Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2

Amanda B. Payne(Centers for Disease Control and Prevention), Zunera Gilani(Centers for Disease Control and Prevention), Shana Godfred‐Cato(Centers for Disease Control and Prevention), Ermias D. Belay(Centers for Disease Control and Prevention), Leora R. Feldstein(Centers for Disease Control and Prevention), Manish Patel(Centers for Disease Control and Prevention), Adrienne G. Randolph(Boston Children's Hospital), Margaret M. Newhams(Boston Children's Hospital), Deepam Thomas(New Jersey Department of Health), Reed Magleby(Centers for Disease Control and Prevention), Katherine Hsu(Massachusetts Department of Mental Health), Meagan Burns(Massachusetts Department of Mental Health), Elizabeth Dufort(New York State Department of Health), Angie Maxted(New York State Department of Health), Michael Pietrowski(Philadelphia Department of Public Health), Allison Longenberger(Pennsylvania Department of Health), Sally Bidol(Michigan Department of Health and Human Services), Justin Henderson(Michigan Department of Health and Human Services), Lynn Sosa(Connecticut Department of Public Health), Alexandra Edmundson(Council of State and Territorial Epidemiologists), Melissa Tobin‐D’Angelo(Georgia Department of Public Health), Laura Edison(Georgia Department of Public Health), Sabrina M. Heidemann(Central Michigan University), Aalok R. Singh(Westchester Medical Center), John S. Giuliano(Yale University), Lawrence C. Kleinman(Rutgers, The State University of New Jersey), Keiko M. Tarquinio(Emory University), Rowan Walsh(Newark Beth Israel Medical Center), Julie C. Fitzgerald(University of Pennsylvania), Katharine N. Clouser(Hackensack University Medical Center), Shira J. Gertz(Saint Barnabas Medical Center), Ryan W. Carroll(Harvard University), Christopher L. Carroll(Connecticut Children's Medical Center), Brooke Hoots(Centers for Disease Control and Prevention), Carrie Reed(Centers for Disease Control and Prevention), F. Scott Dahlgren(Centers for Disease Control and Prevention), Matthew E. Oster(Centers for Disease Control and Prevention), Timmy Pierce(Centers for Disease Control and Prevention), Aaron T. Curns(Centers for Disease Control and Prevention), Gayle Langley(Centers for Disease Control and Prevention), Angela P. Campbell(Centers for Disease Control and Prevention), MIS-C Incidence Authorship Group(Centers for Disease Control and Prevention), Neha Balachandran(Centers for Disease Control and Prevention), Thomas S. Murray(Michigan Department of Health and Human Services), Cole Burkholder(Michigan Department of Health and Human Services), Troy Brancard(New Jersey Department of Health), Jenna Lifshitz(New Jersey Department of Health), Dylan Leach(Massachusetts Department of Mental Health), Ian M. Charpie(New York State Department of Health), Cory Tice(New York State Department of Health), Susan Coffin(Philadelphia Department of Public Health), Dana Perella(Emory University), Kaitlin Jones(Baystate Medical Center), Kimberly L. Marohn(Baystate Medical Center), Phoebe H. Yager(Harvard University), Neil D. Fernandes(Harvard University), Heidi R. Flori(University of Michigan), Monica L. Koncicki(Cooper University Hospital), Karen Walker(Cooper University Hospital), M. Cecilia Di Pentima(Goryeb Children's Hospital), Simon Li(The Bristol-Myers Squibb Children's Hospital), Steven M. Horwitz(The Bristol-Myers Squibb Children's Hospital), Sunanda Gaur(Lebanon Valley College), Dennis C. Coffey(Lebanon Valley College), Ilana Harwayne‐Gidansky(Stony Brook University Hospital), Saul Hymes(Stony Brook University Hospital), Neal J. Thomas(Golisano Children's Hospital), Kate G. Ackerman(Golisano Children's Hospital), Jill M. Cholette(Golisano Children's Hospital)
JAMA Network Open
June 10, 2021
10.1001/jamanetworkopen.2021.16420
Cited by 402Open Access
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Abstract

Importance: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. Objective: To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. Design, Setting, and Participants: This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1 000 000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. Exposures: Race/ethnicity, sex, and age group (ie, ≤5, 6-10, 11-15, and 16-20 years). Main Outcomes and Measures: Overall and stratum-specific adjusted estimated MIS-C incidence per 1 000 000 person-months and per 1 000 000 SARS-CoV-2 infections. Results: In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1 000 000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1 000 000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1 000 000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1 000 000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1 000 000 person-months). Conclusions and Relevance: In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group.

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