflammatory shock. Key elements of evaluation include case identification using broad clinical characteristics and comprehensive laboratory and imaging investigations. Treatment centers around glucocorticoids and IV immunoglobulin with biologic immunomodulators as adjuncts. Multidisciplinary follow-up after discharge is indicated to manage continued outpatient therapy and evaluate for disease sequelae. In nearly 2 months, we admitted 54 patients with multisystem inflammatory syndrome in children, all of whom survived without the need for invasive ventilatory or mechanical circulatory support. After institution of this protocol, patients received earlier treatment and had shorter lengths of hospital stay.

Conclusions: This report provides guidance to clinicians on evaluation, management, and follow-up of patients with a novel hyperinflammatory syndrome related to coronavirus disease 2019 known as multisystem inflammatory syndrome in children. It is based on the relevant literature and our experience. Instituting such a protocol during a global pandemic is feasible and is associated with patients receiving treatment and returning home more quickly.

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22

Dec, 2020

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

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Authors: Rachel Harwood, MRCS, Benjamin Allin, Dphil, Christine E Jones, Ph.D., Christine E Jones, PhD, Elizabeth Whittaker, PhD, Padmanabhan Ramnarayan, MD, Athimalaipet V Ramanan, FRCP,

Published in: The Lancet

 

Summary: Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.

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24

Nov, 2020

Kinetics and seroprevalence of SARS-CoV-2 antibodies in children

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Authors: Cathal Roarty, Claire Tonry, Lisa McFetridge, Hannah Mitcheòò, Chris Watson, Thomas Waterfeild, on behalf of the Covid Warriors research team

Published in: The Lancet Infectious Diseases

Abstract: To the best of our knowledge, no longitudinal study has reported the kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody responses in children. Here we report the results of the second round of antibody testing in children from a prospective multicentre cohort study in the UK. The protocol and initial results are available elsewhere.

Recruitment took place between April 16, and July 3, 2020, at five UK sites (Belfast, Cardiff, Glasgow, London, and Manchester) and included healthy children aged 2–15 years. Follow-up visits at all five UK sites took place between June 26, and Aug 15, 2020.

Of the 992 participants in the first round, 849 (86%) returned. Seroprevalence was measured with the Elecsys Anti-SARS-CoV-2 Total Antibody assay (Roche, Basel, Switzerland) and the LIAISON SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Saluggia, Italy). The median time between initial and follow-up visits was 62 days (IQR 52–70; range 43–81). 65 (7·66%, 95% CI 6·05–9·64) of 849 tests were reactive based on the manufacturers’ suggested cutoffs. This proportion was not substantially different to the seroprevalence (6·9% 95% CI 5·4 to 8·6; 68 of 992) reported during recruitment. The median age of participants with reactive antibody tests during the second round was 10 years (IQR 7–14; range 3–16). As with the baseline results, there was variation in seroprevalence between sites.
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30

Oct, 2020

COVID and HIV: Psychological impact and awareness of COVID-19 in young people with HIV

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Authors: S. Bernardi1, E. Mozzo, M. Di Pastena, F. Leone, C. Novello, A. Oletto, N. Cotugno, P. Zangari, P. Palma, V. Santilli, P. Palma, O. Rampon, C. Giaquinto

Published in: 12th National Congress of Italian Conference on AIDS and Antiviral Research

Background: Public health emergencies may affect the health, safety, and well-being of both individuals and communities. These effects may translate into a range of emotional reactions and unhealthy behaviours. Some people may be more vulnerable than others to the psychosocial effects of pandemics. Young people living with HIV can experience solitude, depression and anxiety as a consequence of the stigma that continues to surround HIV and the daily challenge of living with a chronic infection. We investigated the psychological impact of the current COVID-19 pandemic among a group of HIV-infected young people and assessed their knowledge on HIV and COVID-19 infections.

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28

Oct, 2020

PAIRED PANDEMICS: Ensuring HIV Care Continuity and Market Stability During COVID-19

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Join this webinar, hosted by CHAI, to get highlights on key trends in the HIV space in LMICs from CHAI’s 2020 HIV Market Report.

You can expect an insightful panel discussion focusing on the resiliency of national HIV programs and markets and ensuring HIV care continuity during these trying times.

Date: November 12 2020

Time: 8am – 9am EST (13 – 14 GMT)

Register to join the webinar here.

2

Sep, 2020

SARS‐CoV‐2 infection in people living with HIV: a systematic review

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Background and setting Little is known about SARS‐CoV‐2 impact on some vulnerable subgroups, such as people living with HIV/AIDS (PLWHA). In our study we reviewed the current knowledge on SARS‐CoV‐2 cases in PLWHA.

Methods A systematic review was conducted by searching the MEDLINE, EMBASE and Google Scholar databases. Studies reporting data on PLWHA affected by SARS‐CoV‐2 were considered for inclusion. The aim of this study was the systematic characterization of cases of SARS‐CoV‐2 infection among PLWHA, particularly focusing on age, clinical findings at diagnosis, radiological features, therapeutic management and clinical outcomes.

Results Twenty three relevant articles were identified, which reported 164 adults with both HIV and SARS‐CoV‐2 infection. Of those, the large majority were males (120/142, 84.5%), often with one or more comorbidities. Fifteen cases needed intensive care treatment and 16 died. For each group, respectively three patients had underlying comorbidities. There were no studies on children. The included studies were mostly retrospective or case series/reports (19 studies). The overall risk of bias was moderate, due to the study types and characteristics.

Conclusion It is still unclear if HIV infection may influence SARS‐CoV‐2 infection and disease course, however some PLWHA and particularly males affected by ARV‐related complications may be at greater risk of severe Covid‐19 course.

31

Aug, 2020

COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center

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Abstract Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women’s and Children’s Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new “double-gate approach”: a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic.

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25

Aug, 2020

COVID-19 and multisystem inflammatory syndrome in children and adolescents

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Abstract As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. However, the association between multisystem inflammatory syndrome in children and COVID-19 is still unknown. We review the epidemiology, causes, clinical features, and current treatment protocols for multisystem inflammatory syndrome in children and adolescents associated with COVID-19. We also discuss the possible underlying pathophysiological mechanisms for COVID-19-induced inflammatory processes, which can lead to organ damage in paediatric patients who are severely ill. These insights provide evidence for the need to develop a clear case definition and treatment protocol for this new condition and also shed light on future therapeutic interventions and the potential for vaccine development.

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30

Jul, 2020

SARS-CoV-2 Infection in Febrile Neonates

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Abstract Most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients are mild or asymptomatic. However, infants have emerged at higher risk of hospitalization and severe outcomes in pediatric coronavirus disease 2019 (COVID-19). We report a case series of 4 full-term neonates hospitalized with fever and found to have SARS-CoV-2 infection with a spectrum of illness severities. Two neonates required admission to the intensive care unit for respiratory insufficiency and end organ involvement. Half of the patients were found to have a coinfection. One neonate received antiviral therapy with remdesivir and is, to our knowledge, the youngest patient to receive this drug for COVID-19. All neonates had favorable outcomes.

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29

Jul, 2020

Harmonisation preserves research resources

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The COVID-19 pandemic is highlighting the importance of international collaboration, particularly in the field of health and science. Collaborative efforts between study leads, scientific societies and researchers has the potential to speed-up research. Through sharing resources and results we can harmonize clinical characterization studies and fill the knowledge-gap in medical research.

This is the focus of a correspondence by Malte Kohns at St George’s University London to The Lancet Infectious Disease Journal. We are proud to have contributed to this work through the Penta global network of clinicians and researchers.

Read the full correspondence here.

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