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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

See all articles by Charlotte Victoria Hobbs

Charlotte Victoria Hobbs

University of Mississippi - Division of Infectious Disease

Sara S. Kim

Government of the United States of America - CDC COVID-19 Response

Preeti Vemula

University of Mississippi - Division of Infectious Disease

Kengo Inagaki

University of Mississippi - Division of Infectious Disease

Virginia A. Harrison

University of Mississippi - Department of Pediatrics

Lacy Malloch

University of Mississippi - Division of Infectious Disease

Lora Martin

University of Mississippi - Division of Infectious Disease

Gurbaksh Singh

University of Mississippi - Division of Infectious Disease

Urita Agana

University of Mississippi - Division of Infectious Disease

John M. Williams

University of Mississippi - Division of Infectious Disease

Kayla Patterson

University of Mississippi - Division of Infectious Disease

Theresa Kittle

Mississippi State Department of Health

Paul Byers

Mississippi State Department of Health

April Palmer

University of Mississippi - Division of Infectious Disease

Roberto P. Santos

University of Mississippi - Division of Infectious Disease

Anita Dhanrajani

University of Mississippi - Division of Rheumatology

Meagan Stephenson

Government of the United States of America - CDC COVID-19 Response

Leroy Hung

University of Mississippi - Center for Informatics and Analytics

Phillip Hankins

University of Mississippi - Center for Informatics and Analytics

Natalie J. Thornburg

Government of the United States of America - CDC COVID-19 Response

Jan Drobeniuc

Government of the United States of America - CDC COVID-19 Response

Brendan Flannery

Government of the United States of America - CDC COVID-19 Response

CDC COVID-19 Response Team

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.

Suggested Citation

Hobbs, Charlotte Victoria and Kim, Sara S. and Vemula, Preeti and Inagaki, Kengo and Harrison, Virginia A. and Malloch, Lacy and Martin, Lora and Singh, Gurbaksh and Agana, Urita and Williams, John M. and Patterson, Kayla and Kittle, Theresa and Byers, Paul and Palmer, April and Santos, Roberto P. and Dhanrajani, Anita and Stephenson, Meagan and Hung, Leroy and Hankins, Phillip and Thornburg, Natalie J. and Drobeniuc, Jan and Flannery, Brendan and Team, CDC COVID-19 Response, Active Surveillance With Seroprevalence-Based Infection Rates Indicates Racial Disparities With Severe Pediatric SARS-CoV-2 in Mississippi, March 2020-February 2021. Available at SSRN: https://ssrn.com/abstract=4039678 or http://dx.doi.org/10.2139/ssrn.4039678

Charlotte Victoria Hobbs (Contact Author)

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Sara S. Kim

Government of the United States of America - CDC COVID-19 Response ( email )

Atlanta, GA
United States

Preeti Vemula

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Kengo Inagaki

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Virginia A. Harrison

University of Mississippi - Department of Pediatrics ( email )

Jackson, MS 39202
United States

Lacy Malloch

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Lora Martin

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Gurbaksh Singh

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Urita Agana

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

John M. Williams

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Kayla Patterson

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Theresa Kittle

Mississippi State Department of Health ( email )

Jackson, MS
United States

Paul Byers

Mississippi State Department of Health ( email )

Jackson, MS
United States

April Palmer

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Roberto P. Santos

University of Mississippi - Division of Infectious Disease ( email )

Jackson, MS 39202
United States

Anita Dhanrajani

University of Mississippi - Division of Rheumatology ( email )

Jackson, MS
United States

Meagan Stephenson

Government of the United States of America - CDC COVID-19 Response ( email )

Atlanta, GA
United States

Leroy Hung

University of Mississippi - Center for Informatics and Analytics ( email )

Jackson, MS
United States

Phillip Hankins

University of Mississippi - Center for Informatics and Analytics ( email )

Jackson, MS
United States

Natalie J. Thornburg

Government of the United States of America - CDC COVID-19 Response ( email )

Atlanta, GA
United States

Jan Drobeniuc

Government of the United States of America - CDC COVID-19 Response ( email )

Atlanta, GA
United States

Brendan Flannery

Government of the United States of America - CDC COVID-19 Response ( email )

Atlanta, GA
United States

No contact information is available for CDC COVID-19 Response Team