COVID-19 Clinical Characteristics and Outcomes in Children Aged < /=16 Years at the University Hospital of the West Indies, Jamaica in 2020-2021

Background: By June 1, 2021, Jamaica recorded 48,639 RT-PCR confirmed SARS-CoV-2 cases and 951 deaths, with a case fatality rate of 2%. Children <18 years comprised 10.3% (4,999) of cases and 0.1% and 0.2% deaths in <10 and 10-18 year age-groups, respectively. Community transmission is ongoing, having been declared September 2020.

Methods: Ambispective case series describing clinical characteristics and outcomes of COVID-19 in children aged </=16 years, hospitalized at the University Hospital of the West Indies (UHWI) Jamaica, April 2020 through June 2021, using modified CDC criteria for diagnosing Multisystem Inflammatory Syndrome of Children (MISC). Admissions are screened for SARS-CoV-2 by RT-PCR/antigen. Children with presumed MISC on presentation, but negative RT-PCR have SARS-CoV-2 IgM/IgG antibody testing (Abbott). All had a Pediatric Infectious Diseases Consultation. 


Results: Seventy-nine children aged </=16 years, with SARS-CoV-2 infection, COVID-19 with/without MISC presented to UHWI, April 2020 to June 2021. There were 38 (48%) mild ambulatory cases. Hospitalizations in 41(52%) cases ranging from two days to 16 years (median 10 years 6 months). Characteristics of the 41 hospitalized children included Afro-Caribbean race/ethnicity 40(98%) and male sex 21(51%). SARS-CoV-2 RT-PCR positivity present in 26(63%); IgM/IgG positivity in 7(17%), confirmed/presumed community contact in 20%/8. Overall, MISC-positive cases (18/41; 44%) were more likely than MISC-negative cases (23/41; 56%) to present with fever (94% vs. 30%,p<0.01), fatigue/lethargy (41% vs. 4%; p=0.004), lymphadenopathy (33% vs. 0%; p=0.003), rhinorrhoea (28% vs. 4%, p=0.035), neutrophilia (100% vs. 87%; p=0.024) and elevated erythrocyte sedimentation rate (78% vs. 9%; p=0.007). Involvement of more than 2 organs was more likely to occur in MISC-positive cases (100% vs. 35%, p<0.01), including gastrointestinal (72% vs. 17%; p<0.01) with vomiting/nausea (39% vs. 9%; p=0.02); haematological and coagulopathic (67% vs. 4%;p<0.01); dermatologic (56% vs. 0%;p<0.01) with mucositis (28% vs. 0%;p=0.007) and cardiac (17% vs. 0%;p=0.042) involvement, Kawasaki Syndrome (44% vs. 0%; p<0.01), pleural effusions (17% vs. 0%; p=0.042) and anaemia (17% vs. 0%; p=0.042). MISC-positive cases had >4 abnormal inflammatory biomarkers (13/72%) including D-dimers, C-reactive protein, ESR, ferritin, troponins, lactate dehydrogenase, neutrophils, platelets, lymphocytes, albumen . MISC-positive cases were treated with intravenous immune gammaglobulin (78% vs. 0%; p<0.01), aspirin (68% vs. 0%; p<0.01) and steroids (50% vs. 9%; p=0.003). MISC-positive cases had intensive care admissions (two), non-invasive ventilation (two) and inotropes/vasopressor support (none). Outcomes included readmission for MISC-related neurological complications two(5%), discharged with one month follow-up 39(95%), transferred one(2.4%) and demise from myocardial complications in a child with premorbid end-stage renal disease and haemodialysis one(2.4%). 

Conclusion: More than half of the children aged </=16 years with COVID-19 were hospitalized. MISC in 44% was promptly diagnosed and successfully treated with gammaglobulin, steroids and aspirin before cardiopulmonary decompensation and need for inotropes, vasopressors, or intensive care. There was one death. All others were successfully discharged.