Hospital for Special Surgery/Weill Cornell Medicine New York, NY, United States
Leanne Mansfield1, Sivia Lapidus2, Matthew Hollander3, Julie Cherian4, Marinka Twilt5, Maryam Piram6, Lakshmi Moorthy7, Brian Nolan8, Geraldina Lionetti9, Eveline Wu10, Heather Tory11, Elizabeth Kessler12, Cassyanne Aguiar13, Sirada Panupattanapong14, Shoghik Akoghlanian15, Felice Adler-Shohet16, Melissa Oliver17, Smriti Mohan18, Patricia DeLaMora19, Karen Durrant20, Theresa Wampler Muskardin21, Samira Nazzar22, Mariana Correia Marques23, Matthew Basiaga24, Tiphanie vogel25, Jamie Lai25, Kathryn Edwards26, Kathryn Garguilo26, Sheila Nolan19, Emily Sheboy Scarcello27, Gabrielle Alonzi28, Ann Szymanski29, Joyce Hui-Yuen30, karen onel31, Fatma Dedeoglu32, Maria Gutierrez33, Grant Schulert34 and CARRA PFAPA/Autoinflammatory Working Group N/A35, 1Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, 2Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Montclair, NJ, 3University of Vermont Medical Center Children's Hospital, Burlington, VT, 4Renaissance School of Medicine at Stony Brook University, Stony Brook Children’s Hospital, Stony Brook, NY, 5Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, 6CHU Sainte Justine, University of Montreal, Montréal, QC, Canada, 7Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 8Ann & Robert H. Lurie Children's Hospital, Chicago, IL, 9UCSF Benioff Children's Hospitals, Oakland, CA, 10University of North Carolina, Chapel Hill, NC, 11Connecticut Children's Medical Center and University of Connecticut School of Medicine, S Glastonbury, CT, 12Spectrum Health Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, MI, 13Children’s Hospital of The King’s Daughters / Eastern Virginia Medical School, Norfolk, VA, 14Cleveland Clinic Children's, Cleveland, OH, 15Division of Rheumatology, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, OH, 16University of California, Irvine and Children’s Hospital of Orange County, Orange, CA, 17Indiana University School of Medicine, Indianapolis, IN, 18University of Michigan Medical School, Ann Arbor, MI, 19Boston Children's Health Physicians, New York Medical College, Valhalla, NY, 20Autoinflammatory Alliance, San Francisco, CA, 21Colton Center for Autoimmunity, NYU School of Medicine, New York, NY, 22University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, 23Children's National Health System/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, 24Mayo Clinic, Inver Grove Heights, MN, 25Baylor College of Medicine, Houston, TX, 26Vanderbilt University Medical Center, Nashville, TN, 27Boston Children's Health Physicians, Valhalla, NY, 28Boston Children's Hospital, Boston, MA, 29Johns Hopkins All Children’s Hospital, St. Petersburg, FL, 30Cohen Children’s Medical Center, Hofstra-Northwell School of Medicine, Feinstein Institutes for Medical Research, Queens, NY, 31Hospital for Special Surgery, New York, NY, 32Division of Immunology, Boston Children's Hospital, Boston, MA, 33Johns Hopkins University School of Medicine, Baltimore, MD, 34Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 35CARRA, Washington, DC
Background/Purpose: The impact of the COVID-19 pandemic on the number of pediatric patients evaluated in North America for recurrent fevers and autoinflammatory diseases is unknown; however, there have been reports of increased numbers of children presenting with these concerns. The purpose of this project was to determine the number of new patients evaluated for recurrent fevers in temporal relation to the COVID-19 pandemic in North America.
Methods: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis Syndrome (PFAPA)/Autoinflammatory Disease Working Group used previously determined recurrent fever ICD-10 codes, including periodic fever and autoinflammatory syndromes, to quantify monthly numbers of new pediatric patients evaluated for recurrent fever diagnoses by outpatient subspecialists from March 1, 2019 to February 29, 2020 (pre-pandemic) and from March 1, 2020 to February 28, 2021 (during the pandemic). The proportion of new visits evaluated for recurrent fever diagnoses relative to all new visit diagnoses during these two years were compared using a two-sample test of proportions. This study was determined to be IRB exempt by the Cincinnati Children's Hospital IRB.
Results: Twenty-four sites reported 1684 new patient visits coded with recurrent fever diagnoses pre-pandemic compared with 2181 during the first year of the pandemic. There was an increase in the total number of recurrent fever evaluations after the onset of the pandemic compared to the year prior in 20 of 24 sites (range -48% to +360%). Of the 20 sites who provided the total number of new visits for all diagnoses, there were 19305 new visits pre-pandemic of which 1318 (6.83%) had a recurrent fever code compared to 17040 new visits during the pandemic with 1690 (9.92%) who received a recurrent fever diagnosis code. The difference between the proportion of new recurrent fever evaluations and total number of new visits pre-pandemic versus during the pandemic was statistically significant (p< 0.0001).
Conclusion: Across 24 CARRA-associated North American centers, there was an increase in pediatric patients evaluated for new recurrent fever diagnoses during the first year of the COVID-19 pandemic compared to the year prior, despite a decrease in the total number of new patients. An increase in recurrent fever evaluations merits further investigation given that many daycare centers and schools were closed during a time of increased infection control precautions and attention to fevers. A speculated potential etiology is that unknown, noninfectious triggers precipitate recurrent fever syndromes. The CARRA PFAPA/Autoinflammatory Disease Working Group's project is the first collaborative, multidisciplinary effort to assess the number of children evaluated for recurrent fevers in relation to the COVID-19 pandemic in North America.
Disclosures: L. Mansfield, None; S. Lapidus, None; M. Hollander, None; J. Cherian, None; M. Twilt, None; M. Piram, Novartis, Pierre Fabre dermatology, L'Oréal, Patent Valor; L. Moorthy, Bristol-Myers Squibb(BMS); B. Nolan, Sobi; G. Lionetti, None; E. Wu, Pharming Healthcare Inc, AstraZeneca, Bristol-Myers Squibb(BMS), Janssen; H. Tory, None; E. Kessler, None; C. Aguiar, None; S. Panupattanapong, None; S. Akoghlanian, None; F. Adler-Shohet, Bio tech, Moderna, Sequirus; M. Oliver, None; S. Mohan, None; P. DeLaMora, None; K. Durrant, None; T. Wampler Muskardin, None; S. Nazzar, None; M. Correia Marques, None; M. Basiaga, None; T. vogel, Sobi, Novartis, Pfizer, Moderna; J. Lai, None; K. Edwards, Sanofi, Pfizer, Roche, Moderna, Merck/MSD, GlaxoSmithKline, Bionet, X-4 Pharma; K. Garguilo, None; S. Nolan, None; E. Sheboy Scarcello, None; G. Alonzi, None; A. Szymanski, None; J. Hui-Yuen, None; k. onel, None; F. Dedeoglu, Novartis; M. Gutierrez, None; G. Schulert, Novartis, SOBI; C. N/A, Novartis, SOBI.
