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Lash MK, Latham NH, Chan PY, Foote MM, Garcia EA, Silverstein MF, Wong M, Alexander M, Alroy KA, Bajaj L, Chen K, Howard JS, Jones LE, Lee EH, Watkins JL, McPherson TD. Racial and Socioeconomic Equity of Tecovirimat Treatment during the 2022 Mpox Emergency, New York, New York, USA. Emerg Infect Dis 2023; 29:2353-2357. [PMID: 37796277 PMCID: PMC10617352 DOI: 10.3201/eid2911.230814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
We assessed tecovirimat treatment equity for 3,740 mpox patients in New York, New York, USA, during the 2022 mpox emergency; 32.4% received tecovirimat. Treatment rates by race/ethnicity were 38.8% (White), 31.3% (Black/African American), 31.0% (Hispanic/Latino), and 30.1% (Asian/Pacific Islander/other). Future public health emergency responses must prioritize institutional and structural racism mitigation.
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Affiliation(s)
| | | | - Pui Ying Chan
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Mary M.K. Foote
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Elizabeth A. Garcia
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Matthew F. Silverstein
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Marcia Wong
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Mark Alexander
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Karen A. Alroy
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Lovedeep Bajaj
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Kuan Chen
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - James Steele Howard
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Lucretia E. Jones
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Julian L. Watkins
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
| | - Tristan D. McPherson
- New York City Department of Health and Mental Hygiene, Queens, New York, USA (M.K. Lash, N.H. Latham, P.Y. Chan, M.M.K. Foote, E.A. Garcia, M.F. Silverstein, M. Wong, M. Alexander, K.A. Alroy, L. Bajaj, K. Chen, J.S. Howard, L.E. Jones, E.H. Lee, J.L. Watkins, T.D. McPherson)
- Columbia University, New York, New York, USA (N.H. Latham)
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Oakley LP, Hufstetler K, O’Shea J, Sharpe JD, McArdle C, Neelam V, Roth NM, Olsen EO, Wolf M, Pao LZ, Gold JAW, Davis KM, Perella D, Epstein S, Lash MK, Samson O, Pavlick J, Feldpausch A, Wallace J, Nambiar A, Ngo V, Halai UA, Richardson CW, Fowler T, Taylor BP, Chou J, Brandon L, Devasia R, Ricketts EK, Stockdale C, Roskosky M, Ostadkar R, Vang Y, Galang RR, Perkins K, Taylor M, Choi MJ, Weidle PJ, Dawson P, Ellington S. Mpox Cases Among Cisgender Women and Pregnant Persons - United States, May 11-November 7, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:9-14. [PMID: 36602932 PMCID: PMC9815154 DOI: 10.15585/mmwr.mm7201a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Monkeypox (mpox) cases in the 2022 outbreak have primarily occurred among adult gay, bisexual, and other men who have sex with men (MSM); however, other populations have also been affected (1). To date, data on mpox in cisgender women and pregnant persons have been limited. Understanding transmission in these populations is critical for mpox prevention. In addition, among pregnant persons, Monkeypox virus can be transmitted to the fetus during pregnancy or to the neonate through close contact during or after birth (2-5). Adverse pregnancy outcomes, including spontaneous abortion and stillbirth, have been reported in previous mpox outbreaks (3). During May 11-November 7, 2022, CDC and U.S. jurisdictional health departments identified mpox in 769 cisgender women aged ≥15 years, representing 2.7% of all reported mpox cases.† Among cases with available data, 44% occurred in cisgender women who were non-Hispanic Black or African American (Black), 25% who were non-Hispanic White (White), and 23% who were Hispanic or Latino (Hispanic). Among cisgender women with available data, 73% reported sexual activity or close intimate contact as the likely route of exposure, with mpox lesions most frequently reported on the legs, arms, and genitals. Twenty-three mpox cases were reported in persons who were pregnant or recently pregnant§; all identified as cisgender women based on the mpox case report form.¶ Four pregnant persons required hospitalization for mpox. Eleven pregnant persons received tecovirimat, and no adverse reactions were reported. Continued studies on mpox transmission risks in populations less commonly affected during the outbreak, including cisgender women and pregnant persons, are important to assess and understand the impact of mpox on sexual, reproductive, and overall health.
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McCormick DW, Richardson LC, Young PR, Viens LJ, Gould CV, Kimball A, Pindyck T, Rosenblum HG, Siegel DA, Vu QM, Komatsu K, Venkat H, Openshaw JJ, Kawasaki B, Siniscalchi AJ, Gumke M, Leapley A, Tobin-D’Angelo M, Kauerauf J, Reid H, White K, Ahmed FS, Richardson G, Hand J, Kirkey K, Larson L, Byers P, Garcia A, Ojo M, Zamcheck A, Lash MK, Lee EH, Reilly KH, Wilson E, de Fijter S, Naqvi OH, Harduar-Morano L, Burch AK, Lewis A, Kolsin J, Pont SJ, Barbeau B, Bixler D, Reagan-Steiner S, Koumans EH. Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States. Pediatrics 2021; 148:peds.2021-052273. [PMID: 34385349 PMCID: PMC9837742 DOI: 10.1542/peds.2021-052273] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
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Affiliation(s)
| | | | | | | | | | - Anne Kimball
- CDC COVID-19 Response Team,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | - Heather Venkat
- Arizona Department of Health Services,CDC Career Epidemiology Field Officer Program
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kim Kirkey
- Michigan Department of Health and Human Services
| | | | | | - Ali Garcia
- Nevada Department of Health and Human Services
| | | | | | - Maura K. Lash
- New York City Department of Health and Mental Hygiene
| | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene
| | | | - Erica Wilson
- North Carolina Department of Health and Human Services
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Godfred-Cato S, Tsang CA, Giovanni J, Abrams J, Oster ME, Lee EH, Lash MK, Le Marchand C, Liu CY, Newhouse CN, Richardson G, Murray MT, Lim S, Haupt TE, Hartley A, Sosa LE, Ngamsnga K, Garcia A, Datta D, Belay ED. Multisystem Inflammatory Syndrome in Infants <12 months of Age, United States, May 2020-January 2021. Pediatr Infect Dis J 2021; 40:601-605. [PMID: 33872279 PMCID: PMC8408805 DOI: 10.1097/inf.0000000000003149] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified in infants <12 months old. Clinical characteristics and follow-up data of MIS-C in infants have not been well described. We sought to describe the clinical course, laboratory findings, therapeutics and outcomes among infants diagnosed with MIS-C. METHODS Infants of age <12 months with MIS-C were identified by reports to the CDC's MIS-C national surveillance system. Data were obtained on clinical signs and symptoms, complications, treatment, laboratory and imaging findings, and diagnostic SARS-CoV-2 testing. Jurisdictions that reported 2 or more infants were approached to participate in evaluation of outcomes of MIS-C. RESULTS Eighty-five infants with MIS-C were identified and 83 (97.6%) tested positive for SARS-CoV-2 infection; median age was 7.7 months. Rash (62.4%), diarrhea (55.3%) and vomiting (55.3%) were the most common signs and symptoms reported. Other clinical findings included hypotension (21.2%), pneumonia (21.2%) and coronary artery dilatation or aneurysm (13.9%). Laboratory abnormalities included elevated C-reactive protein, ferritin, d-dimer and fibrinogen. Twenty-three infants had follow-up data; 3 of the 14 patients who received a follow-up echocardiogram had cardiac abnormalities during or after hospitalization. Nine infants had elevated inflammatory markers up to 98 days postdischarge. One infant (1.2%) died after experiencing multisystem organ failure secondary to MIS-C. CONCLUSIONS Infants appear to have a milder course of MIS-C than older children with resolution of their illness after hospital discharge. The full clinical picture of MIS-C across the pediatric age spectrum is evolving.
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Affiliation(s)
| | | | | | | | | | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Maura K. Lash
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | | | | | | | | | | | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | - Lynn E. Sosa
- Connecticut Department of Public Health, Hartford, Connecticut
| | | | - Ali Garcia
- Nevada Department of Health and Human Services, Reno, Nevada
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Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, Lee EH, Paneth-Pollak R, Geevarughese A, Lash MK, Dorsinville MS, Ballen V, Eiras DP, Newton-Cheh C, Smith E, Robinson S, Stogsdill P, Lim S, Fox SE, Richardson G, Hand J, Oliver NT, Kofman A, Bryant B, Ende Z, Datta D, Belay E, Godfred-Cato S. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1450-1456. [PMID: 33031361 PMCID: PMC7561225 DOI: 10.15585/mmwr.mm6940e1] [Citation(s) in RCA: 360] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bixler D, Miller AD, Mattison CP, Taylor B, Komatsu K, Peterson Pompa X, Moon S, Karmarkar E, Liu CY, Openshaw JJ, Plotzker RE, Rosen HE, Alden N, Kawasaki B, Siniscalchi A, Leapley A, Drenzek C, Tobin-D'Angelo M, Kauerauf J, Reid H, Hawkins E, White K, Ahmed F, Hand J, Richardson G, Sokol T, Eckel S, Collins J, Holzbauer S, Kollmann L, Larson L, Schiffman E, Kittle TS, Hertin K, Kraushaar V, Raman D, LeGarde V, Kinsinger L, Peek-Bullock M, Lifshitz J, Ojo M, Arciuolo RJ, Davidson A, Huynh M, Lash MK, Latash J, Lee EH, Li L, McGibbon E, McIntosh-Beckles N, Pouchet R, Ramachandran JS, Reilly KH, Dufort E, Pulver W, Zamcheck A, Wilson E, de Fijter S, Naqvi O, Nalluswami K, Waller K, Bell LJ, Burch AK, Radcliffe R, Fiscus MD, Lewis A, Kolsin J, Pont S, Salinas A, Sanders K, Barbeau B, Althomsons S, Atti S, Brown JS, Chang A, Clarke KR, Datta SD, Iskander J, Leitgeb B, Pindyck T, Priyamvada L, Reagan-Steiner S, Scott NA, Viens LJ, Zhong J, Koumans EH. SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1324-1329. [PMID: 32941417 DOI: 10.15585/mmwr.mm6937e4] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.
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Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, Roguski K, Wallace B, Prezzato E, Koumans EH, Lee EH, Geevarughese A, Lash MK, Reilly KH, Pulver WP, Thomas D, Feder KA, Hsu KK, Plipat N, Richardson G, Reid H, Lim S, Schmitz A, Pierce T, Hrapcak S, Datta D, Morris SB, Clarke K, Belay E. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1074-1080. [PMID: 32790663 PMCID: PMC7440126 DOI: 10.15585/mmwr.mm6932e2] [Citation(s) in RCA: 507] [Impact Index Per Article: 126.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients' signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2-4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition,† and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2-4), had a less severe clinical course, or had features of Kawasaki disease.§ Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.
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