We read with interest the clinical profile of 33 children with multisystem inflammatory syndrome in children by Kaushik et al from 3 New York City tertiary care children's hospitals.1Kaushik S. Aydin S.I. Derespina K.R. Bansal P.B. Kowalsky S. Trachtman R. et al.Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York City.J Pediatr. 2020; 224: 24-29Abstract Full Text Full Text PDF PubMed Scopus (232) Google Scholar There have been similar reports of a surge in children presenting with systemic inflammation, including Kawasaki-like disease from Europe and other parts of the US but not from Asia to date.2Belhadjer Z. Méot M. Bajolle F. Khraiche D. Legendre A. Abakka S. et al.Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic.Circulation. 2020; ([Epub ahead of print])Crossref PubMed Scopus (721) Google Scholar, 3Verdoni L. Mazza A. Gervasoni A. Martelli L. Ruggeri M. Ciuffreda M. et al.An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.Lancet. 2020; 395: 1771-1778Abstract Full Text Full Text PDF PubMed Scopus (1422) Google Scholar, 4Riphagen S. Gomez X. Gonzalez-Martinez C. Wilkinson N. Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic.Lancet. 2020; 395: 1607-1608Abstract Full Text Full Text PDF PubMed Scopus (1373) Google Scholar, 5Chiotos K. Bassiri H. Behrens E.M. Blatz A.M. Chang J. Diorio C. et al.Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series.J Pediatric Infect Dis Soc. 2020; 9: 393-398Crossref PubMed Scopus (90) Google Scholar We compared the epidemiologic trends in Kawasaki disease at the only public specialist children's hospital in Singapore before coronavirus disease-19 (COVID-19) (January 1, 2017, to December 31, 2019) and during COVID-19 (January 1, 2020, to April 30, 2020). Since the emergence of severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) in Singapore, the number of cases of Kawasaki disease was lower (n = 41) compared with the average for the same period before COVID-19 (n = 56). Although cases in children 4 years of age and younger mirrored the overall lower trend, cases in children 5-9 years of age seem to be higher during COVID-19 (Figure). In the ≥10-year-old category, there were no major variations with 1 case in 2020 vs 2 each in 2019 and 2018 and none in 2017. Comparing 2017-2019 with 2020, the mean age of patients with Kawasaki disease increased from 2.53 years to 2.80 years of age and the proportion of female cases increased from 43.9% to 51.2%. There was no significant change in average duration of hospitalization (4.9 days to 5.6 days), which may be a proxy measure of no change in Kawasaki disease case severity. Pediatric COVID-19 cases in our hospital have been mild to moderate with no cases requiring oxygen or ventilatory support and no mortality. We have not detected a surge in Kawasaki disease cases during COVID-19 in Singapore, but noted a possible increase in age and shift in sex distribution. Close monitoring and analysis of children with systemic inflammation, especially their exposure to SARS-CoV-2 through serologic testing is warranted to evaluate whether children in Asia are at similar risk to the phenomenon reported in Europe and the US. ReplyThe Journal of PediatricsVol. 226PreviewWe read with interest the well-founded observation made by Yung et al regarding no change in epidemiology or cases of Kawasaki disease in Singapore amid the current ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. When it was initially recognized, there was uncertainty whether the SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C) represented Kawasaki disease. Evidence and evolving understanding suggest it to be a separate clinical entity. Full-Text PDF Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York CityThe Journal of PediatricsVol. 224PreviewTo assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C). Full-Text PDF

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