May 18, 2020

COVID-19: Death toll rises above 315,000 globally; WHO develops case definition for multisystem inflammatory disorder in children and adolescents

ECDC case count update

According to the European Centre for Disease Prevention and Control (ECDC), since 31 December 2019 and as of 18 May 2020, 4 679 511 cases of COVID-19 have been reported, including 315 005 deaths.

Cases have been reported from:

Africa: 84 819 cases; the five countries reporting most cases are South Africa (15 515), Egypt (12 229), Algeria (7 019), Morocco (6 870) and Nigeria (5 959).

Asia: 791 993 cases; the five countries reporting most cases are Turkey (149 435), Iran (120 198), India (96 169), China (84 054) and Saudi Arabia (54 752).

America: 2 088 098 cases; the five countries reporting most cases are United States (1 486 757), Brazil (241 080), Peru (92 273), Canada (76 991) and Mexico (49 219).

Europe: 1 705 432 cases; the five countries reporting most cases are Russia (281 752), United Kingdom (243 695), Spain (231 350), Italy (225 435) and Germany (174 697).

Oceania: 8 473 cases; the five countries reporting most cases are Australia (7 045), New Zealand (1 149), Guam (154), French Polynesia (60) and Northern Mariana Islands (21).

Other: 696 cases have been reported from an international conveyance in Japan.

Deaths have been reported from:

Africa: 2 759 deaths; the five countries reporting most deaths are Egypt (630), Algeria (548), South Africa (264), Morocco (192) and Nigeria (182).

Asia: 24 648 deaths; the five countries reporting most deaths are Iran (6 988), China (4 638), Turkey (4 140), India (3 029) and Indonesia (1 148).

America: 124 862 deaths; the five countries reporting most deaths are United States (89 562), Brazil (16 118), Canada (5 782), Mexico (5 177) and Ecuador (2 736).

Europe: 162 603 deaths; the five countries reporting most deaths are United Kingdom (34 636), Italy (31 908), France (28 108), Spain (27 650) and Belgium (9 052).

Oceania: 126 deaths; the four countries reporting deaths are Australia (98), New Zealand (21), Guam (5) and Northern Mariana Islands (2).

Other: 7 deaths have been reported from an international conveyance in Japan

Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19

In a Scientific Brief published on its site on 15 May, WHO noted that there have been reports from Europe and North America describing clusters of children and adolescents being admitted to intensive care units with a multisystem inflammatory condition with some features similar to those of Kawasaki disease and toxic shock syndrome.

According to the Scientific Brief, case reports and small series have described a presentation of acute illness accompanied by a hyperinflammatory syndrome, leading to multiorgan failure and shock.

"Initial hypotheses are that this syndrome may be related to COVID-19 based on initial laboratory testing showing positive serology in a majority of patients. Children have been treated with anti-inflammatory treatment, including parenteral immunoglobulin and steroids", the Scientific Brief stated.

The Scientific Brief noted that it is essential to characterize this syndrome and its risk factors, to understand causality, and describe treatment interventions. "It is not yet clear the full spectrum of disease, and whether the geographical distribution in Europe and North America reflects a true pattern, or if the condition has simply not been recognized elsewhere", the Scientific Brief added.

WHO has developed a preliminary case definition and case report form for multisystem inflammatory disorder in children and adolescents. The preliminary case definition reflects the clinical and laboratory features observed in children reported to date, and serves to identify suspected or confirmed cases both for the purpose of providing treatment and for provisional reporting and surveillance. WHO added that the case definition will be revised as more data become available.

The preliminary case definition by WHO is as follows:

Children and adolescents 0–19 years of age with fever >3 days

AND two of the following:

  1. Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
  2. Hypotension or shock.
  3. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP).
  4. Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).
  5. Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain).

AND
Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.

AND
No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.

AND
Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.

SOURCE: ECDC; WHO