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| EDITORIAL |
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| Year : 2022 | Volume
: 9
| Issue : 4 | Page : 109-110 |
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Impact of SARS-CoV-2 variants and vaccination on multisystem inflammatory syndrome in children
Vijai William
Department of Critical Care, Division of Pediatric Critical Care, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| Date of Submission | 17-Jun-2022 |
| Date of Acceptance | 21-Jun-2022 |
| Date of Web Publication | 20-Jul-2022 |
Correspondence Address:
Dr. Vijai William
Department of Critical Care, Division of Pediatric Critical Care, Sheikh Khalifa Medical City, Abu Dhabi
UAE
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jpcc.jpcc_55_22
How to cite this article:
William V. Impact of SARS-CoV-2 variants and vaccination on multisystem inflammatory syndrome in children. J Pediatr Crit Care 2022;9:109-10 |
How to cite this URL:
William V. Impact of SARS-CoV-2 variants and vaccination on multisystem inflammatory syndrome in children. J Pediatr Crit Care [serial online] 2022 [cited 2023 Feb 8];9:109-10. Available from: http://www.jpcc.org.in/text.asp?2022/9/4/109/351520 |
As the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection continues, new variants of concern (VOC) of SARS-CoV-2 emerge. Overall, most children experienced relatively milder disease than adults. Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening hyperinflammatory condition post-acute SARS-CoV-2 infection. The clinical profile of MIS-C has been reported in several parts of the world, and a study by Rajebhosale et al. in this issue Journal of Pediatric Critical Care[1] adds to the current literature. As novel VOCs emerge, our understanding of their impact on MIS-C continues to grow. In addition, evidence is accumulating that SARS-CoV-2 vaccination may be effective in preventing or lowering the severity of MIS-C.
Data on variants causing MIS-C are not robust. The Centers for Disease Control and Prevention reported SARS-CoV-2 variants B.1.617.2 (Delta) and B.1.1.529 (Omicron) as the predominant circulating variants in the United States (U.S.) in July 2021 and December 2021, respectively. It was observed that the period with Delta variant predominance had a significantly lower proportion of severe organ involvement including cardiovascular and respiratory complications with lower intensive care unit (ICU) need and shorter length of hospital stay.[2],[3] Similarly, a multicentric prospective study of MIS-C patients in Israel reported Alpha (December 20, 2020, to April 10, 2021), Delta (July 18, 2021, to November 13, 2021), and Omicron (November 21, 2021, to March 12, 2022) as the most common variants.[4] Of 171 patients (59 during the Alpha wave, 79 during the Delta wave, and 33 during the Omicron wave) diagnosed with MIS-C in this study, the incidence rate and severity of MIS-C during the Omicron wave were lower than during the Delta and Alpha waves. The lower severity of illness in newer variants can be related to variations in the host immune response, previous infection with SARS-CoV-2, earlier clinical diagnosis, improvement in treatment over time, and vaccination against SARS-CoV-2. We need more data in newer VOC along with genetic studies to identify deleterious heterozygous variants to understand disease pathogenesis better.[5]
Evidence that SARS-CoV-2 vaccination is associated with lower MIS-C incidence among adolescents is evolving. Fully vaccinated children required lesser ICU care in MIS-C compared with no vaccination (47.8% vs. 60.8%).[2] A multicentric case–control study from the U.S. demonstrated that receipt of two doses of the Pfizer BioNTech vaccine was associated with a high level of protection against MIS-C in patients aged 12 to 18 years. The estimated effectiveness of two doses of Pfizer BioNTech vaccine against MIS-C was 91% (95% confidence interval, 78%–97%). All of the MIS-C patients requiring hospitalization and life support were unvaccinated. Despite its limitations, this study confirms evidence that the vaccination of children and adolescents protects against COVID-19 and MIS-C, emphasizing the relevance of vaccination.[3] Similarly, a French study that evaluated the effects of the SARS-CoV-2 mRNA vaccine on MIS-C outcomes in adolescents 12 years and older suggested that vaccination was associated with a lower incidence of MIS-C, although the limitation was the number of children who received vaccination in this study was very low.[6] Theoretical concerns have been raised on MIS-C post-SARS-CoV-2 vaccination (MIS-V).[7],[8] Although limited to a few case reports, it is still concerning. In these children, the antibody screen was positive only for SARS-2-CoV anti-spike and not for anti-nucleocapsid antibodies consistent with a postvaccine and not a postinfection event.[9]
While SARS-CoV-2 vaccination remains the foremost strategy to forestall COVID-19 and its complications, the vaccination rates in children are still low. With data increasingly demonstrating the beneficial effects of SARS-CoV-2 vaccination, vaccination policies might change in future. Improvements in vaccination are often led to by making governmental policy, ensuring more doses, and recommending it during health-care visits.
| References | |  |
| 1. | Rajebhosale P, Mohamed MY, Swilem M, Abdelmogheth A, Nabawi MI, Farahat AS, et al. Clinical profile and immediate outcome of the multisystem inflammatory syndrome in children: Retrospective observational single-centerstudy from the United Arab Emirates. J Pedatr Crit Care 2022;9:116-23.  |
| 2. | Miller AD, Yousaf AR, Bornstein E, Wu MJ, Lindsey K, Melgar M, et al. Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 delta and omicron variant circulation-United States, July 2021-January 2022. Clin Infect Dis 2022;ciac471. |
| 3. | Zambrano LD, Newhams MM, Olson SM, Halasa NB, Price AM, Boom JA, et al. Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12-18 years – United States, July-December 2021. MMWR Morb Mortal Wkly Rep 2022;71:52-8. |
| 4. | Levy N, Koppel JH, Kaplan O, Yechiam H, Shahar-Nissan K, Cohen NK, et al. Severity and incidence of multisystem inflammatory syndrome in children during 3 SARS-CoV-2 pandemic waves in Israel. JAMA 2022;327(24):2452-2454 327(24):2452-2454. |
| 5. | Abuhammour W, Yavuz L, Jain R, Abu Hammour K, Al-Hammouri GF, El Naofal M, et al. Genetic and clinical characteristics of patients in the middle east with multisystem inflammatory syndrome in children. JAMA Netw Open 2022;5:e2214985. |
| 6. | Levy M, Recher M, Hubert H, Javouhey E, Fléchelles O, Leteurtre S, et al. Multisystem inflammatory syndrome in children by COVID-19 vaccination status of adolescents in France. JAMA 2022;327:281-3. |
| 7. | Yalçinkaya R, Öz FN, Polat M, Uçan B, Teke TA, Kaman A, et al. A case of multisystem inflammatory syndrome in a 12-year-old male after COVID-19 mRNA vaccine. Pediatr Infect Dis J 2022;41:e87-9. |
| 8. | Abdelgalil AA, Saeedi FA. Multisystem inflammatory syndrome in a 12-year-old boy after mRNA-SARS-CoV-2 vaccination. Pediatr Infect Dis J 2022;41:e93-4. |
| 9. | Karatzios C, Scuccimarri R, Chédeville G, Basfar W, Bullard J, Stein DR. Multisystem inflammatory syndrome following SARS-CoV-2 vaccination in two children. Pediatrics 2022. doi: 10.1542/peds.2021-055956. Epub ahead of print. PMID: 35614536. |
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