News Scan for Apr 28, 2021

COVID-related inflammation syndrome hits poorer, minority children harder

Pediatric Multisystem Inflammatory Syndrome (MIS-C), which has been linked to COVID-19 for children, may pose a higher risk for children of lower socioeconomic status or who are minorities, according to a study on Pediatrics today.

The study compared MIS-C patients with those who had COVID-19, those who were evaluated for MIS-C but without, children with febrile illness, children with Kawasaki disease, and healthy children in the state. Everyone in the cohort was under the age of 21 and lived in Massachusetts.

A total of 43 patients had MIS-C. Most (58.1%) were boys and of non-white racial or ethnic origin (44.2% Hispanic, 25.6% Black). The median age at diagnosis was 9.7 years. About two thirds (67.4%) of children with MIS-C had a positive antibody test for COVID-19, and 19 (44.2%) had pre-existing co-morbidities, the most common being obesity (17) and asthma (6 ).

Just over half of the MIS-C patients were in the lowest socioeconomic status (SES) quartile (51.1%) or in the highest social vulnerability index (SVI) quartile (53.5%). The researchers calculated that, compared to the general Massachusetts population, both groups had more than double the risk of MIS-C (SES OR, 2.2; 95% confidence interval [CI]1.1 to 4.4 and SVI OR 2.8; 95% CI, 1.5 to 4.1). SES and SVI values ​​were comparable between the MIS-C and COVID-19 groups, but patients in the other groups tended to have a higher household income.

Black and Hispanic children were independently associated with greater risk. The researchers report that children in the lowest SES quartile who were black had between a 8.7 and 10.8 times higher risk of MIS-C compared to white, non-Hisptanic children in the same neighborhood. In the same SES group, Hispanics of any race had an OR of 8.7 to 49.8.

“Steps to reduce the risk of COVID-19 exposure are essential to limit the incidence of MIS-C,” the researchers write. “Identifying neighborhoods where children are most likely to be exposed to COVID-19 can contribute to public health efforts and enable proactive protection of high-risk populations.”
April 28 Pediatrics study

Pediatric hospital admissions for any reason decreased from March to August 2020

According to a JAMA research letter from yesterday, all causes of weekly pediatric hospital admissions in the United States decreased by 48.3% in the spring and 23.5% in the pandemic months in the summer of 2020 compared to the median volumes in 2017 to 2019 .

The researchers looked at 1,699,911 pediatric hospital admissions in 42 detached children’s hospitals and found that the weekly median decreased from 12,830 in the spring of 2017 to 2019 to 7,033 in 2020 and from 11,697 in the summer of 2017 to 2019 to 9,178 in 2020. In all demographics and clinical subgroups.

The smallest percentage change per week was in the summer of 2020 among teens aged 15 to 18 years (-9.6%), and the largest was among children with low disease severity in the spring of 2020 (-56.4% ). In terms of condition-specific hospital admissions, the largest decrease was found in patients with respiratory failure in the spring of 2020 (a median 2017-19 of 296, decreased to 87 in 2020; -167.7%).

The researchers also note that the smallest percentage change per week was in the summer of 2020 for diabetic ketoacidosis (-0.7% from 2017-19 to 2020), although the change was not statistically significant. Suicide / intentional injury was the only cause of hospitalization to increase in summer 2020 compared to previous years (+ 11.8% from 2017-19 to 2020), but the change was not statistically significant either.

Possible reasons for the lower hospital admissions may be due to social detachment and higher symptom monitoring in children, the researchers conclude.
April 27 JAMA
study

Study Finds Low Uptake Of HPV Vaccine In Young American Men

A research letter in JAMA yesterday shows that less than 20% of American men ages 18 to 21 have had at least one dose of the human papillomavirus (HPV) vaccine.

The study, conducted by researchers at the University of Michigan, was based on data collected during the National Health Interview Surveys from 2010 to 2018. Only 16.2% of men between the ages of 18 and 21 for any year of the survey said they had received one or more doses of the HPV vaccine, compared to 42% of the women in that age group.

Of the young men aged 18 to 21 who received at least one dose, 29% completed the vaccination series. The percentage of young men who received a single dose increased from 2% in 2010 to 34% in 2018, while it rose from 32% to 55% for women.

The Advisory Committee on Immunization Practice (ACIP) recommends that American boys and girls ages 11 to 12 receive two doses of the vaccine, with a third catch-up dose before the age of 26 if the vaccination series begins after the age of 15.

The Food and Drug Administration (FDA) approved HPV vaccines for women and men in 2006 and 2009. Last year, the FDA expanded the indication to include protection against oropharyngeal cancer. That cancer, which can affect the throat, tonsils, or back of the tongue, has surpassed cervical cancer as the main cancer caused by HPV, and 80% of cases are detected in men.

“I don’t think many people, healthcare providers and patients alike, know that this vaccine is actually a cancer prevention vaccine for both men and women,” said Michelle Chen, MD, the study’s lead author and a clinical lecturer at the University of Michigan. , in a university press release. “But HPV-associated oropharyngeal cancer can affect anyone – and there is no proper screening for it, which makes vaccination even more important.”
April 27 JAMA
research letter
April 27 University of Michigan
press release

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