Mangat, Chetna

Vaccination is critical to control the ongoing COVID-19 pandemic, but despite the availability of safe and effective vaccine in children over 5 years, vaccination rates remain low. There is paucity of data about vaccine acceptance and factors influencing parents’ hesitancy about the COVID-19 vaccine for young children. Aims and objectives To estimate vaccine acceptance by parents of children 6 months through 4 years, and to evaluate the factors influencing vaccine hesitancy. Methods Electronic survey was sent to parents of children 6 months through 4 years through an online portal account at Mayo Clinic Health System, Northwest-Wisconsin. Data were captured via Research Electronic Data Capture secured data collection software. Bivariate and multivariate regression was used to determine most pertinent factors influencing parents’ decisions against the outcome, ‘Intent to Vaccinate’. Results 39.7% of the parents were ‘very likely’ or ‘somewhat likely ’ to vaccinate their children once the vaccine became available, while 49.8% were not likely or highly unlikely to vaccinate. Routine childhood vaccination, receiving seasonal influenza vaccine, parents' perception of COVID-19 severity in children and safety and effectiveness of the vaccine were all associated with more vaccine acceptance. 71.4% of parents who will likely not vaccinate their children indicated that they are unlikely to change their decision. The need for more research on the vaccine and more information from the PCP office were the most common reasons behind the vaccine decision-making. Conclusions Vaccine hesitancy remains a major issue regarding uptake of the upcoming COVID-19 vaccine. Strong and clear evidence-based recommendations from primary care provider and more information from trusted websites such as Centers for Disease Control and Prevention can decrease vaccine hesitancy in parents. Further research targeted at understanding beliefs and perspectives of parents from different demographics can assist policy-makers in implementing measures to improve vaccination rates in children and tailor our dialogue to match the needs of our patients and families.

COVID-19 infection in the pediatric population usually leads to a mild illness; however, a rare but serious complication of MIS-C has been seen in children. MIS-C usually presents 2–4 weeks after COVID-19 infection or exposure, and rare reports have been documented in neonates. Vaccinations for COVID-19 have been approved for children aged 6 months and above in the United States, and recent reports suggest significantly low prevalence and risk of complications of Multi-organ Inflammatory Syndrome (MIS-C) in vaccinated children compared to unvaccinated children. Vaccinations for COVID-19 are safe and recommended during pregnancy and prevent severe maternal morbidity and adverse birth outcomes. Evidence from other vaccine-preventable diseases suggests that through passive transplacental antibody transfer, maternal vaccinations are protective against infections in infants during the first 6 months of life. Various studies have demonstrated that maternal COVID-19 vaccination is associated with the presence of anti-spike protein antibodies in infants, persisting even at 6 months of age. Further, completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy is associated with reduced risk for COVID-19–associated hospitalization among infants aged 6 months or less. Therefore, it can be hypothesized that maternal COVID-19 vaccination can reduce the risk of and severity of MIS-C in infants. In this article, we review the literature to support this hypothesis.

Background. Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare respiratory disorder. During infancy, it typically presents with hypoxemia, tachypnea, and respiratory distress, and is commonly misdiagnosed as common childhood illnesses such as pneumonia, reactive airway disease, or bronchiolitis. Lack of awareness about this relatively new and rare disorder in primary care and acute care settings lead to delayed diagnosis and unnecessary use of antibiotics. Case Presentation. We present a case of a 7-month-old girl, born prematurely at 32 weeks with tachypnea and respiratory distress who was initially diagnosed with viral pneumonia, then upper respiratory infection, and finally with community-acquired bacterial pneumonia, while the child never had any fever or upper respiratory symptoms. Failure of outpatient treatment with oral antibiotic and bronchodilator, with the persistence of respiratory symptoms such as retractions, bilateral crackles, and hypoxemia led to hospitalization for intravenous antibiotics. Given persistent symptoms, further evaluation was performed, and she was diagnosed with NEHI based on characteristic chest CT findings. Conclusions. Viral respiratory infections are the most frequent cause of respiratory illnesses in the first years of life. Primary care providers should be aware of less frequent causes of persistent respiratory symptoms in infancy like NEHI and other interstitial lung diseases in children. This may prevent unnecessary use of antibiotics and delayed diagnosis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in general leads to a mild disease in children, but a rare yet serious complication of multisystem inflammatory syndrome in children (MIS-C) has been reported.1 MIS-C cases are on the rise during the COVID-19 pandemic, and clinical features overlap between MIS-C and an already well-known clinical entity in children: Kawasaki disease (KD). Both KD and MIS-C are diagnoses of exclusion, and can present with acute fever and increased inflammatory markers without any other potential etiology.2 Despite the overlap in clinical presentation, there are some differentiating features that could help establish an accurate diagnosis and appropriate management, which are highlighted in this article.