Assessing the Number of Children Evaluated for Recurrent Fevers During the COVID-19 Pandemic in North America

Leanne Mansfield¹, Sivia Lapidus², Matthew Hollander³, Julie Cherian⁴, Marinka Twilt⁵, Maryam Piram⁶, Lakshmi Moorthy⁷, Brian Nolan⁸, Geraldina Lionetti⁹, Eveline Wu¹⁰, Heather Tory¹¹, Elizabeth Kessler¹², Cassyanne Aguiar¹³, Sirada Panupattanapong¹⁴, Shoghik Akoghlanian¹⁵, Felice Adler-Shohet¹⁶, Melissa Oliver¹⁷, Smriti Mohan¹⁸, Patricia DeLaMora¹⁹, Karen Durrant²⁰, Theresa Wampler Muskardin²¹, Samira Nazzar²², Mariana Correia Marques²³, Matthew Basiaga²⁴, Tiphanie vogel²⁵, Jamie Lai²⁵, Kathryn Edwards²⁶, Kathryn Garguilo²⁶, Sheila Nolan¹⁹, Emily Sheboy Scarcello²⁷, Gabrielle Alonzi²⁸, Ann Szymanski²⁹, Joyce Hui-Yuen³⁰, karen onel³¹, Fatma Dedeoglu³², Maria Gutierrez³³, Grant Schulert³⁴ and CARRA PFAPA/Autoinflammatory Working Group N/A³⁵, ¹Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, ²Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Montclair, NJ, ³University of Vermont Medical Center Children's Hospital, Burlington, VT, ⁴Renaissance School of Medicine at Stony Brook University, Stony Brook Children’s Hospital, Stony Brook, NY, ⁵Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, ⁶CHU Sainte Justine, University of Montreal, Montréal, QC, Canada, ⁷Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, ⁸Ann & Robert H. Lurie Children's Hospital, Chicago, IL, ⁹UCSF Benioff Children's Hospitals, Oakland, CA, ¹⁰University of North Carolina, Chapel Hill, NC, ¹¹Connecticut Children's Medical Center and University of Connecticut School of Medicine, S Glastonbury, CT, ¹²Spectrum Health Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, MI, ¹³Children’s Hospital of The King’s Daughters / Eastern Virginia Medical School, Norfolk, VA, ¹⁴Cleveland Clinic Children's, Cleveland, OH, ¹⁵Division of Rheumatology, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, OH, ¹⁶University of California, Irvine and Children’s Hospital of Orange County, Orange, CA, ¹⁷Indiana University School of Medicine, Indianapolis, IN, ¹⁸University of Michigan Medical School, Ann Arbor, MI, ¹⁹Boston Children's Health Physicians, New York Medical College, Valhalla, NY, ²⁰Autoinflammatory Alliance, San Francisco, CA, ²¹Colton Center for Autoimmunity, NYU School of Medicine, New York, NY, ²²University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, ²³Children's National Health System/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, ²⁴Mayo Clinic, Inver Grove Heights, MN, ²⁵Baylor College of Medicine, Houston, TX, ²⁶Vanderbilt University Medical Center, Nashville, TN, ²⁷Boston Children's Health Physicians, Valhalla, NY, ²⁸Boston Children's Hospital, Boston, MA, ²⁹Johns Hopkins All Children’s Hospital, St. Petersburg, FL, ³⁰Cohen Children’s Medical Center, Hofstra-Northwell School of Medicine, Feinstein Institutes for Medical Research, Queens, NY, ³¹Hospital for Special Surgery, New York, NY, ³²Division of Immunology, Boston Children's Hospital, Boston, MA, ³³Johns Hopkins University School of Medicine, Baltimore, MD, ³⁴Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ³⁵CARRA, Washington, DC

Meeting: ACR Convergence 2022

Keywords: Autoinflammatory diseases, COVID-19, Pediatric rheumatology

Session Information

Date: Monday, November 14, 2022

Title: Pediatric Rheumatology – Clinical Poster III: Other

Session Type: Poster Session D

Session Time: 1:00PM-3:00PM

Background/Purpose: The impact of the COVID-19 pandemic on the number of pediatric patients evaluated in North America for recurrent fevers and autoinflammatory diseases is unknown; however, there have been reports of increased numbers of children presenting with these concerns. The purpose of this project was to determine the number of new patients evaluated for recurrent fevers in temporal relation to the COVID-19 pandemic in North America.

Methods: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis Syndrome (PFAPA)/Autoinflammatory Disease Working Group used previously determined recurrent fever ICD-10 codes, including periodic fever and autoinflammatory syndromes, to quantify monthly numbers of new pediatric patients evaluated for recurrent fever diagnoses by outpatient subspecialists from March 1, 2019 to February 29, 2020 (pre-pandemic) and from March 1, 2020 to February 28, 2021 (during the pandemic). The proportion of new visits evaluated for recurrent fever diagnoses relative to all new visit diagnoses during these two years were compared using a two-sample test of proportions. This study was determined to be IRB exempt by the Cincinnati Children’s Hospital IRB.

Results: Twenty-four sites reported 1684 new patient visits coded with recurrent fever diagnoses pre-pandemic compared with 2181 during the first year of the pandemic. There was an increase in the total number of recurrent fever evaluations after the onset of the pandemic compared to the year prior in 20 of 24 sites (range -48% to +360%). Of the 20 sites who provided the total number of new visits for all diagnoses, there were 19305 new visits pre-pandemic of which 1318 (6.83%) had a recurrent fever code compared to 17040 new visits during the pandemic with 1690 (9.92%) who received a recurrent fever diagnosis code. The difference between the proportion of new recurrent fever evaluations and total number of new visits pre-pandemic versus during the pandemic was statistically significant (p< 0.0001).

Conclusion: Across 24 CARRA-associated North American centers, there was an increase in pediatric patients evaluated for new recurrent fever diagnoses during the first year of the COVID-19 pandemic compared to the year prior, despite a decrease in the total number of new patients. An increase in recurrent fever evaluations merits further investigation given that many daycare centers and schools were closed during a time of increased infection control precautions and attention to fevers. A speculated potential etiology is that unknown, noninfectious triggers precipitate recurrent fever syndromes. The CARRA PFAPA/Autoinflammatory Disease Working Group’s project is the first collaborative, multidisciplinary effort to assess the number of children evaluated for recurrent fevers in relation to the COVID-19 pandemic in North America.

Disclosures: L. Mansfield, None; S. Lapidus, None; M. Hollander, None; J. Cherian, None; M. Twilt, None; M. Piram, Novartis, Pierre Fabre dermatology, L'Oréal, Patent Valor; L. Moorthy, Bristol-Myers Squibb(BMS); B. Nolan, Sobi; G. Lionetti, None; E. Wu, Pharming Healthcare Inc, AstraZeneca, Bristol-Myers Squibb(BMS), Janssen; H. Tory, None; E. Kessler, None; C. Aguiar, None; S. Panupattanapong, None; S. Akoghlanian, None; F. Adler-Shohet, Bio tech, Moderna, Sequirus; M. Oliver, None; S. Mohan, None; P. DeLaMora, None; K. Durrant, None; T. Wampler Muskardin, None; S. Nazzar, None; M. Correia Marques, None; M. Basiaga, None; T. vogel, Sobi, Novartis, Pfizer, Moderna; J. Lai, None; K. Edwards, Sanofi, Pfizer, Roche, Moderna, Merck/MSD, GlaxoSmithKline, Bionet, X-4 Pharma; K. Garguilo, None; S. Nolan, None; E. Sheboy Scarcello, None; G. Alonzi, None; A. Szymanski, None; J. Hui-Yuen, None; k. onel, None; F. Dedeoglu, Novartis; M. Gutierrez, None; G. Schulert, Novartis, SOBI; C. N/A, Novartis, SOBI.

To cite this abstract in AMA style:

Mansfield L, Lapidus S, Hollander M, Cherian J, Twilt M, Piram M, Moorthy L, Nolan B, Lionetti G, Wu E, Tory H, Kessler E, Aguiar C, Panupattanapong S, Akoghlanian S, Adler-Shohet F, Oliver M, Mohan S, DeLaMora P, Durrant K, Wampler Muskardin T, Nazzar S, Correia Marques M, Basiaga M, vogel T, Lai J, Edwards K, Garguilo K, Nolan S, Sheboy Scarcello E, Alonzi G, Szymanski A, Hui-Yuen J, onel k, Dedeoglu F, Gutierrez M, Schulert G, N/A C. Assessing the Number of Children Evaluated for Recurrent Fevers During the COVID-19 Pandemic in North America [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/assessing-the-number-of-children-evaluated-for-recurrent-fevers-during-the-covid-19-pandemic-in-north-america/. Accessed .

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