Yousaf Anna R, Cortese Margaret M, Taylor Allan W, Broder Karen R, Oster Matthew E, Wong Joshua M, Guh Alice Y, McCormick David W, Kamidani Satoshi, Schlaudecker Elizabeth P, Edwards Kathryn M, Creech C Buddy, Staat Mary A, Belay Ermias D, Marquez Paige, Su John R, Salzman Mark B, Thompson Deborah, Campbell Angela P
CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet Child Adolesc Health. 2022 May;6(5):303-312. doi: 10.1016/S2352-4642(22)00028-1. Epub 2022 Feb 23.
Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with antecedent SARS-CoV-2 infection. In the USA, reporting of MIS-C after vaccination is required under COVID-19 vaccine emergency use authorisations. We aimed to investigate reports of individuals aged 12-20 years with MIS-C after COVID-19 vaccination reported to passive surveillance systems or through clinician outreach to the US Centers for Disease Control and Prevention (CDC).
In this surveillance activity, we investigated potential cases of MIS-C after COVID-19 vaccination reported to CDC's MIS-C national surveillance system, the Vaccine Adverse Event Reporting System (co-administered by CDC and the US Food and Drug Administration), and CDC's Clinical Immunization Safety Assessment Project. A multidisciplinary team adjudicated cases by use of the CDC MIS-C definition. Any positive SARS-CoV-2 serology test satisfied case criteria; although anti-nucleocapsid antibodies indicate previous SARS-CoV-2 infection, anti-spike protein antibodies indicate either past or recent infection or COVID-19 vaccination. We describe the demographic and clinical features of cases, stratified by laboratory evidence of SARS-CoV-2 infection. To calculate the reporting rate of MIS-C, we divided the count of all individuals meeting the MIS-C case definition, and of those without evidence of SARS-CoV-2 infection, by the number of individuals aged 12-20 years in the USA who received one or more COVID-19 vaccine doses up to Aug 31, 2021, obtained from CDC national vaccine surveillance data.
Using surveillance results from Dec 14, 2020, to Aug 31, 2021, we identified 21 individuals with MIS-C after COVID-19 vaccination. Of these 21 individuals, median age was 16 years (range 12-20); 13 (62%) were male and eight (38%) were female. All 21 were hospitalised: 12 (57%) were admitted to an intensive care unit and all were discharged home. 15 (71%) of 21 individuals had laboratory evidence of past or recent SARS-CoV-2 infection, and six (29%) did not. As of Aug 31, 2021, 21 335 331 individuals aged 12-20 years had received one or more doses of a COVID-19 vaccine, making the overall reporting rate for MIS-C after vaccination 1·0 case per million individuals receiving one or more doses in this age group. The reporting rate in only those without evidence of SARS-CoV-2 infection was 0·3 cases per million vaccinated individuals.
Here, we describe a small number of individuals with MIS-C who had received one or more doses of a COVID-19 vaccine before illness onset; the contribution of vaccination to these illnesses is unknown. Our findings suggest that MIS-C after COVID-19 vaccination is rare. Continued reporting of potential cases and surveillance for MIS-C illnesses after COVID-19 vaccination is warranted.
US Centers for Disease Control and Prevention.
儿童多系统炎症综合征（MIS-C）是一种与先前感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的过度炎症状态。在美国，根据2019冠状病毒病（COVID-19）疫苗紧急使用授权，需要报告接种疫苗后发生的MIS-C病例。我们旨在调查向被动监测系统报告或通过临床医生向美国疾病控制与预防中心（CDC）报告的12至20岁接种COVID-19疫苗后发生MIS-C的个体情况。
在这项监测活动中，我们调查了向CDC的MIS-C国家监测系统、疫苗不良事件报告系统（由CDC和美国食品药品监督管理局共同管理）以及CDC的临床免疫安全评估项目报告的接种COVID-19疫苗后发生MIS-C的潜在病例。一个多学科团队依据CDC的MIS-C定义对病例进行判定。任何SARS-CoV-2血清学检测呈阳性均符合病例标准；尽管抗核衣壳抗体表明既往感染过SARS-CoV-2，但抗刺突蛋白抗体表明既往或近期感染过SARS-CoV-2或接种过COVID-19疫苗。我们按SARS-CoV-2感染的实验室证据对病例的人口统计学和临床特征进行分层描述。为计算MIS-C的报告率，我们将所有符合MIS-C病例定义且无SARS-CoV-2感染证据的个体数量，除以截至2021年8月31日美国12至20岁接种一剂或多剂COVID-19疫苗的个体数量，该数据来自CDC国家疫苗监测数据。
利用2020年12月14日至2021年8月31日的监测结果，我们确定了21例接种COVID-19疫苗后发生MIS-C的个体。在这21例个体中，年龄中位数为16岁（范围12至20岁）；13例（62%）为男性，8例（38%）为女性。所有21例均住院治疗：12例（57%）入住重症监护病房，所有患者均已出院回家。21例个体中有15例（71%）有既往或近期SARS-CoV-2感染的实验室证据，6例（29%）没有。截至2021年8月31日，12至20岁的个体中有21335331人接种了一剂或多剂COVID-19疫苗，使得该年龄组接种疫苗后MIS-C的总体报告率为每百万接种一剂或多剂疫苗的个体中有1.0例。仅在无SARS-CoV-2感染证据的个体中，报告率为每百万接种疫苗个体中有0.3例。
在此，我们描述了少数在发病前接种过一剂或多剂COVID-19疫苗的MIS-C个体；疫苗接种对这些疾病的影响尚不清楚。我们的研究结果表明，接种COVID-19疫苗后发生MIS-C的情况很少见。有必要继续报告潜在病例并对接种COVID-19疫苗后的MIS-C疾病进行监测。
美国疾病控制与预防中心。
