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Background and ObjectivesMultisystem inflammatory syndrome of children (MISC) carries a high attributable morbidity. We describe children aged MethodsAll were tested for SARS-CoV-2, infectious disease consultations performed, modified CDC criteria for MISC applied, charts reviewed and data analyzed.ResultsAmong 79 consecutive children with SARS-CoV-2, 41(52%) were hospitalised; with median age 10.5 years; Afro-Caribbean ethnicity 40(98%); males 21(51%); SARS-CoV-2 RT-PCR positivity 26 (63%), IgG/IgM positivity 7(17%), community exposures 8 (20%). MISC-cases 18 (44%) vs. non-MISC 23(56%) had fever (94% vs. 30%; pConclusionMISC was treated successfully with intravenous gammaglobulin, steroids and/or aspirin in 94% before cardiopulmonary decompensation, or need for inotropes, vasopressors, or invasive ventilation.

The Caribbean region is lacking an assessment of the antibody response and side effects experienced after AstraZeneca COVID-19 vaccination (AZD1222). We examined SARS-CoV-2 spike receptor binding domain (RBD) IgG levels and reported side effects in a Jamaican population after AZD1222 vaccination. Median RBD IgG levels for persons without evidence of previous SARS-CoV-2 infection were 43.1 bIU/mL after 3-7 weeks post first dose, rising to 100.1 bIU/mL 3-7 weeks post second dose, and falling 46.9 bIU/mL 16-22 weeks post second dose. The median RBD IgG level 2-8 weeks after symptom onset for unvaccinated SARS-CoV-2 infected persons of all disease severities was 411.6 bIU/mL. Common AZD1222 side effects after first dose were injection site pain, headache and chills. Most persons reported no side effects after second dose. AZD1222 is widely used across the English-speaking Caribbean and the study provides evidence for its continued safe and effective use in vaccination programs.

SARS-CoV-2 seroprevalence in an antenatal population in Kingston, Jamaica was assessed for September-November 2020 in a repeated cross-sectional study using the Abbott Architect SARS-CoV-2 IgG assay. After adjusting for test performance, seroprevalence was 6.9% for September, 16.9% for October, and 24.0% for November. Of the 37 pregnant women testing SARS-CoV-2 IgG positive, only 3 were symptomatic. One symptomatic woman testing SARS-CoV-2 IgG positive had multiple co-morbidities and succumbed to COVID-19 pneumonia. Up to January 31, 2021, 8 women identified as SARS-CoV-2 IgG positive delivered, all without complications. Comparison of test adjusted seroprevalence data with cumulative PCR-confirmed COVID-19 cases within the Kingston Metropolitan Area indicated that as many as 44.4 times more people were infected with SARS-CoV-2 than identified with PCR testing. These findings provide the first evidence for the extent of SARS-CoV-2 infections in Jamaica and will inform future SARS-CoV-2 testing strategies.

The performance of the Roche Elecsys® Anti-SARS-CoV-2, Abbott Architect SARS-CoV-2 IgG, Euroimmun SARS-CoV-2 IgA, Euroimmun SARS-CoV-2 IgG ELISA, and Trillium IgG/IgM rapid assays was evaluated in Jamaica, the largest country of the English-speaking Caribbean. Diagnostic sensitivities of the assays were assessed by testing serum samples from SARS-CoV-2 PCR-confirmed persons. Serum samples collected ≥14 days after onset of symptoms, or ≥14 days after an initial SARS-CoV-2 RT-PCR positive test for asymptomatics, showed diagnostic sensitivities ranging from 67.9-75.0% when including all possible disease severities and increased to 90.0-95.0% when examining those with moderate to critical disease. Grouping moderate to critical disease showed a significant association with a SARS-CoV-2 antibody positive result for all assays. Diagnostic specificity, assessed by testing serum samples collected during 2018-2019 from healthy persons and from persons with antibodies to a wide range of viral infections, ranged from 96.7-100.0%. For all assays examined, SARS-CoV-2 real-time PCR cycle threshold (Ct) values of the initial nasopharyngeal swab sample testing positive were significantly different for samples testing antibody positive versus negative. These data from a predominantly African descent Caribbean population shows comparable diagnostic sensitivities and specificities for all testing platforms assessed and limited utility of these tests for persons with asymptomatic and mild infections.