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Multisystem Inflammatory Syndrome in Children in New York State.
N Engl J Med. 2020 07 23; 383(4):347-358.NEJM

Abstract

BACKGROUND

A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome.

METHODS

Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.

RESULTS

As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.

CONCLUSIONS

The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

Authors+Show Affiliations

From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).From the New York State Department of Health, Albany (E.M.D., A.M., J.R., A.M.M., D.E., J.K., W.P., L.S., B.H., D.B., H.Z.); the Centers for Disease Control and Prevention (CDC) COVID-19 Response (E.H.K., E.J.C.) and the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (E.J.C.), CDC, Atlanta; and the University at Albany School of Public Health, State University of New York, Rensselaer (E.M.R., M.A.B., E.S.R., T.U.).No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32598830

Citation

Dufort, Elizabeth M., et al. "Multisystem Inflammatory Syndrome in Children in New York State." The New England Journal of Medicine, vol. 383, no. 4, 2020, pp. 347-358.
Dufort EM, Koumans EH, Chow EJ, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020;383(4):347-358.
Dufort, E. M., Koumans, E. H., Chow, E. J., Rosenthal, E. M., Muse, A., Rowlands, J., Barranco, M. A., Maxted, A. M., Rosenberg, E. S., Easton, D., Udo, T., Kumar, J., Pulver, W., Smith, L., Hutton, B., Blog, D., & Zucker, H. (2020). Multisystem Inflammatory Syndrome in Children in New York State. The New England Journal of Medicine, 383(4), 347-358. https://doi.org/10.1056/NEJMoa2021756
Dufort EM, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020 07 23;383(4):347-358. PubMed PMID: 32598830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multisystem Inflammatory Syndrome in Children in New York State. AU - Dufort,Elizabeth M, AU - Koumans,Emilia H, AU - Chow,Eric J, AU - Rosenthal,Elizabeth M, AU - Muse,Alison, AU - Rowlands,Jemma, AU - Barranco,Meredith A, AU - Maxted,Angela M, AU - Rosenberg,Eli S, AU - Easton,Delia, AU - Udo,Tomoko, AU - Kumar,Jessica, AU - Pulver,Wendy, AU - Smith,Lou, AU - Hutton,Brad, AU - Blog,Debra, AU - Zucker,Howard, AU - ,, Y1 - 2020/06/29/ PY - 2020/7/1/pubmed PY - 2020/7/31/medline PY - 2020/6/30/entrez SP - 347 EP - 358 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 383 IS - 4 N2 - BACKGROUND: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. METHODS: Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. RESULTS: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. CONCLUSIONS: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32598830/Multisystem_Inflammatory_Syndrome_in_Children_in_New_York_State_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa2021756?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -