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In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients' signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2-4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition, and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2-4), had a less severe clinical course, or had features of Kawasaki disease. Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.

During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections, interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition.

This cohort study describes the distribution of race/ethnicity among cases of coronavirus disease 2019 (COVID-19)–associated multisystem inflammatory syndrome in children reported to the New York City Department of Health and Mental Hygiene.

New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections.

Objectives. We determined the success of the school-located vaccination (SLV) program, implemented in 2009 in New York City to deliver pandemic influenza A (H1N1) monovalent vaccine (pH1N1), versus provider offices in reaching children who had never previously received influenza vaccine. Methods. We compared the immunization history of children vaccinated in school versus provider offices. We included records in the Citywide Immunization Registry with pH1N1 administered between October 2009 and March 2010 to elementary school-aged children. Results. In total, 96 524 children received pH1N1 vaccine in schools, and 102 933 children received pH1N1 vaccine in provider offices. Of children vaccinated in schools, 34% had never received seasonal influenza vaccination in the past, compared with only 10% of children vaccinated at provider offices (P < .001). Children vaccinated in schools were more likely to have received a second dose of pH1N1 in 2009–2010 than those vaccinated in provider offices (80% vs 45%). Conclusions. The SLV program was more successful at reaching children who had never received influenza immunization in the past and should be considered as a strategy for delivering influenza vaccine in routine and emergency situations.

Background : Green housing reduces energy costs and may mitigate indoor allergens and pollutants, improving asthma morbidity. High asthma burden is seen in low-income neighborhoods. Past studies show improvements in respiratory symptoms when living in green homes. Objective: Develop partnership with Blue Sea Development Company to determine impacts of living in Melrose Commons V (MCV), a Leadership in Energy and Environmental Design (LEED) Platinum-certified affordable housing complex, on asthma in the South Bronx. Methods: Participants completed a home-based respiratory health questionnaire before moving into MCV. Follow-up occurred at 6, 12, and 18 months post-move. A home-based educational module was delivered on indoor environmental interventions to avoid asthma triggers. A pretest was given before the module and a posttest was given 9 months later, including an evaluation of behavioral practice changes. Results: Outcomes included decreases in continuous daily respiratory symptoms ( p < .001), asthma symptoms disrupting sleep in the past month ( p = .028), and urgent visits to a healthcare professional for asthma in the past 3 months ( p = .038). Clinically relevant outcomes included fewer days with asthma symptoms; asthma episodes; days of work, school, or daycare missed; and emergency department visits. Education changes from pretest to posttest included increased knowledge about dust mites, roaches, mold, and chemical irritants ( p = .007). Common behavioral changes included using hypoallergenic mattress covers, using green cleaning products, and eliminating bedroom carpets. Conclusions: Findings support the beneficial effect of LEED Platinum-certified buildings on respiratory health. Trends may be clinically and economically relevant. Advocacy efforts should promote the expansion of green housing and emphasize the development of healthy communities.

WHO SHOULD CARE MOST? * Public health workers and environmental health specialists working to decrease the burden of asthma in their communities can use this information to implement educational tools and outreach programs, as well as to help shape advocacy efforts. * City planners and builders, particularly those responsible for building affordable housing, can utilize the environmentally sound building principles encouraged by LEED and other green building rating programs, to design quality housing for their communities. * Individuals with asthma and their families can use methods highlighted in this study to maintain healthier homes and decrease environmental triggers of asthma.

The recent interest in eco-friendly living has led toward the emergence of environmentally sustainable construction practices. While the health benefits of an environmentally sound built environment can be imagined intuitively, little evidence-based data exists regarding specific health outcomes, particularly asthma. The purpose of this project is to document the effects of Leadership in Energy and Environmental Design (LEED) certified, affordable housing on respiratory health. We studied tenants moving into Melrose Commons V (MC V), a 63-unit LEED-certified apartment building in the South Bronx. We initially visited each family at their current residence, where participants were interviewed using our respiratory health questionnaire. Lung function testing and environmental assessment, including particulate matter (PM2.5) sampling, were also conducted. After participants move into MC V, spirometry is conducted every 3 months and a full assessment, including questionnaire and environmental sampling, is conducted at 6 month and 1 year intervals. At the 6-month visit, comprehensive environmental asthma education is offered to families. We expect that functional respiratory status will improve in tenants after moving into an environment with improved ventilation and built with green building materials. Our findings will help to support the expansion of low-income green housing in high asthma-prevalence communities.