The clinical features and estimated incidence of MIS-C in Cape Town, South Africa

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dc.contributor.authorButters, Claire
dc.contributor.authorAbraham, Deepthi R
dc.contributor.authorStander, Raphaella
dc.contributor.authorFacey-Thomas, Heidi
dc.contributor.authorAbrahams, Debbie
dc.contributor.authorFaleye, Ayodele
dc.contributor.authorAllie, Nazneen
dc.contributor.authorSoni, Khushbu
dc.contributor.authorRabie, Helena
dc.contributor.authorScott, Christiaan
dc.contributor.authorZühlke, Liesl
dc.contributor.authorWebb, Kate
dc.date.accessioned2022-07-08T06:38:02Z
dc.date.available2022-07-08T06:38:02Z
dc.date.issued2022-05-02
dc.date.updated2022-05-08T03:25:07Z
dc.description.abstractBackground 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.en_US
dc.identifier.apacitationButters, C., Abraham, D. R., Stander, R., Facey-Thomas, H., Abrahams, D., Faleye, A., ... Webb, K. (2022). The clinical features and estimated incidence of MIS-C in Cape Town, South Africa. <i>BMC Pediatrics</i>, 22(1), 241. http://hdl.handle.net/11427/36628en_ZA
dc.identifier.chicagocitationButters, Claire, Deepthi R Abraham, Raphaella Stander, Heidi Facey-Thomas, Debbie Abrahams, Ayodele Faleye, Nazneen Allie, et al "The clinical features and estimated incidence of MIS-C in Cape Town, South Africa." <i>BMC Pediatrics</i> 22, 1. (2022): 241. http://hdl.handle.net/11427/36628en_ZA
dc.identifier.citationButters, C., Abraham, D.R., Stander, R., Facey-Thomas, H., Abrahams, D., Faleye, A., Allie, N. & Soni, K. et al. 2022. The clinical features and estimated incidence of MIS-C in Cape Town, South Africa. <i>BMC Pediatrics.</i> 22(1):241. http://hdl.handle.net/11427/36628en_ZA
dc.identifier.ris TY - Journal Article AU - Butters, Claire AU - Abraham, Deepthi R AU - Stander, Raphaella AU - Facey-Thomas, Heidi AU - Abrahams, Debbie AU - Faleye, Ayodele AU - Allie, Nazneen AU - Soni, Khushbu AU - Rabie, Helena AU - Scott, Christiaan AU - Zühlke, Liesl AU - Webb, Kate AB - 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. DA - 2022-05-02 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Pediatrics KW - MIS-C KW - SARS-CoV-2 KW - Paediatrics KW - Low-middle income countries KW - Global health KW - Epidemiology KW - Incidence LK - https://open.uct.ac.za PY - 2022 T1 - The clinical features and estimated incidence of MIS-C in Cape Town, South Africa TI - The clinical features and estimated incidence of MIS-C in Cape Town, South Africa UR - http://hdl.handle.net/11427/36628 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12887-022-03308-z
dc.identifier.urihttp://hdl.handle.net/11427/36628
dc.identifier.vancouvercitationButters C, Abraham DR, Stander R, Facey-Thomas H, Abrahams D, Faleye A, et al. The clinical features and estimated incidence of MIS-C in Cape Town, South Africa. BMC Pediatrics. 2022;22(1):241. http://hdl.handle.net/11427/36628.en_ZA
dc.language.rfc3066en
dc.publisher.departmentDivision of Infectious Disease and HIV Meden_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.sourceBMC Pediatricsen_US
dc.source.journalissue1en_US
dc.source.journalvolume22en_US
dc.source.pagination241en_US
dc.source.urihttps://bmcmedicine.biomedcentral.com/
dc.subjectMIS-Cen_US
dc.subjectSARS-CoV-2en_US
dc.subjectPaediatricsen_US
dc.subjectLow-middle income countriesen_US
dc.subjectGlobal healthen_US
dc.subjectEpidemiologyen_US
dc.subjectIncidenceen_US
dc.titleThe clinical features and estimated incidence of MIS-C in Cape Town, South Africaen_US
dc.typeJournal Articleen_US
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