Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a systematic review.

BACKGROUND: Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC). METHODS: We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study. RESULTS: A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC. CONCLUSION: MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC. PROSPERO REGISTRATION NUMBER: CRD42020195823.

Development and Validation of Parental Vaccine Attitudes Scale for Use in Low-income Setting.

BACKGROUND: This study aimed to develop a tool and assess its validity to measure childhood vaccine related attitudes among parents in a low-income setting. METHODS: We developed a vaccine attitudes scale (VAS) composed of 14 Likert items each with 5 responses ranging from strongly agree to strongly disagree (sum of scores range 14-70). The tool was administered to 901 parents with children 4-12 months of age during a vaccine coverage survey in Sindh, Pakistan. We performed factor analysis with eigenvalues >0.3 for sufficient factor loading and calculated Cronbach alpha for reliability. RESULTS: The mean ± SD score on VAS was 48 ± 3 and Cronbach alpha was 0.61. Factor analysis identified that VAS measured 2 different domains related to the childhood vaccine related attitudes; (1) 10 items related to vaccine perceptions and concerns (mean 40 ± 5.5; Cronbach alpha 0.95) and (2) 4 items related to vaccine preventable disease salience and community benefit (mean 7 ± 3; Cronbach alpha 0.97). The odds of children being unimmunized was 5 times higher among parents who scored high (13-20) as compared with low (<13) on the subscale related to disease salience and community benefit (odds ratio 5.2; 95% CI: 3.6-7.6). The odds of children being unimmunized was 1.5 times higher among parents scoring high (40-50) as compared with low (<40) on subscale related to vaccine perception/concerns (odds ratio 1.5; 95% CI: 1.1-2.2). CONCLUSION: The 4-item scale assessing parental attitudes toward vaccine preventable disease salience and community benefit is sufficiently reliable and can predict vaccine acceptance among parents in low income setting.