COVID-19 in a Subset of Hospitalized Children in Israel

Shalom Ben-Shimol, Gilat Livni, Orli Megged, David Greenberg, Dana Danino, Ilan Youngster, Yael Shachor-Meyouhas, Halima Dabaja-Younis, Oded Scheuerman, Meirav Mor, Eli Somekh, Husam Yakub Hanna, Noga Givon-Lavi, Alex Guri, Eugene Leibovitz, Yoav Alkan, Daniel Grupel, Uri Rubinstein, Zohar Steinberg Ben Zeev, Ellen BambergerAmir Asher Kuperman, Galia Grisaru-Soen, Diana Tasher, Giora Gottesman, Daniel Glikman, Michal Stein

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. Methods: An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). Results: Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P <. 001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. Conclusions: At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.

Original languageEnglish
Pages (from-to)757-765
Number of pages9
JournalJournal of the Pediatric Infectious Diseases Society
Issue number7
StatePublished - 1 Jul 2021


  • SARS-CoV-2
  • children
  • coronavirus disease 2019 (COVID-19)
  • multisystem inflammatory syndrome in children (MIS-C)
  • pediatric inflammatory multisystem syndrome (PIMS)

ASJC Scopus subject areas

  • Medicine (all)


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