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Pediatric Inflammatory Multisystem Syndrome (PIMS)

FDA Authorizes Pfizer-BioNTech Vaccine for Children 12 to 15

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Vaccinating children is crucial to building up population levels of immunity and curtailing the spread of the coronavirus. Though children spread the virus less efficiently than adults do, they make up about 23 percent of the population.

Experts have said that the country is unlikely to reach the “herd immunity” threshold — the point at which virus transmission essentially stalls — but vaccinating children will be important for getting as close as possible.

Ty Dropic, 14, one of the trial participants, urged others his age to be vaccinated so they could build up widespread immunity and protect themselves. He had no side effects, leading him to suspect that he got the placebo. If that turns out to be the case, he plans to be immunized as soon as possible.

“I know it can be kind of scary, but it’s really not as bad as it seems,” he said. “If you do get Covid, it’ll be a lot worse than getting stuck with a needle for, like, two seconds.”

Ty’s three siblings, ages 8, 10 and 16, are also enrolled in vaccine trials for their age groups. Their mother, Dr. Amanda Dropic, a pediatrician in northern Kentucky, said that in her practice, most parents were eager to have their children vaccinated so they could regain some semblance of normalcy.

“The anxiety and depression that we’re seeing with kids, the social delays, has been tremendous,” she said.

Dr. Dropic said her children understood the risks and were willing to volunteer because they saw it as a civic duty. Every medicine available today came to be because “somebody was willing to go first,” she added.

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Some Children With Covid-Related Syndrome Develop Neurological Symptoms

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Reports about the mysterious Covid-related inflammatory syndrome that afflicts some children and teenagers have mostly focused on physical symptoms: rash, abdominal pain, red eyes and, most seriously, heart problems like low blood pressure, shock and difficulty pumping.

Now, a new report shows that a significant number of young people with the syndrome also develop neurological symptoms, including hallucinations, confusion, speech impairments and problems with balance and coordination. The study of 46 children treated at one hospital in London found that just over half — 24 — experienced such neurological symptoms, which they had never had before.

Those patients were about twice as likely as those without neurological symptoms to need ventilators because they were “very unwell with systemic shock as part of their hyperinflammatory state,” said an author of the study, Dr. Omar Abdel-Mannan, a clinical research fellow at University College London’s Institute of Neurology. Patients with neurological symptoms were also about twice as likely to require medication to improve the heart’s ability to squeeze, he said.

The condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), typically emerges two to six weeks after a Covid infection, often one that produces only mild symptoms or none at all. The syndrome is rare, but can be very serious. The latest data from the Centers for Disease Control and Prevention reports 3,165 cases in 48 states, Puerto Rico and the District of Columbia, including 36 deaths.

study published last month in JAMA Neurology, 126 of 616 young people with the syndrome admitted to 61 U.S. hospitals last year had neurological issues, including 20 with what the researchers described as “life-threatening” problems like strokes or “severe encephalopathy.”

The new report, presented as preliminary research on Tuesday as part of an annual conference of the American Academy of Neurology, evaluated children under 18 who were admitted to Great Ormond Street Hospital (GOSH) between April and September of last year with the syndrome (it has a different name and acronym, PIMS-TS, in Britain). The data is also included in a preprint of a larger study that has not yet been peer-reviewed.

As was the case with other studies of the syndrome, including in the United States, the researchers said a majority of those afflicted were “nonwhite,” a pattern that public health experts believe reflects the disproportionate way the pandemic has affected communities of color. Nearly two-thirds of the patients were male, and the median age was 10.

All 24 of the patients with neurological symptoms had headaches and 14 had encephalopathy, a general term that can involve confusion, problems with memory or attention and other types of altered mental function. Six of the children were experiencing hallucinations, including “describing people in the room that were not there or seeing cartoons or animals moving on the walls,” Dr. Abdel-Mannan said. He said some experienced auditory hallucinations involving “hearing voices of people not present.”

Six of the children had weakness or difficulty controlling muscles used in speech. Four had balance or coordination problems. One child had seizures and three children had peripheral nerve abnormalities including weakness in facial or shoulder muscles. One patient’s peripheral nerve damage led to a foot-drop problem that required the use of crutches and a recommendation for a nerve transplant, said Dr. Abdel-Mannan, who is also a senior resident in pediatric neurology at GOSH.

Some of the patients underwent brain scans, nerve conduction tests or electroencephalograms (EEGs), including 14 who showed slower electrical activity in their brains, the study reported.

Thirteen of the 24 with neurological symptoms needed to be placed on ventilators and 15 needed medication to improve their heart contractions, Dr. Abdel-Mannan said. By contrast, only three of the 22 children without neurological issues needed ventilators and seven needed such heart medication, he said. None of the children with hallucinations needed psychotropic medications.

Three children had to be hospitalized again after their initial stay, one for another episode of encephalopathy and two for infectious complications, Dr. Abdel-Mannan said, but he added that there were no deaths and “almost all children made a complete functional recovery.”

Dr. Abdel-Mannan said a team led by the study’s senior author, Dr. Yael Hacohen, will be following patients who had the syndrome — both those who had neurological symptoms and those who did not. They will conduct brain scans and cognitive assessments to see if the children experience any long-term cognitive or psychological effects.

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