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Letters to the Editor

COVID-19 in South American Children: A Call For Action

Antúnez-Montes, Omar Yassef MD; Escamilla, María Isabel MD; Figueroa-Uribe, Augusto Flavio MD; Arteaga-Menchaca, Erick MD; Lavariega-Sárachaga, Manuel MD; Salcedo-Lozada, Perla MD; Sunohara, Rosa Arana MD; Melchior, Priscilla MD; del Razo, Jorge Omar Flores MD; Tirado-Caballero, Juan Carlos MD; Tasayco-Muñoz, Jaime Amadeo MD; Pinzon-Redondo, Hernando MD; Montes-Fontalvo, Laura Vanessa MD; Ochoa, Teresa MD; Eduardo Campos, Francisco MD; Hernandez, Roger MD; Limansky, Lara MD; del Aguila, Olguita MD; Buonsenso, Danilo MD

Author Information
The Pediatric Infectious Disease Journal: October 2020 - Volume 39 - Issue 10 - p e332-e334
doi: 10.1097/INF.0000000000002851
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Since its first description in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread all over the world. Coronavirus Disease 2019 (COVID-19) is causing a massive impact on adults, while pediatric COVID-19 has been relatively mild so far. First comprehensive pediatric reports arrived from China, Italy, and the United States (summarized by Parri et al1, showing that the majority of children develop paucy-symptomatic or even asymptomatic infection. However, later during the pandemic, several research groups from Europe2,3 and United States4 described a new syndrome, called Pediatric Multisystem Inflammatory Syndrome Temporally related with SARS-CoV-2 (PIMS-TS) or Multisystem inflammatory syndrome in children (MIS-C). All research groups highlighted that only a minority of children with known exposure to SARS-CoV-2 developed this syndrome, describing a higher prevalence in children of Afro-Caribbean origin.

The COVID-19 pandemic gave a strong impetus to the development of new national or international research groups, or well-established networks refocused their aims and expertise trying to give better comprehension of the pediatric COVID-19. For example, the Pediatric Tuberculosis Network European Trialgroup (PTBNET), is a well-recognized network that primarily comprises of Pediatric Infectious Diseases specialists and Pediatric Pulmonologists from all over the Europe, providing educational, clinical, and research activities in the field of pediatric tuberculosis. Due to the peculiar epidemiologic period related to the pandemic, the presence within the network of clinicians involved in the COVID-19 frontline, and the need to provide immediate access to vital information needed for service planning and provision worldwide, the PTBNET launched a data collection project. The initiative was particularly successful, involving 82 participating health-care institutions across 25 European countries5. Gotzinger et al described 582 individuals with PCR-confirmed SARS-CoV-2 infection, with a median age of 5.0 years (IQR 0.5–12.0) and a sex ratio of 1:15 males per female. One hundred and forty-five (25%) had preexisting medical conditions, 363 (62%) individuals were admitted to hospital, 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and 1 (<1%) extracorporeal membrane oxygenation. Four children died. The data also reflects the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.

Being inspired by the successful European experience from the PTBNET, and aware of the current lack of comprehensive pediatric data from South America, which is still facing the hardest phase of the pandemic, a number of independent researchers from Mexico, Colombia, Peru, and Brazil decided to launch a data collection project on COVID-19 children in South America. Such a project would also give visibility to South American centers highlighting potentials from further collaborations in future.

We are also fully aware that many colleagues are stretched to their limits with clinical work. However, we strongly feel that the pediatric community needs more data from South America, and that those data are needed now, to implement proper preventive and treatment recommendations in the region. The collected data will be made available upon requests to other research groups working on similar topics, with the final aim to develop a worldwide data collection on children with COVID-19, and to understand if geographic differences can help to explain better the current and future pandemics. This pandemic is showing us the need of a new approach to research: since there are no borders for diseases, there should not be borders dividing researchers and research, nor economic disparities leading to the exclusion of the most populated areas of the world from research projects of primary importance for human and child health.

With this article, the CoviD in sOuth aMerIcaN children—study GrOup (CoviDOMINGO) is calling South American clinicians and researchers, of any gender, age group, and academic degree, to join this not-for-profit project aiming to better define the clinical and epidemiologic picture of South America children with COVID-19, including the impact of PIMS-TS (or MIS-C) in this area (Fig. 1).

If you require any further information about this project, please eail the corresponding authors.

FIGURE 1.
FIGURE 1.:
The participating countries so far are marked with the black dot. This editorial letter is an open invitation for those professionals from Latin America who wish to participate in this ambitious project.

Omar Yassef Antúnez-Montes, MD
Departamento de Docencia e Investigación, Instituto Latinoamericano de Ecografía en Medicina (ILEM), Ciudad de México, and SOLJAC MD, Servicios Médicos de Emergencia, CDMX, México
María Isabel Escamilla, MD
Fundación Neumológica Colombiana, Bogotá, Colombia
Augusto Flavio Figueroa-Uribe, MD
Departamento de Urgencias, Hospital Pediátrico Peralvillo, Secretaria de salud, Ciudad de, México, México.
Erick Arteaga-Menchaca, MD
Hospital General Regional 200, Instituto Mexicano del Seguro Social, Estado de México, México
Manuel Lavariega-Sárachaga, MD
Grupo Home Health Medical, Ciudad de México, México
Perla Salcedo-Lozada, MD
Hospital General de Ecatepec Las Américas Estado de México, México
Rosa Arana Sunohara, MD
Hospital Cayetano Heredia, Lima, Perù
Priscilla Melchior, MD
Sao Luiz Hospita, Sao Luiz, Brazil
Jorge Omar Flores del Razo, MD
Departamento de urgencias, Instituto Nacional de Pediatria, Ciudad de Mèxico, Mexico
Juan Carlos Tirado-Caballero, MD
JAS Mèdica/Plus Mèdica, Lima, Perù
Jaime Amadeo Tasayco-Muñoz, MD
Hospital de Emergencias Villa el Salvador, Instituto Nacional de Salud del Niño, Lima, Perù
Hernando Pinzon-Redondo, MD, and Laura Vanessa Montes-Fontalvo, MD
Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
Teresa Ochoa, MD
Instituto de Medicina Tropical, Alexander von Humoldt, Unversidad Peruana Cayetano, Heredia, Lima, Perú
Francisco Eduardo Campos, MD
Unidad de Infectologia Pediatrica, Hospital San Bartolomé, Enfermedades Infecciosas Pediátricas, Lima, Perù
Roger Hernandez, MD
Hospital Cayetano Heredia, Lima, Perù
Lara Limansky, MD
Hospital de Niños Ricardo Gutiérrez, Argentina
Olguita del Aguila, MD
Unidad de Infectologia Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
Danilo Buonsenso, MD
Department of Woman and Child Health and Public Health, Fondazione Policlinico, Universitario A. Gemelli IRCCS, Rome, Italy, Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy

REFERENCES

1. Parri N, Lenge M, Buonsenso D; Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with covid-19 in pediatric emergency departments in Italy. N Engl J Med. 2020;383:187–190.
2. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395:1771–1778.
3. Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020 Jun 8;e2010369. doi: 10.1001/jama.2020.10369. Online ahead of print.
4. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021680.
5. Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolescent Health. June 25, 2020https://doi.org/10.1016/S2352-4642(20)30177-2.
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