MIS-C, COVID-19 Vaccine, Fractures in Pandemic, Sex Differences in Psychiatric Disorders

By limjr [at] email.chop.edu (Jillian Rose Lim) and shafere1 [at] email.chop.edu (Emily Shafer)

Between studies on multisystem inflammatory syndrome in children (MIS-C) and speaking up about safety in vaccine development, our researchers are keeping busy at the forefront of COVID-19 research and beyond. In this week’s roundup of research headlines, read about how Critical Care experts at Children’s Hospital of Philadelphia are learning more about MIS-C, get highlights from Paul Offit, MD’s Q&A about COVID-19 vaccine development, discover the potential impact of social distancing on pediatric fracture rates, and see how researchers are looking at sex differences in psychiatric disorders through the lens of genetic studies.

CHOP Researchers Publish Case Series of Patients With MIS-C

Researchers at CHOP published a case series describing six patients with suspected multisystem inflammatory syndrome in children (MIS-C). The syndrome has garnered worldwide attention, appearing to affect children with evidence of a previous COVID infection.

Katie Chiotos, MD, attending physician in the Division of Critical Care Medicine at CHOP, and assistant professor of Anesthesia and Critical Medicine at Perelman School of Medicine at the University of Pennsylvania, and colleagues described the symptoms of the six children who presented at CHOP with suspected MIS-C. The case series appeared in the Journal of Pediatric Infectious Diseases.

The key findings indicate that fever, abdominal pain and diarrhea, shock, and variable presence of rash are the main symptoms, as well as conjunctivitis, extremity edema, and mucous membrane changes. Although the symptoms appear to overlap with Kawasaki disease (KD), Dr. Chiotos noted that MIS-C is distinct from KD, particularly in that children with MIS-C are generally sicker and need ICU care. In addition, children with MIS-C present with abdominal pain and diarrhea, which is not typical in KD.“The outlook is very good for these patients, and despite its attention, (MIS-C) is rare,” Dr. Chiotos said. “There have been a few hundred cases in the world, and while we’re still understanding the epidemiology, it seems to be a very infrequent occurrence.”

JAMA Live features Paul Offit, MD, in COVID-19 Vaccine Discussion

Paul Offit, MD, PhD, director of the Vaccine Education Center at CHOP and an internationally recognized virology and immunology expert, participated in a Q&A about COVID-19 vaccine development earlier this week. In the lively conversation with Howard Bauchner, MD, editor in chief of the Journal of the American Medical Association (JAMA), Dr. Offit covered a range of topics related to the principles and progress-to-date of a COVID-19 vaccine, drawing on his lengthy experience in vaccine development and research. Dr. Offit is co-inventor of RotaTeq®, the rotavirus vaccine recommended for use in infants by the Centers for Disease Control. Currently, he is a member of the National Institutes of Health’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) group.

In the Q&A, Dr. Offit described the multiple strategies that more than 70 companies are taking to develop a COVID-19 vaccine, including taking the SARS CoV-2 virus and weakening it (similar to what is done in measles, mumps, or chicken pox vaccines), taking just the part of the virus that attaches to cells (similarly to hepatitis or human papillomavirus vaccines), and more. Above all, Dr. Offit stressed the importance of safety over speed, particularly in Phase 3 trials.

“If the proof is in the pudding, the pudding is the Phase 3 trial,” Dr. Offit said. “What you want is the best and safest vaccine, which might not necessarily be the first vaccine.”

Dr. Offit also spoke to any hesitancy or anxiety parents might feel over a new vaccine. Parents and caregivers should be able to see enough data on safety and efficacy before a vaccine is distributed widely to children.

“We ask a lot of parents in this country,” Dr. Offit said. “We ask them to give children 14 different vaccines to prevent disease most people don’t see, using fluids most people don’t understand. We generally have the confidence of parents in this country (…) I think we do put that on the line here, and we better make sure that before we inoculate tens of millions that we make sure we hold it to the highest standard of safety and efficacy.”

The Q&A is available to watch on JAMA Network’s YouTube channel.

Research Shows Increase in At-home Fractures During COVID-19 Pandemic

A new study from CHOP researchers finds that social distancing measures due to COVID-19 have led to a nearly 60 percent decrease in pediatric fractures, but an increase in the proportion of fractures sustained at home.

Some examples of these at-home fractures include bicycle and trampoline injuries, highlighting the need for heightened awareness of safety measures even for recreational activities close to home. The team published their findings in the Journal of Pediatric Orthopaedics.

“It is important to remind parents about the importance of basic safety precautions with bicycles and trampolines, as many children are substituting these activities in place of organized sports and school activities,” said Apurva Shah, MD, MBA, an orthopaedic surgeon in the Division of Orthopaedics and senior author of the study.

Dr. Shah and his colleagues compared data from over 1,700 CHOP patients presenting with fractures between March and April 2020 with data from those same months in 2018 and 2019. The team identified a nearly 2.5-fold decrease in daily incidence of fracture cases, particularly in sports-related fractures. However, they also found that fractures happening at home increased by more than 25 percent. In particular, fractures caused by high-energy falls such as falling from a bicycle or trampoline increased by 12 percent.

Alongside the importance of more stringent safety measures, Dr. Shah suggested that the findings also highlight an opportunity to utilize telemedicine appointments during social distancing as well as alternative, widely available options such as wrist splints with fasteners.

“This pandemic highlights new opportunities for improvement of patient care, as we observed significant increases in the use of telemedicine and prescription of generic wrist splints,” Dr. Shah said. “These treatment trends may serve as the basis for more cost-effective fracture care long after the conclusion of the outbreak.”

Learn more about this research in the CHOP press release.

Review Highlights Sex Differences in Psychiatric Disorders

Two researchers at CHOP published a review article in Genes, Brains and Behavior, describing the sex differences in psychiatric disorders, and the genetic and non-genetic mechanisms that may contribute to these differences.

Alison Merikangas, PhD, and Laura Almasy, PhD, both of the Department of Biomedical and Health Informatics at CHOP, and the Penn-CHOP Lifespan Brain Institute at the University of Pennsylvania, discussed the various genetic studies that have sought to explain the sex differences in certain psychiatric disorders. For example, females have higher rates of anxiety, mood and eating disorders, but males have higher rates of autism, attention deficit, and substance use disorders.

The genetic factors underlying most mental disorders do not differ in males and females, and environmental and/or biologic exposures may lead to differences in the clinical presentation of mental disorders in men and women, according to Dr. Merikangas.

“As we are striving for personalized medicine, sex and age are among the most important individual characteristics that should be incorporated into this effort, yet our review indicates that sex has only rarely been considered as a source of genetic variation,” Dr. Merikangas said. “We recommend that future genetic studies systematically include sex in identifying risk factors for neuropsychiatric disorders.”

ICYMI

Catch up on our headlines from our May 22 In the News:

• PolicyLab Researchers Update Risk Model for Second Waves of COVID-19
• Childhood Vaccination Coverage Declined During COVID-19 Pandemic
• Intervention for Parent-teen Communication Increased Teens’ Positive Emotions
• Universal Screening for Autism Spectrum Disorder Linked to Earlier Diagnosis
• Exposure to Violent Events Related to Depression in Adolescents

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