SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C)

In April 2020, amid the coronavirus disease 2019 (COVID-19) pandemic, providers in the United Kingdom described a group of pediatric hospital admissions secondary to fever and multisystem inflammation which has subsequently been described in several countries, including the United States.1–4 Since t...

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Published in:Infection control and hospital epidemiology 2021-09, Vol.42 (9), p.1108-1110
Main Authors: Muller, Martha L, Logan, Latania K, Kociolek, Larry K, Guzman-Cottrill, Judith A, Bartlett, Allison H, Schaffzin, Joshua K, Ravin, Karen A, Rubin, Lorry G, Lake, Jason, Caughell, Carolyn, Ramirez-Avila, Lynn
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Language:English
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Child
Coronaviruses
COVID-19
Disease control
Humans
Infectious diseases
Leadership
Multisystem inflammatory syndrome in children
Pandemics
Pediatrics
Personal Protective Equipment
Protective equipment
Public health
Respiratory tract
Systemic Inflammatory Response Syndrome - therapy
Teenagers
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container_end_page 1110
container_issue 9
container_start_page 1108
container_title Infection control and hospital epidemiology
container_volume 42
creator Muller, Martha L
Logan, Latania K
Kociolek, Larry K
Guzman-Cottrill, Judith A
Bartlett, Allison H
Schaffzin, Joshua K
Ravin, Karen A
Rubin, Lorry G
Lake, Jason
Caughell, Carolyn
Ramirez-Avila, Lynn
description In April 2020, amid the coronavirus disease 2019 (COVID-19) pandemic, providers in the United Kingdom described a group of pediatric hospital admissions secondary to fever and multisystem inflammation which has subsequently been described in several countries, including the United States.1–4 Since then, several countries have described an epidemiologic association of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and this clinical presentation,5 with the development of cases noted a few weeks following peaks in community COVID-19 activity.1 The condition has been named Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States and Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in Europe.5 Patients present variably along a spectrum, including fever, conjunctival injection, rash, abdominal pain, and vomiting.1,2,4 Laboratory evidence of inflammation is routinely present.1,4 The clinical presentation in patients has been similar to other pediatric inflammatory conditions, to include Kawasaki disease, toxic shock syndrome, bacterial sepsis, and macrophage activation syndrome.1,3,4,6–9 Although MIS-C has been compared to Kawasaki disease, several symptoms are more notable in MIS-C disease: presentation in older aged children, a predominance of abdominal symptoms, frequent lymphopenia, increased incidence of left ventricular systolic dysfunction, and acute heart failure.3,4,10,11 MIS-C is likely a rare complication of SARS-CoV-2 infection,1,4,12 with a reported incidence of ˜2 in 100,000 persons
doi_str_mv 10.1017/ice.2021.242
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Several factors influence the outcome of viral detection with RT-PCR, including intermittent viral shedding,14 low viral levels in the upper respiratory tract,15 and sampling error.15 However, Greninger et al16 reported only 3.5% of a cohort of patients who initially tested negative for SARS-CoV-2 RT-PCR developed a positive test within 7 days, while most of those necessitating additional testing for any reason within the 7-day period remained negative for any additional testing. Pediatric patients admitted with concerns for MIS-C without a previous history of SARS-CoV-2 testing should have initial SARS-CoV-2 RT-PCR testing to help guide isolation precautions and to assist in establishing a diagnosis. Because MIS-C most likely represents a postinfectious, inflammatory disease process, the need for repeated SARS-CoV-2 RT-PCR in patients with confirmed disease is unclear. The Infectious Diseases Society of America (IDSA) does not recommend repeat SARS-CoV-2 RT PCR testing if there is a low clinical suspicion for COVID-19.26 Even in the setting of a positive SARS-CoV-2 PCR, most patients with MIS-C would not require isolation according to current recommendations by the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html).</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2021.242</identifier><identifier>PMID: 34121639</identifier><language>eng</language><publisher>United States: Cambridge University Press</publisher><subject>Child ; Coronaviruses ; COVID-19 ; Disease control ; Humans ; Infectious diseases ; Leadership ; Multisystem inflammatory syndrome in children ; Pandemics ; Pediatrics ; Personal Protective Equipment ; Protective equipment ; Public health ; Respiratory tract ; Systemic Inflammatory Response Syndrome - therapy ; Teenagers</subject><ispartof>Infection control and hospital epidemiology, 2021-09, Vol.42 (9), p.1108-1110</ispartof><rights>The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America</rights><rights>The Society for Healthcare Epidemiology of America 2021 2021 The Society for Healthcare Epidemiology of America</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c369t-98a5c4ea57c4268a7a0425f4056b567ccfce17f3aa04f416217f04e870868e663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34121639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muller, Martha L</creatorcontrib><creatorcontrib>Logan, Latania K</creatorcontrib><creatorcontrib>Kociolek, Larry K</creatorcontrib><creatorcontrib>Guzman-Cottrill, Judith A</creatorcontrib><creatorcontrib>Bartlett, Allison H</creatorcontrib><creatorcontrib>Schaffzin, Joshua K</creatorcontrib><creatorcontrib>Ravin, Karen A</creatorcontrib><creatorcontrib>Rubin, Lorry G</creatorcontrib><creatorcontrib>Lake, Jason</creatorcontrib><creatorcontrib>Caughell, Carolyn</creatorcontrib><creatorcontrib>Ramirez-Avila, Lynn</creatorcontrib><creatorcontrib>SHEA Pediatric Leadership Council</creatorcontrib><creatorcontrib>for the SHEA Pediatric Leadership Council</creatorcontrib><title>SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C)</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>In April 2020, amid the coronavirus disease 2019 (COVID-19) pandemic, providers in the United Kingdom described a group of pediatric hospital admissions secondary to fever and multisystem inflammation which has subsequently been described in several countries, including the United States.1–4 Since then, several countries have described an epidemiologic association of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and this clinical presentation,5 with the development of cases noted a few weeks following peaks in community COVID-19 activity.1 The condition has been named Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States and Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in Europe.5 Patients present variably along a spectrum, including fever, conjunctival injection, rash, abdominal pain, and vomiting.1,2,4 Laboratory evidence of inflammation is routinely present.1,4 The clinical presentation in patients has been similar to other pediatric inflammatory conditions, to include Kawasaki disease, toxic shock syndrome, bacterial sepsis, and macrophage activation syndrome.1,3,4,6–9 Although MIS-C has been compared to Kawasaki disease, several symptoms are more notable in MIS-C disease: presentation in older aged children, a predominance of abdominal symptoms, frequent lymphopenia, increased incidence of left ventricular systolic dysfunction, and acute heart failure.3,4,10,11 MIS-C is likely a rare complication of SARS-CoV-2 infection,1,4,12 with a reported incidence of ˜2 in 100,000 persons &lt;21 years of age.19 Reported mortality is ˜1%–2%.23–25 The pathogenesis of this syndrome is not completely delineated.19–22 However, it is thought to be a post–SARS-CoV-2 infection inflammatory syndrome based on the following (1) MIS-C incidence generally reaches its peak ˜1 month after a region’s peak in acute COVID-19 cases; (2) preceding symptoms consistent with acute COVID-19 are noted in certain children; and (3) many of the affected children demonstrate the presence of SARS-CoV-2 antibody in the setting of negative RT-PCR testing.19,22 Role of SARS-CoV-2 testing in MIS-C for personal protective equipment (PPE) considerations Several case reports and case series describing pediatric patients with MIS-C have been published, and some of these include information about the SARS-CoV-2 infection status.1–4,6,9,13 In these studies, SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) positivity ranged from 13% to 70% of patients, and evidence of serologic conversion was noted in 73%–100%.1–4,6,9,13 The presence of IgG in many of the patients with MIS-C suggests a postinfectious syndrome occurring outside the primary infection.8 However, the demonstration of SARS-CoV-2 virus RT-PCR positivity in these patients potentially suggests that the syndrome may occur in a later stage of primary infection.8 Testing strategy and validity play important roles in PPE determination. Several factors influence the outcome of viral detection with RT-PCR, including intermittent viral shedding,14 low viral levels in the upper respiratory tract,15 and sampling error.15 However, Greninger et al16 reported only 3.5% of a cohort of patients who initially tested negative for SARS-CoV-2 RT-PCR developed a positive test within 7 days, while most of those necessitating additional testing for any reason within the 7-day period remained negative for any additional testing. Pediatric patients admitted with concerns for MIS-C without a previous history of SARS-CoV-2 testing should have initial SARS-CoV-2 RT-PCR testing to help guide isolation precautions and to assist in establishing a diagnosis. Because MIS-C most likely represents a postinfectious, inflammatory disease process, the need for repeated SARS-CoV-2 RT-PCR in patients with confirmed disease is unclear. The Infectious Diseases Society of America (IDSA) does not recommend repeat SARS-CoV-2 RT PCR testing if there is a low clinical suspicion for COVID-19.26 Even in the setting of a positive SARS-CoV-2 PCR, most patients with MIS-C would not require isolation according to current recommendations by the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html).</description><subject>Child</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Disease control</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Leadership</subject><subject>Multisystem inflammatory syndrome in children</subject><subject>Pandemics</subject><subject>Pediatrics</subject><subject>Personal Protective Equipment</subject><subject>Protective equipment</subject><subject>Public health</subject><subject>Respiratory tract</subject><subject>Systemic Inflammatory Response Syndrome - therapy</subject><subject>Teenagers</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNpdkV1rFDEUhoModq3eeS0Bbyo4a5LJ1_RCKEu1hRWFKngX0syZbspksk0ylf0z_laztNaPq5CTJy958yD0kpIlJVS98w6WjDC6ZJw9QgsqRNdI3fLHaEF01zWatd8P0LOcrwkhquvoU3TQcsqobLsF-nlxdnqCv0DvbUne4TXYHlLe-C1exXlyfsQuhgBTsWl3XMGU42RHvE2xgCv-FjDczH67J3A_Jz9dYWcT4Dhgt_Fjn2DCP3zZ4DCPxeddLhCwn4bRhmBLTDucd1OfYoA6_XPl6NP5RbN68xw9GeyY4cX9eoi-fTj9ujpr1p8_nq9O1o1rZVeaTlvhOFihHGdSW2UJZ2LgRMhLIZVzgwOqhtbW-cCpZHVDOGhFtNQgZXuI3t_lbufLAL2rbZIdzTb5UHubaL3592TyG3MVb41mRAlBasDRfUCKNzPkYoLPDsbRThDnbJjgRDHSKl3R1_-h13FO9VMrpZiSgmjBK_X2jnIp5pxgeHgMJWYv3lTxZi_eVPEVf_V3gQf4t-n2F_uZrF8</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Muller, Martha L</creator><creator>Logan, Latania K</creator><creator>Kociolek, Larry K</creator><creator>Guzman-Cottrill, Judith A</creator><creator>Bartlett, Allison H</creator><creator>Schaffzin, Joshua K</creator><creator>Ravin, Karen A</creator><creator>Rubin, Lorry G</creator><creator>Lake, Jason</creator><creator>Caughell, Carolyn</creator><creator>Ramirez-Avila, Lynn</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210901</creationdate><title>SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C)</title><author>Muller, Martha L ; Logan, Latania K ; Kociolek, Larry K ; Guzman-Cottrill, Judith A ; Bartlett, Allison H ; Schaffzin, Joshua K ; Ravin, Karen A ; Rubin, Lorry G ; Lake, Jason ; Caughell, Carolyn ; Ramirez-Avila, Lynn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-98a5c4ea57c4268a7a0425f4056b567ccfce17f3aa04f416217f04e870868e663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Child</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Disease control</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Leadership</topic><topic>Multisystem inflammatory syndrome in children</topic><topic>Pandemics</topic><topic>Pediatrics</topic><topic>Personal Protective Equipment</topic><topic>Protective equipment</topic><topic>Public health</topic><topic>Respiratory tract</topic><topic>Systemic Inflammatory Response Syndrome - therapy</topic><topic>Teenagers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muller, Martha L</creatorcontrib><creatorcontrib>Logan, Latania K</creatorcontrib><creatorcontrib>Kociolek, Larry K</creatorcontrib><creatorcontrib>Guzman-Cottrill, Judith A</creatorcontrib><creatorcontrib>Bartlett, Allison H</creatorcontrib><creatorcontrib>Schaffzin, Joshua K</creatorcontrib><creatorcontrib>Ravin, Karen A</creatorcontrib><creatorcontrib>Rubin, Lorry G</creatorcontrib><creatorcontrib>Lake, Jason</creatorcontrib><creatorcontrib>Caughell, Carolyn</creatorcontrib><creatorcontrib>Ramirez-Avila, Lynn</creatorcontrib><creatorcontrib>SHEA Pediatric Leadership Council</creatorcontrib><creatorcontrib>for the SHEA Pediatric Leadership Council</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database</collection><collection>ProQuest Health &amp; 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(2) preceding symptoms consistent with acute COVID-19 are noted in certain children; and (3) many of the affected children demonstrate the presence of SARS-CoV-2 antibody in the setting of negative RT-PCR testing.19,22 Role of SARS-CoV-2 testing in MIS-C for personal protective equipment (PPE) considerations Several case reports and case series describing pediatric patients with MIS-C have been published, and some of these include information about the SARS-CoV-2 infection status.1–4,6,9,13 In these studies, SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) positivity ranged from 13% to 70% of patients, and evidence of serologic conversion was noted in 73%–100%.1–4,6,9,13 The presence of IgG in many of the patients with MIS-C suggests a postinfectious syndrome occurring outside the primary infection.8 However, the demonstration of SARS-CoV-2 virus RT-PCR positivity in these patients potentially suggests that the syndrome may occur in a later stage of primary infection.8 Testing strategy and validity play important roles in PPE determination. Several factors influence the outcome of viral detection with RT-PCR, including intermittent viral shedding,14 low viral levels in the upper respiratory tract,15 and sampling error.15 However, Greninger et al16 reported only 3.5% of a cohort of patients who initially tested negative for SARS-CoV-2 RT-PCR developed a positive test within 7 days, while most of those necessitating additional testing for any reason within the 7-day period remained negative for any additional testing. Pediatric patients admitted with concerns for MIS-C without a previous history of SARS-CoV-2 testing should have initial SARS-CoV-2 RT-PCR testing to help guide isolation precautions and to assist in establishing a diagnosis. Because MIS-C most likely represents a postinfectious, inflammatory disease process, the need for repeated SARS-CoV-2 RT-PCR in patients with confirmed disease is unclear. The Infectious Diseases Society of America (IDSA) does not recommend repeat SARS-CoV-2 RT PCR testing if there is a low clinical suspicion for COVID-19.26 Even in the setting of a positive SARS-CoV-2 PCR, most patients with MIS-C would not require isolation according to current recommendations by the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html).</abstract><cop>United States</cop><pub>Cambridge University Press</pub><pmid>34121639</pmid><doi>10.1017/ice.2021.242</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record>
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1559-6834
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source Cambridge University Press
subjects Child
Coronaviruses
COVID-19
Disease control
Humans
Infectious diseases
Leadership
Multisystem inflammatory syndrome in children
Pandemics
Pediatrics
Personal Protective Equipment
Protective equipment
Public health
Respiratory tract
Systemic Inflammatory Response Syndrome - therapy
Teenagers
title SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C)
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