Approaches to SARS-CoV-2 and other vaccinations in children with a history of multisystem inflammatory syndrome (MIS-C): An international survey

Francesca Minoia; Federica Lucioni; Merav Heshin-Bekenstein; Sebastiaan Vastert; Christoph Kessel; Yosef Uziel; Lovro Lamot; Nicolino Ruperto; Marco Gattorno; Claudia Bracaglia; Natasa Toplak

doi:10.3389/fped.2022.1030083

Approaches to SARS-CoV-2 and other vaccinations in children with a history of multisystem inflammatory syndrome (MIS-C): An international survey

Front Pediatr. 2022 Nov 9:10:1030083. doi: 10.3389/fped.2022.1030083. eCollection 2022.

Authors

Affiliations

¹ Pediatric Immuno-Rheumatology Unit, Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
³ Division of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
⁴ Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany.
⁵ Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel.
⁶ University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
⁷ UOSID Centro Trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁸ Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁹ Division of Rheumatology and Laboratory of Immuno Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
¹⁰ Department of Pediatric Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre, MF, UL, Ljubljana, Slovenia.

Abstract

Background: Following the Coronavirus Disease-19 (COVID-19) pandemic outbreaks, the hyperinflammatory condition termed Multisystem Inflammatory Syndrome in Children (MIS-C) became a healthcare issue worldwide. Since December 2020 the mRNA vaccine against SARS-CoV-2 has become available with a good safety profile. However, evidence regarding safety and vaccination strategies in children with previous MIS-C is still lacking. The aim of our study was to investigate the current approach of international centers to anti-SARS-CoV-2 and other vaccinations in children with a history of MIS-C.

Methods: Physicians who care for patients with MIS-C were invited to anonymously complete a 15-question, web-based survey. The survey was open from October 6 to December 31, 2021.

Results: A total of 290 replies from 236 centers in 61 countries were collected. Most respondents (86%) were pediatric rheumatologists. The anti-SARS-CoV-2 vaccine was available in 85% of the countries. Sixty-seven centers (28%) in 22 countries already vaccinated MIS-C patients without adverse reactions in most cases (89%). Six reported complications: 2 not specified, 3 mild symptoms and 1 reported a MIS-C-like reaction. Most centers (84%) favored vaccinating MIS-C patients against SARS-CoV-2, after 3-6 months (40%), 6-12 months (52%) or >12 months (8%). The survey revealed broad heterogeneity of responses among healthcare providers within the same country and within the same center. The variable with the greatest impact on the decision not to vaccinate MIS-C patients was the current lack of evidence (51%), followed by patient/parent objection (40%). The most relevant parameters in the vaccination strategy were time from MIS-C episode (78%), immunosuppressive treatment (35%), SARS-CoV-2 serologic status (32%), and MIS-C features (31%). Almost all centers favored continuing regular vaccination with non-live (99%) and live (93%) vaccines; however, with high variability in suggested timelines.

Conclusion: To date, the experience of the international pediatric rheumatology community in vaccinating MIS-C patients against SARS-CoV-2 is overall reassuring. However, lack of evidence causes broad heterogeneity in vaccination strategy worldwide.

Keywords: COVID-19; MIS-C; SARS-CoV-2; multisystem inflammatory syndrome; pediatric inflammatory multisystem syndrome; vaccination.