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Active Surveillance With Seroprevalence-Based Infection Rates Indicates Racial Disparities With Severe Pediatric SARS-CoV-2 in Mississippi, March 2020-February 2021
30 Pages Posted: 21 Feb 2022
More...Abstract
Background: Racial disparities in SARS-CoV-2-infection, hospitalization, and multi-system inflammatory syndrome in children (MIS-C) have been widely reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and acute COVID-19 among non-Hispanic Black and White children using active surveillance based on cumulative incidence of pediatric SARS-CoV-2 infection in a tightly defined catchment 16-county area, including Jackson, Mississippi.
Methods: Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the pediatric referral hospital for central Mississippi, University of Mississippi Medical Center (UMMC) from March 2020 through February 2021. Monthly race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples of residual serum specimens from persons younger than 18 years to calculate cumulative SARS-CoV-2 infections in the population. Main outcomes and measures included cumulative incidence of MIS-C and acute COVID-19 hospitalizations per 100,000 SARS-CoV-2 infections.
Findings: A total of 38 patients with MIS-C and 74 pediatric acute COVID-19 hospitalizations were identified in the 16-county catchment area. Through February 2021, cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of pediatric acute COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.
Interpretation: From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show higher incidence of SARS-CoV-2-severe complications in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These data suggest racial disparities in severe SARS-CoV-2 outcomes cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions may lessen the disparities observed with SARS-CoV-2- infection and its severe manifestations in children.
Funding Information: Support for this study was provided by the University of Mississippi Medical Center, Vice Chancellor’s Office for Research. Laboratory and epidemiologic support were provided by CDC.
Declaration of Interests: CVH receives funding from CDC for public health-related activities. CVH is a consultant/speaker for BioFire (bioMérieux).
Ethics Approval Statement: This study was reviewed and approved by UMMC Institutional Review Board and conducted consistent with applicable federal law and policy of the Centers for Disease Control and Prevention.
Keywords: SARS-CoV-2, COVID-19, multi-system inflammatory syndrome in children, MIS-C, pediatric, Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2, Severe COVID-19, hospitalization, PIMS-TS, racial, disparities.
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