Freedom from infections for all children. That’s always been the vision of the Pediatric Infectious Diseases Society. But from this day forward, we must also acknowledge that structural racism is more harmful to the health and well-being of children than infectious diseases, including COVID-19.

Dear Prospective Fellowship Applicant,

Thank you for your interest in pediatric infectious diseases, an incredibly diverse and rewarding specialty. As evidenced by the ongoing COVID-19 pandemic, pediatric infectious diseases physicians have never been more important nor their duties more diverse. This pandemic has highlighted the wide array of career paths available to a pediatric infectious diseases’ specialist; everything from clinical care, disaster planning, infection prevention and control, antimicrobial and diagnostic stewardship, immunology, microbial pathogenesis, vaccine development, epidemiology and public health, public relations, and social determinants of health. We need you to join this exciting profession and we are committed to helping you find your particular niche within it.

The PIDS Foundation is pleased to announce the 2020 call for applications for the ASP Fellowship Award.  The goal of this award is to support the development of future researchers in pediatric antimicrobial stewardship by providing mentorship to complete a scholarly research project in a timely manner during fellowship or residency.  Fostering trainees who have an interest in ASP is important for continuous improvement in patient safety and ensures the continued efficacy of antibiotics.

Past awardees indicated the value of the ASP Fellowship Award.  “Being awarded the PIDS ASP Fellowship Award at the start of my 2nd year of fellowship served not only to solidify that interest, but afforded me the incredible opportunity to personally connect with and learn from leaders in the field of AS” said Dr. Candance (CeCe) Johnson, Columbia University.  “The award provided the means for me to pursue an exploration of the use of AS strategies in an understudied healthcare setting (pediatric post-acute care facilities); even more it also supplied me with tools and resources that served to strengthen my foundational knowledge of AS and with invaluable connections that have continued to keep me abreast of the latest developments in the world of stewardship.”

Dr. Sophie Katz, Vanderbilt University, said “receiving the ASP Fellowship Award was a great opportunity as it allowed mentorship from anywhere around the globe.”  “It was also helpful to have the accomplishment on my CV,” added Dr. Katz.

Applicants may propose any type of study focusing on antimicrobial stewardship. The project should be able to be completed in one year, and the award will provide travel funds for awardees to present their work at the annual Pediatric Antimicrobial Stewardship Conference in St. Louis.  Applicants wishing to discuss a project proposal pre-submission may email This email address is being protected from spambots. You need JavaScript enabled to view it..
 The application deadline for the 2020 ASP Fellowship Award cycle is Thursday, July 2nd.  Submission and other details can be viewed by clicking here.  For questions, please email Christy Phillips at This email address is being protected from spambots. You need JavaScript enabled to view it..

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So… how are you doing? I understand the answer may not be straightforward. The SARS-CoV-2 pandemic has created exceptional challenges over the last several months. Please let me know how the Society can offer you support during this time and I pledge to you that we will try.

I thought this letter would be a good opportunity to highlight some of the important work done by our members relative to the pandemic.

  1. What’s in a name?
    • Europe/UK: Paediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 infection (PMIS-TS or PIMS)
    • United States: Multi-system Inflammatory Syndrome in Children (MIS-C)
  2. Whatever you call it, in both Europe and US, there has been a temporal association of MIS-C cases being reported to occur approximately 4 weeks after the start of documented SARS-CoV-2 transmission in communities. Whether MIS-C is caused by the virus, a post-viral immune response, or other etiology is currently unknown.
  3. Time (and a comprehensive evaluation to understand immunopathogenesis!) will provide further evidence to inform whether MIS-C is indeed one condition or a manifestation of a disease spectrum, as yet not fully characterized. Currently, there are interim MIS-C case definitions to guide clinicians:
  4. While the clinical findings in MIS-C overlap with several other syndromes including toxic shock syndrome, Kawasaki disease (incomplete, KD shock), macrophage activation syndrome/hemophagocytic lymphohistiocytosis, and cytokine release syndrome, MIS-C appears to be a distinct syndrome. Similarities and differences were highlighted throughout the call.
  5. Children with MIS-C that require hospitalization have varied symptoms at presentation – these symptoms are distinct from those seen in acute, severe COVID-19. Patients with MIS-C have fever and GI symptoms (abdominal pain, diarrhea) consistently reported. The majority of reported patients (≥ 65%) with MIS-C progress to shock, which may be cardiogenic, distributive, hypovolemic, or some combination of the three. All patients develop ≥ 1 organ dysfunction – most frequently with myocardial impairment suggesting a cardiac injury similar to myocarditis; renal/AKI, GI/hepatitis, hematologic, CNS/neurologic, etc. Notably, few patients have respiratory symptoms and the need for mechanical ventilation is more often to support cardiac function or facilitate procedures than a primary pulmonary process.
  6. Initial labs in patients with MIS-C are notable for neutrophilia, lymphopenia, thrombocytopenia, and over-exuberant immune profile including markedly elevated CRP, PCT, d-dimer, ferritin, and IL-6. Markers of cardiac injury or dysfunction including troponin and BNP are abnormal. Concurrent infections are rare. Few patients have detection of SARS-CoV-2 PCR (nasopharyngeal and stool) at presentation, but most patients do have detectable antibodies (multiple platforms used)
  7. Echocardiographic findings early on often demonstrate impaired left ventricular function of variable severity as well as coronary artery dilations and rarely, coronary artery aneurysms. Serial echocardiography and follow up with cardiology should be ensured
  8. The optimal management of MIS-C beyond intensive care support to reverse shock is unknown and best practices are evolving. Many centers consider use of IVIG, including in in patients who satisfy 2017 AHA KD criteria; some centers also prescribe other immunomodulators (corticosteroids, anakinra, infliximab, and less frequently tocilizumab) in patients with ongoing inflammation. ID physicians are strongly encouraged (as always) to participate in multi-disciplinary discussions with local institutional experts in intensive care, rheumatology, cardiology, hematology, etc to develop best management plans for individual patients.
  9. Understanding the immunopathogenesis of MIS-C will allow us to provide targeted therapies. There are research efforts ongoing and clinicians are encouraged to contribute to the advancement of the science.
  10. Unknowns: a lot! MIS-C needs thoughtful, systematic study, and ongoing, multi-disciplinary collaboration. #WeAreID (pedsID, that is!)

No doubt we have all been consumed with COVID 19 over these past many weeks. It is almost hard to recall life and work before this predicable, and yet still surprising pandemic overtook them. But there was indeed activity BC*

The burden of COVID-19 in children has been small compared with adults; children under 18 years of age comprising <2% of all cases. Recently, a syndrome resembling Kawasaki Disease (KD) has been described in children with current or recent infection with SARS-CoV-2. Since then, additional cases have been identified, including 15 patients reported to the New York City Department of Health. As a result, the CDC recently distributed a health advisory through the Health Alert Network for Healthcare providers to report similar cases to their local, state, or territorial health department. These two articles, published online in the past two weeks, describe clusters of cases of a hyperinflammatory syndrome (Kawasaki-like) in South East England and the Lombardy region of Italy.

With numerous clinical trials of novel and repurposed therapies for COVID-19 now underway or under rapid development, a recent JAMA Pediatrics viewpoint article highlighted importance of including children in such trials. Among 275 COVID-19 interventional clinical trials registered on ClinicalTrials.gov from Feb. 1 to April 11, 2020, only 30 were open to patients younger than the age of 18, according to the article.

Vaccinating children against infectious diseases is one of the most effective public health interventions of modern times, reducing the incidence of many diseases and saving millions of lives in the U.S. every year. These benefits, however, are threatened when immunization rates drop, either because of vaccine hesitancy among parents or more recently, because of disruptions to health care delivery because of the COVID-19 pandemic. This week, the Pediatric Infectious Diseases Society (PIDS), in collaboration with partners at Children’s Mercy Kansas City in Kansas City, Missouri, and Vanderbilt University Medical Center in Nashville, Tennessee, is launching Vaccine Education from Training to Practice, a new educational program designed to provide health care providers with training and resources they need to be strong advocates for childhood immunizations and support high immunization rates.

In December 2019, a cluster of cases of pneumonia of unknown origin was reported in Wuhan, China. This was subsequently etiologically attributed to a novel RNA virus of the coronavirus family that has phylogenetic similarity to severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). Termed 2019 coronavirus disease (COVID-19) by the WHO, it has been designated as public health emergency of international concern (PHEIC). The literature has largely reported the epidemiological and clinical characteristics of COVID-19 in adult patients, and scarcely in children. This present study is the largest epidemiological case series of pediatric COVID patients to date.

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Dr. Mobeen Rathore is a Professor and Associate Chair at the University of Florida (UF) and Hospital Epidemiologist and Chief of Pediatric Infectious Diseases and Immunology at Wolfson Children’s Hospital, in Jacksonville, Florida. He is the founding director of the UF Center for HIV/AIDS Research, Education and Service (UF CARES).

He received his medical degree from King Edward Medical College in Lahore, Pakistan, completed his pediatric residency at Akron Children’s Hospital and his pediatric infectious diseases fellowship at Washington University in St. Louis and St. Louis University. As chair of the Infection Control Committee for the five-hospital Baptist Health System, he has been very active in the COVID-19 pandemic response.

Immunizing children may be a powerful tool in the effort to combat antimicrobial resistance globally, a recent study in Nature suggests. The new research found that pneumococcal conjugate and rotavirus vaccines prevent 23.8 million and 13.6 million illnesses, respectively, each year in children under 5 years old in low- and middle-income countries that would otherwise be treated with antibiotics. The study, using data from health and demographic studies of 78 countries, published April 29.

Over the past two months, first in Europe, and more recently principally in cities along the East Coast of the United States, with some now also reported in the Midwest and South, a small number of children have developed a more serious inflammatory syndrome in temporal association with COVID-19 in the community, often leading to hospitalization, and occasionally requiring intensive care. Children with SARS-CoV2-associated pediatric multisystem inflammatory syndrome have persistent fever, inflammation, evidence of poor function in a single organ or many organs, and other specific clinical and laboratory features, in the absence of other known infections. Some these children have part or all of the features seen in Kawasaki Syndrome.

In order to promote awareness of this newly emerged phenotype, please read the media statement (linked below) which contains important information about case definition, proposed lab testing, and evaluation.

Statement to the Media following the 2 May Pediatric Intensive Care-COVID-19 International Collaborative Conference Call (pdf)

As pediatric practices work to adapt to the COVID-19 pandemic and still provide routine care, concerns about missed opportunities to vaccinate children are growing. Pediatricians across the country are reporting that some parents are cancelling routine checkups and vaccination appointments, including for first-time vaccinations for infants, according to an April 11 article in The Washington Post. Many practices are also delaying booster shots for older children, the article noted. A similar report appeared in The New York Times on April 23.

The Centers for Disease Control and Protection (CDC) recently issued guidance for maintaining immunizations during the current pandemic in the U.S., as has the American Academy of Pediatrics and the American Academy of Family Physicians. Globally, more than 117 million children in 37 countries may not receive measles vaccines, according to the Measles & Rubella Initiative, a partnership founded by the American Red Cross, CDC, UNICEF, the United Nations Foundation, and the World Health Organization. Measles immunization campaigns in 24 countries have already been delayed, the group said in an April 14 news release.

The concerns come as health care providers, advocates, and others prepare to mark National Infant Immunization Week (April 25 - May 2) and World Immunization Week (April 24 - 30), annual observances that highlight the benefits of vaccination in the U.S and around the world.

There have been recent articles related to COVID-19 published in the Society’s journal, the Journal of the Pediatric Infectious Diseases Society (JPIDS). They include articles authored by the SHARPS Collaborative, titled, “Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2”; Dr. Matthew Kan et al, “Fever without a source in a young infant due to SARS-CoV-2”; and Dr. Ogimi et al, “What’s new with the old coronaviruses?”. Feel free to peruse the JPIDS website to read the full articles. We also encourage PIDS members to consider submitting your next manuscript to JPIDS.

Background: Following the emergence of SARS-CoV-2 in Wuhan, China in December 2019, early epidemiological reports using data reported to the Chinese government suggested that increasing age was associated with severe symptoms and poor clinical outcomes. Although these reports identified SARS-CoV-2 infection in children, they did not provide thorough clinical descriptions or details of outcomes.