a look back and a look forward

Vikash S. Oza, MD, associate professor of dermatology and pediatrics and director of pediatric dermatology at NYU Grossman School of Medicine, kept his talking points simple: To answer those burning questions pediatric dermatologists might have, 2 years after the start of the COVID-19 pandemic; provide updates on multisystem inflammatory syndrome (MIS-C) in children; and discuss what awaits this medical discipline.

A few statistics first: Oza provided data that showed the increase in the seroprevalence of COVID-19 among children aged 0-17, where between September 2021 and February 2022 these rates increased from approximately 38 % to 75%. Additionally, among children aged 5–11 years, once eligible for vaccinations, hospitalizations for unvaccinated populations were twice as high as for vaccinated populations. And the sobering statistics: As of June 1, 2022, there were more than 13 million cases of COVID-19 and 1,533 COVID-19-associated deaths among children under the age of 18.

Children at high risk of hospitalization include patients with asthma (odds ratio 2.1); obesity (6.8); chronic kidney disease (5.3); sickle cell disease (6.2); bone marrow transplant (7.1); and neurodevelopmental disorder (5.2). However, some silver linings here: Oza noted that children who were treated with dupilumab for atopic dermatitis were less likely to experience moderate to severe COVID-19 symptoms compared to patients on other systemic treatments.

Next, Oza launched into a discussion about MIS-C, which became less severe during the Omicron phase of COVID-19. “Vaccines strongly protect against MIS-C,” Oza noted, finding an impressive 91% reduction in MIS-C cases. with vaccination: Among eligible children hospitalized in the United States with MISC-C between July 21 and January 22, only 3% were fully vaccinated. The most common dermatologic signs of MIS-C in children include morbilliform, macular erythema, urticaria, and scarlatiniform, with additional presentations such as conjunctival injection, palmoplantar erythema, hyperemia, and fissure lips, strawberry tongue and periorbital erythema and edema.

“What about childhood immunization schedules: have we caught up?” asked Oza. The simple answer with the current data available is, not completely. For example, 81% of children aged 7 months in September 2019 were up to date with their vaccinations, while a year later only 74% were. To put these percentages into context, Oza pointed to the fact that a 95% vaccination rate was needed to eradicate measles (considered eliminated from the general public in 2000).

Finally, Oza touched on one of the most serious illnesses that have been in the spotlight during the pandemic: the mental health status of children. Regarding various skin disorders in children and their impact on mental health, Oza said, “We deal with chronic conditions that have a significant impact on quality of life, many of which are independently associated with depression.

The message here was clearly: in the future, with this pandemic and all future pandemics, to be informed not only on how best to treat new viral infections, but also on how to deal with the mental health problems of dermatological patients will be an integral part of comprehensive medical care for our children.

Reference

Oza vs. COVID-19: A look back and a look forward. SPD 2022 47th Annual Meeting. July 10, 2022. Indianapolis, Indiana.

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