Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): Prospective, national surveillance, United Kingdom and Ireland, 2020

Jessica Flood; Joseph Shingleton; Emma Bennett; Brodie Walker; Zahin Amin-Chowdhury; Godwin Oligbu; Jacob Avis; Richard M Lynn; Peter Davis; Tara Bharucha; Clare E Pain; Deepthi Jyothish; Elizabeth Whittaker; Buvana Dwarakanathan; Rachael Wood; Christopher Williams; Olivia Swann; Malcolm G Semple; Mary E Ramsay; Christine E Jones; Athimalaipet V Ramanan; Nick Gent; Shamez N Ladhani

doi:10.1016/j.lanepe.2021.100075

Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): Prospective, national surveillance, United Kingdom and Ireland, 2020

Lancet Reg Health Eur. 2021 Apr:3:100075. doi: 10.1016/j.lanepe.2021.100075. Epub 2021 Mar 22.

Authors

Jessica Flood¹, Joseph Shingleton^{2

3}, Emma Bennett^{2

3}, Brodie Walker^{2

3}, Zahin Amin-Chowdhury¹, Godwin Oligbu¹, Jacob Avis⁴, Richard M Lynn^{4

5}, Peter Davis⁶, Tara Bharucha⁷, Clare E Pain⁸, Deepthi Jyothish⁹, Elizabeth Whittaker¹⁰, Buvana Dwarakanathan¹¹, Rachael Wood^{12

13}, Christopher Williams¹⁴, Olivia Swann^{15

16}, Malcolm G Semple^{17

18}, Mary E Ramsay¹, Christine E Jones¹⁹, Athimalaipet V Ramanan^{20

21}, Nick Gent^{2

3}, Shamez N Ladhani^{1

22}

Affiliations

¹ Immunisation and Countermeasures Division, Public Health England, London, UK.
² Emergency Response Department, Public Health England, Porton Down, UK.
³ Public Health England's Joint Modelling Cell, Public Health England, Porton Down, UK.
⁴ BPSU, Royal College of Paediatrics, London, UK.
⁵ Institute of Child Health, University College London Research Department of Epidemiology and Public Health, London, UK.
⁶ Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, UK.
⁷ Department of congenital cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁸ BMBS, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
⁹ Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
¹⁰ Paediatrics, Imperial College London Faculty of Medicine, London, UK.
¹¹ Paediatric Intensive Care Unit, St George's Hospital, London, UK.
¹² Public Health Scotland, UK.
¹³ Centre for Clinical Brain Sciences, University of Edinburgh, UK.
¹⁴ Public Health Wales, Cardiff, UK.
¹⁵ Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
¹⁶ Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK.
¹⁷ National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
¹⁸ Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.
¹⁹ Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
²⁰ University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
²¹ Translational Health Sciences, University of Bristol, Bristol, UK.
²² Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.

Abstract

Background: Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), first identified in April 2020, shares features of both Kawasaki disease (KD) and toxic shock syndrome (TSS). The surveillance describes the epidemiology and clinical characteristics of PIMS-TS in the United Kingdom and Ireland.

Methods: Public Health England initiated prospective national surveillance of PIMS-TS through the British Paediatric Surveillance Unit. Paediatricians were contacted monthly to report PIMS-TS, KD and TSS cases electronically and complete a detailed clinical questionnaire. Cases with symptom onset between 01 March and 15 June 2020 were included.

Findings: There were 216 cases with features of PIMS-TS alone, 13 with features of both PIMS-TS and KD, 28 with features of PIMS-TS and TSS and 11 with features of PIMS-TS, KD and TSS, with differences in age, ethnicity, clinical presentation and disease severity between the phenotypic groups. There was a strong geographical and temporal association between SARS-CoV-2 infection rates and PIMS-TS cases. Of those tested, 14.8% (39/264) children had a positive SARS-CoV-2 RT-PCR, and 63.6% (75/118) were positive for SARS-CoV-2 antibodies. In total 44·0% (118/268) required intensive care, which was more common in cases with a TSS phenotype. Three of five children with cardiac arrest had TSS phenotype. Three children (1·1%) died.

Interpretation: The strong association between SARS-CoV-2 infection and PIMS-TS emphasises the importance of maintaining low community infection rates to reduce the risk of this rare but severe complication in children and adolescents. Close follow-up will be important to monitor long-term complications in children with PIMS-TS.

Funding: PHE.