Association of Ethnicity With Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection: An International Case-Referent Study

Judith G Middelburg; Thomas E M Crijnen; Lorenzo D'Antiga; Lucio Verdoni; Ashish Chikermane; Padma Garg; Bhaswati C Acharyya; Giulia Pruccoli; Aviad Schnapp; Abdul Rauf; Rutger A Middelburg

doi:10.3389/fped.2021.707650

Association of Ethnicity With Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection: An International Case-Referent Study

Front Pediatr. 2021 Oct 15:9:707650. doi: 10.3389/fped.2021.707650. eCollection 2021.

Authors

Judith G Middelburg¹, Thomas E M Crijnen², Lorenzo D'Antiga³, Lucio Verdoni³, Ashish Chikermane⁴, Padma Garg^{5

6

7}, Bhaswati C Acharyya^{8

9

10}, Giulia Pruccoli¹¹, Aviad Schnapp¹², Abdul Rauf¹³, Rutger A Middelburg¹⁴

Affiliations

¹ Department of Medical Science, Middelburg Solutions, Oegstgeest, Netherlands.
² Paediatric Intensive Care Unit, Ziekenhuis Netwerk Antwerpen Queen Paola Children's Hospital, Antwerp, Belgium.
³ Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy.
⁴ Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
⁵ Division of Pediatric Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
⁶ Division of Pediatric Infectious Disease, University of Mississippi Medical Center, Jackson, MS, United States.
⁷ Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, United States.
⁸ Department of Pediatric Gastroenterology, AMRI Hospitals, Kolkata, India.
⁹ Department of Pediatrics, AMRI Hospitals, Kolkata, India.
¹⁰ Department of Pediatric Cardiology, AMRI Hospitals, Kolkata, India.
¹¹ Department of Pediatric and Public Health Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
¹² Department of Pediatrics, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹³ Department of Pediatrics, Baby Memorial Hospital, Calicut, India.
¹⁴ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Background: It has been suggested that children and infants can develop multisystem inflammatory syndrome in children (MIS-C) in response to a SARS-CoV-2 infection and that Black children are overrepresented among cases. The aim of the current study was to quantify the association between Black, Asian, or other non-White genetic background and COVID-19-related MIS-C in children and infants. Methods: Eight different research groups contributed cases of MIS-C, potentially related to SARS-CoV-2 infection. Several sensitivity analyses were performed, including additional data available from the literature. Analyses were stratified by geographical region. Results: Seventy-three cases from nine distinct geographical regions were included in the primary analyses. In comparison to White children, the relative risk for developing MIS-C after SARS-CoV-2 infection was 15 [95% confidence interval (CI): 7.1 to 32] for Black children, 11 (CI: 2.2 to 57) for Asian, and 1.6 (CI: 0.58 to 4.2) for other ethnic background. Conclusion: Pediatricians should be aware of the fact that the risk of COVID-19-related MIS-C is severely increased in Black children.

Keywords: COVID-19; MIS-C; PIMS; SARS-CoV2; ethnicity.