Severity of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 Diminished during Successive Waves of the COVID-19 Pandemic: Data from a Nationwide German Survey

Florens Lohrmann; Maren Doenhardt; Natalie Diffloth; André Jakob; Anton Hospach; Dominik T Schneider; Andreas Trotter; Jürgen Brunner; Sarah Goretzki; Stefan Arens; Michael Rank; René Mauer; Jakob Armann; Reinhard Berner; Markus Hufnagel

doi:10.1016/j.jpeds.2024.114419

Severity of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 Diminished during Successive Waves of the COVID-19 Pandemic: Data from a Nationwide German Survey

J Pediatr. 2024 Nov 25:114419. doi: 10.1016/j.jpeds.2024.114419. Online ahead of print.

Authors

Affiliations

¹ Division of Neonatology and Pediatric Intensive Care, Department for Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Germany, Mathildenstr. 1, 79106 Freiburg, Germany; Division of Pediatric Infectious Diseases and Rheumatology, Department for Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Germany, Mathildenstr. 1, 79106 Freiburg, Germany. Electronic address: florens.lohrmann@uniklinik-freiburg.de.
² Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria, Strubergasse 21, 5020, Salzburg, Austria.
³ Department of Pediatrics, University Hospital, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstraße 74, 01307, Dresden, Germany.
⁴ Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian's University of Munich, Munich, Germany, Marchioninistr. 15, 81377, München, Germany.
⁵ Department of Pediatrics, Olga-Hospital, Stuttgart, Germany, Kriegsbergstrasse 62, 70174, Stuttgart, Germany.
⁶ Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany, Beurhausstraße 45, 44137, Dortmund, Germany.
⁷ Children's Hospital and Center for Perinatal Medicine, Singen, Germany, Virchowstr. 10, 78224, Singen, Germany.
⁸ Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria, Anichstr. 35, A-6020, Innsbruck, Austria; Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria, Anichstr. 35, A-6020, Innsbruck, Austria.
⁹ Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University of Duisburg-Essen, Essen, Germany, Hufelandstraße 55, 45147, Essen, Germany.
¹⁰ Children's Hospital Auf der Bult, Hannover, Germany, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
¹¹ Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstraße 74, 01307 Dresden, Germany.
¹² Division of Pediatric Infectious Diseases and Rheumatology, Department for Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Germany, Mathildenstr. 1, 79106 Freiburg, Germany.

PMID: 39603520
DOI: 10.1016/j.jpeds.2024.114419

Abstract

Objective: To elucidate how the clinical presentation of Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) was influenced by the successive variants of concern (VOC) and patient age.

Study design: A nationwide PIMS-TS registry was established in Germany in May 2020, shortly after the first cases were described in the US and United Kingdom. The registry captured information on patient characteristics, clinical course, laboratory findings, imaging and outcome. All pediatric hospitals in Germany, along with one in Austria, were invited to participate. Between March 18, 2020, and April 30, 2023, 920 cases were reported.

Results: By examining a combination of data on clinical features, laboratory findings, treatment, imaging results, and outcomes, our analysis demonstrated disease severity to have continuously declined over the course of the Wildtype, Alpha, Delta and Omicron waves. Based on clinical symptoms, laboratory and diagnostic findings, and ICU admission rates, older children, irrespective of the related VOC, were shown to experience more severe, acute PIMS-TS; however, they had lower rates of coronary aneurysm.

Conclusions: During the course of COVID-19 pandemic, as each new VOC emerged, PIMS-TS lessened in severity. In parallel, older children came to experience more debilitating disease.