BRIEF REPORTS
Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in Children
with a History of Multisystem Inflammatory Syndrome in Children:
An International Survey
Levi Hoste, MD1,2, MIS-C researchers*, Antoni Soriano-Arandes, MD, PhD3, Emilie Pauline Buddingh, MD, PhD4,
Elizabeth Whittaker, MD, PhD5,6, Alexandre Belot, MD, PhD7, Rolando Ulloa-Gutierrez, MD8, Peter Olbrich, MD, PhD9,10,†,
and Filomeen Haerynck, MD, PhD1,2,†
The optimal severe acute respiratory syndrome coronavirus 2 vaccine strategy for patients with a history of multi-
system inflammatory syndrome in children (MIS-C) is unclear. We performed an international survey (32 countries)
and found substantial variations in vaccine policies. Respondents did not report relapses of MIS-C or other severe
inflammatory side effects after severe acute respiratory syndrome coronavirus 2 vaccination in 273 patients with a
history of MIS-C. (J Pediatr 2022;248:114-8).
I
n approximately 1 in 3000 to 5000 severe acute respiratory SARS-CoV-2 spike, S1, and nucleocapsid antigens have
syndrome coronavirus 2 (SARS-CoV-2) infections, multi- been detected in plasma of patients with MIS-C.14
system inflammatory syndrome in children (MIS-C) oc- Currently approved pediatric vaccines against coronavirus
curs with a severe and potentially life-threatening disease disease 2019 are mRNA-based and encode for the SARS-
course (1%-2% mortality).1-3 MIS-C primarily affects previ- CoV-2 spike protein.15-17 SARS-CoV-2 vaccination generally
ously healthy children between 6 and 10 years of age.2,3 Be- is well tolerated, even in young children.18 Nevertheless, rare
sides high-grade fever, the clinical spectrum includes but severe inflammatory events have been documented after
gastrointestinal, cardiovascular, dermatologic, and neuro- SARS-CoV-2 vaccination, such as myocarditis in young
logic symptoms.3,4 In addition to supportive care, most pa- (male) adults,19 or broader multisystem inflammation
tients are treated with immunomodulatory therapies, (MIS after SARS-CoV-2 vaccination) in adolescents or
including 1 or more of intravenous immunoglobulin, sys- adults.20-26 In children who previously experienced MIS-C,
temic corticosteroid, and a biologic response–modifying re-exposure to the viral protein could trigger a relapse of hy-
agent.5 Pediatric SARS-CoV-2–related hospitalizations perinflammation, especially with a presumed superantigen
increased during the more recent omicron surge, both in underlying the pathophysiology of MIS-C. To date, limited
relative (18% of hospitalizations in South Africa were chil- data are available in children receiving SARS-CoV-2 vaccina-
dren)6 and absolute numbers (4-5 times as many children tion after MIS-C. We performed an international survey
hospitalized in the US compared with delta surge).7 To
date, it is unclear how the incidence of MIS-C evolves with
different SARS-CoV-2 variants, although a recent preprint
From the 1Primary Immune Deficiency Research Laboratory, Department of Internal
suggests a lower risk for MIS-C when delta and omicron Diseases and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell
were dominant compared with alpha lineage.8 Diagnosis and Research Centre, and 2Department of Internal Medicine and
Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Inborn Errors
Although the pathophysiology of MIS-C remains enig- of Immunity, Ghent University Hospital, Ghent, Belgium; 3Pediatric Infectious
Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron (HUVH),
matic, data show activation of oligoclonally expanded T lym- Barcelona, Spain; 4Department of Pediatrics, Leiden University Medical Centre,
Leiden, The Netherlands; 5Paediatric Infectious Diseases, Imperial College
phocytes, reminiscent of disease driven by superantigen Healthcare NHS Trust, London, United Kingdom; 6Section of Paediatric Infectious
exposure such as in toxic shock syndrome. In MIS-C, howev- Diseases, Imperial College, London, United Kingdom; 7Pediatric Nephrology
Rheumatology and Dermatology, CHU Lyon, Lyon, France; 8Servicio de Infectologıa
er, upregulated T lymphocytes associated with MIS-C harbor Pediatrica, Hospital Nacional de Nin~os “Dr Carlos Sa enz Herrera,” Centro de
Ciencias Me dicas, Caja Costarricense de Seguro Social (C.C.S.S.), San Jose , Costa
the TRBV11-2 gene, encoding for the T-cell receptor Vb 21.3, 9
Rica; Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital
which appears to be a highly sensitive and specific feature.9-12 Universitario Virgen del Rocıo, Instituto de Biomedicina de Sevilla, IBiS/Universidad
de Sevilla/CSIC, Red de Investigacio n Traslacional en Infectologıa Pedia
trica RITIP,
Although the exact source of superantigen in MIS-C remains Sevilla, Spain; and 10Departamento de Farmacologıa, Pediatrıa y Radiologıa,
Facultad de Medicina, Universidad de Sevilla, Spain
unknown, persistence of viral exposure is one of the possibil- *List of MIS-C researchers is available at www.jpeds.com (Appendix 1).
ities, given that widespread replication of SARS-CoV-2 has †Contributed equally.
been demonstrated in deceased patients with MIS-C13 and L.H. was funded by the VIB Grand Challenge Programs and FWO-TBM (T004721N).
F.H. is supported by Ghent University research grant (BOF-UGent), VIB Grand
Challenges Programs, and the Jeffrey Modell Foundation. A.S.-A. is supported by
the Departments of Health and Education of the Government of Catalonia (Spain) for
the coronavirus disease 2019 Sentinel School Network project. P.O. has received
s, JR18/00042),
funding by the Instituto de Salud Carlos III (Contrato Juan Rode
AE Adverse event
Madrid, Spain. The authors declare no conflicts of interest.
MIS-C Multisystem inflammatory syndrome in children
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 0022-3476/$ - see front matter. ª 2022 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jpeds.2022.05.028
114
Volume 248 September 2022
among health care professionals to assess experience with excluded after personal communication with the involved
tolerability of SARS-CoV-2 vaccine in children with a history respondents. Given the study design, overall survey
of MIS-C. response rates and subsequently any comparisons between
survey respondents with nonrespondents could not be
Methods performed. On an individual patient level, no identifiable
information was collected. Data were collected from
Our cross-sectional electronic survey (Appendix 2; available November 1, 2021, to December 15, 2021.
at www.jpeds.com) was composed of 24 questions covering
vaccination policies used for children with previous MIS-C
(local, regional, and/or national guidelines); number of
children with a history of MIS-C who were or were not Results
(yet) vaccinated against SARS-CoV-2; and identification of
uncommon adverse events (AEs), codified as possible, Health care professionals (n = 132) involved in the care of pa-
probable, or certain, occurring after SARS-CoV-2 tients with MIS-C initiated the survey. After excluding incom-
vaccination in these children. Respondents were asked to plete entries, we collected complete data from 83 health care
specify whether the entered cases were counted accurately professionals from 32 different countries (Figure 1). Most
(eg, registered as cases) or as estimated numbers. The respondents were clinicians (79/83) and/or clinical
survey link was distributed globally through personal researchers (21/83). Medical specialties included pediatrics
communication by the authors and through email (53/83), pediatric infectious diseases (23/83), cardiology (13/
invitations by multiple professional (inter)national societies 83), immunology (8/83), intensive care and emergency
of pediatrics, infectious diseases, intensive care medicine, medicine (8/83), rheumatology (7/83), and dermatology (1/
inborn errors of immunity, Kawasaki disease/MIS-C 83). Four entries were excluded because of probable or
networks, and clinical trials networks. Participants also confirmed overlapping data. After we excluded these cases,
were asked to distribute the survey invitation to other information from 5673 patients with MIS-C was analyzed
colleagues involved in MIS-C care. The professional (Figure 2). In total, 3465 of these cases were accurately
background of respondents was evaluated to confirm counted and 2208 were reported as estimated case numbers
relevant roles in care and/or policymaking regarding of patients with MIS-C; 44% of the patients had been
patients with MIS-C. IP addresses were verified to ensure admitted to intensive care units during their MIS-C episode.
the uniqueness of each participant. Possible overlapping Of the eligible cohort only 15.6% (273/1750) were
data (eg, national data that included regional counts) were confirmed to have been vaccinated (24.0% [420/1750]).
Figure 1. World map with countries colored that are represented in the dataset. For each country, the number of respondents (n)
is mentioned as well as the number of patients with MIS-C who were reported. Map created by mapchart.net.
Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in Children with a History of Multisystem 115
Inflammatory Syndrome in Children: An International Survey
THE JOURNAL OF PEDIATRICS www.jpeds.com Volume 248
well as safety concerns (9/14). Furthermore, 9 participants
stated deviation from the standard vaccine regimen for these
children compared with previously healthy children without
MIS-C or SARS-CoV-2 infection. Recommendations
included a minimal interval between MIS-C and administra-
tion of the first vaccine dose ranging from 3 months (respon-
dents from Italy, Spain, Sweden, Turkey, United Kingdom,
Uruguay, and US) up to 6 months (The Netherlands, United
Kingdom). Some respondents declared intent to administer
only 1 dose instead of the typical 2-dose regimen (Italy,
Spain, and Switzerland).
Most children with previous MIS-C were vaccinated in
the same locations as healthy children according to local
health authority guidelines, such as vaccination centers or
schools (n = 45 respondents), hospitals without admission
(n = 3 from India, Italy and Turkey), or hospitals with
admission (n = 13 from Belgium, South Korea, Colombia,
Indonesia, Spain, Turkey, India, Italy, US). Only 1 respon-
dent from Italy declared that vaccination in a hospital
without admission was a specific procedure for MIS-C not
applying to healthy children.
Tolerability of SARS-CoV-2 Vaccine
Most respondents (54 of 65 entries without contraindication
for vaccination) could not provide specific data on mild or
moderate AE, either because there was lack of formal registra-
tion and/or that respondents were not at all confronted with
Figure 2. Flowchart representing the selection process of these specific AE in patients. Of registered data, mild or mod-
included entries, number of patients with MIS-C reported, and erate AE was reported to a variable extent, including both
their eligibility for COVID-19 vaccination. COVID-19, corona- localized reactions (swelling, redness, pain) and systemic re-
virus disease 2019. sponses (fever, chills, nausea, fatigue, headache, lymphade-
nopathy). As such, frequencies of AEs for individual entries
ranged from 0 to 100% of patients, although importantly,
Patients Who Received the SARS-CoV-2 Vaccine all mild or moderate AEs disappeared after 1-3 days without
As stated by the participants at the time of the survey, 1750 requiring specific interventions. One 13-year-old male recip-
patients with MIS-C (30.8% of the study cohort) were eligible ient was reported with acute-onset facial nerve palsy (Bell’s
by age, vaccine availability, and time since the episode of palsy) 1 week after his second BNT162b2 (Pfizer-BioNTech)
MIS-C for vaccination. In total, 273 (15.6% of eligible pa- vaccine. He was hospitalized and given methylprednisolone
tients) were confirmed to have been vaccinated at the time (40 mg/d) and recovered without sequelae. No other severe
of the survey. For an additional 420 cases (24.0% of eligible AE was reported by the participants. Importantly, no MIS-
patients), respondents assumed vaccine administration based C relapse or any other inflammatory conditions were re-
on the absence of formal contraindication, although no regis- ported after vaccination.
tration or follow-up was performed. This included 81 accu-
rately counted cases and 339 based on estimate numbers. Discussion
Policy and Practice The survey documents heterogeneity of vaccine policy as well
Fourteen of 79 (17.7%) respondents from Belgium, France, as limited data on vaccination after recovery from MIS-C.
India, Italy, Mexico, Pakistan, Turkey, and the US declared Our data suggest that vaccine recommendations or their un-
MIS-C as a contraindication for SARS-CoV-2 vaccination derstanding or both in the context of MIS-C not only differ
at the time of the survey, accounting for 1144 patients between continents and health care systems but also within
(20.2% of the cohort). Of note, not all respondents from countries. Potential harms and benefits of SARS-CoV-2
the same country declared MIS-C as a contraindication (eg, vaccination in children with a history of MIS-C may be
Belgium 7 of 12 respondents, Italy 1/6, Turkey 1/5, US 1/ weighted differently in each setting. Individual choices or
7), suggesting heterogeneous policies or their knowledge on concerns regarding vaccine safety also might exist. Although
a national level. The participants affirmed that vaccination SARS-CoV-2 vaccination was not contraindicated in patients
was contraindicated in their settings due to recommenda- according to the Centers for Disease Control and Prevention
tions of national or regional guidelines (9/14 regions) as guidelines, we observed a heterogeneous advice within
116 Hoste et al
September 2022 BRIEF REPORTS
respondents from the US.27 Although in most countries AEs with MIS-C worldwide who chose to participate and should
of vaccines and drugs are registered centrally by health care be interpreted as such. n
agencies, the rarity of MIS-C and the absence of registries
documenting follow up of vaccination episodes in affected The authors express their sincere gratitude to all collaborating partners,
patients leads to a lack of specific knowledge regarding toler- including Chiara Biazzo, for the relevant literature search. MIS-C re-
ability of SARS-CoV-2 vaccination in these children. searchers who provided data for their hospital (network), region, or
country are listed in Appendix 1.
We found that in most regions around the world, MIS-C is
not considered a contraindication for SARS-CoV-2 vaccina- Submitted for publication Feb 11, 2022; last revision received Apr 25, 2022;
tion. In addition, respondents stated that 273 patients effec- accepted May 16, 2022.
tively received at least 1 dose of SARS-CoV-2 vaccine after Reprint requests: Filomeen Haerynck, MD, PhD, Department of Pediatric
MIS-C. There was no overt experience of increased frequency Pulmonology, Infectious Diseases and Immunology, Ghent University
Hospital, Corneel Heymanslaan 10, Ghent, Belgium. E-mail: filomeen.
or severity of AE and no case of MIS-C relapse or other in- [email protected]
flammatory conditions after vaccination Our observations
are consistent with the overall good safety profile of SARS-
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Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in Children with a History of Multisystem 117
Inflammatory Syndrome in Children: An International Survey
THE JOURNAL OF PEDIATRICS www.jpeds.com Volume 248
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118 Hoste et al
MIS-C researchers
Individual MIS-C professionals that provided data for their hospital (network), region or country are
listed below.
Belgium: Annick Covents - AZ Nikolaas; Ann Verschelde - AZ Sint-Jan Brugge-Oostende; Jelle
Degraeuwe - AZ Maria Middelares Gent; Amaury Delestienne - Europa hospitals Brussels; Emmi Van
Damme - ZNA Middelheim; Petra Schelstraete, Jef Willems, Evelyn Dhont, Joke Dehoorne, Kristof
Vandekerckhove - Ghent University Hospital; Inge Matthijs - AZ Delta Roeselare; Rik De Wolf - UZ
Brussels; Olga Chatzis - University Hospital St-Luc Brussels; Nele Baeck - AZ Jan Palfijn Ghent;
Marguerite Landsberg - Crèches et libéral Bruxelles; Ann De Guchtenaere - AZ Damiaan Oostende;
Catherine Heijmans - CH Jolimont, La Louvière
Brazil: Almeida Flavia - Santa Casa de São Paulo and Sabara Hospital, Rolando Paternina-De La Ossa -
Clinical Hospital of the School of Medicine at the University of São Paulo, Ribeirão Preto; Aline Islabão
- Hospital da Criança de Brasilia José Alencar
Canada: Nagib Dahdah - CHU Sainte-Justine (University of Montreal), Montreal
Chile: Raul Bustos Betanzo - Sanatorio Aleman Concepción Chile
Colombia: Germán Camacho Moreno - HOMI, Fundación Hospital pediatrico La Misericordia,
Universidad Nacional de Colombia; María Claudia Ortega-López - Hospital Infantil Universitario de San
José, Bogotá
Costa Rica : Rolando Ulloa-Gutierrez - Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José ;
REKAMLATINA Network (Red de Enfermedad de Kawasaki en América Laitina).
Denmark: Trine Mogensen - Aarhus University Hospital, Aarhus
Ecuador: Nelly Chavez - Interhospital, Guayaquil
France: Alexandre Belot, Etienne Javouhey - Hospices Civils de Lyon, Lyon ; Brigitte Bader Meunier,
Sylvain Renolleau, Hopital Necker, Paris ; Isabelle Kone-Paut, Hopital Kremlin Bicètre, Paris ; Veronique
Hentgen, CH de Versaille, Le Chesnay ; Francois Angoulvant, Hopital Robert Debré, Paris ; Xavier Iriart,
Hopital Cardiologique, Bordeaux ; Caroline Ovaert, Hopital de La Timone, Marseille ; Loic de Pontual,
Hopital Jean Verdier, Bondy ; Nina Deschamps, CH de St Malo, St Malo ; Christele Gras-Le Guen, CHU
de Nantes, Nantes
Germany: Markus Hufnagel - University Medical Center Freiburg
Greece: Lampros Fotis - National and Kapodistrian University of Athens; Patra Koletsi - Penteli
Children’s Hospital
Guatemala: Shirley Cuan - Hospital Herrera LLerandi, Guatemala City; Andrea Gatica - Hospitales La
Paz
Honduras : Karla Borjas - IHSS/Hospital Maria
India: Sibabratta Patnaik - Kalinga Institute of Medical Sciences, Bhubaneswar; Chandrika Bhat -
Rainbow Children’s Hospital, Bangalore; Ravindra Pawar - D.Y Patil medical college hospital and
research institute, Kadamwadi, Kolhapur, Maharashtra; Abdul Rauf - Baby Memorial Hospital, Calicut,
Kerala; Vineetranjan Gupta - Asian Institute of medical Sciences, Faridabad; Alpana Mohta - Sardar
Patel Medical College, Bikaner, Rajasthan; Supratim Sen - SRCC Children's Hospital, Mumbai
Indonesia: Nina Dwi Putri - Universitas Indonesia, Cipto Mangunkusumo National Center Hospital,
Jakarta
Iraq: Aso Salih - Sulaimani University
Italy: Riccardo Guanà - Regina Margherita Children's Hospital, Turin; Enza D'Auria - Head Allergy Unit-
Vittore Buzzi Children's Hospital-University of Milan; Buonsenso Danilo - Fondazione Policlinico
Universitario A. Gemelli IRCCS, Rome; Minoia Francesca - Fondazione IRCCS Ca' Granda Ospedale
Maggiore Policlinico, Milan; Luana Nosetti - Pediatric Clinic Insubria University Varese; Gabriele
Simonini - Aou Meyer Firenze
Mexico : Emmanuelle Fernandez - Secretaría de Marina
Pakistan: Indus hospital and health network, Badin, Sindh
Panama: Elizabeth Castaño - Hospital del Niño, Panama
Peru: Elmer Zapata Yarlequé - Hospital Cayetano Heredia and Clinica San Felipe, University Professor
at the Universidad Peruana Cayetano Heredia, Lima
Portugal: Ana Reis-Melo - Centro Hospitalar de São João, Porto
South Africa: Arifa Parker - Stellenbosch University, Cape Town
South Korea: Eun Hwa Choi - Seoul National University Hospital, Seoul; Ji Hee Kwak - Kangbuk Samsung
Hospital, Sungkyunkwan University School of Medicine, Seoul
Spain: García-Salido Alberto - Hospital Infantil Universitario Niño Jesús, Madrid; Marta Aboza Garcia
and Olaf Neth- Virgen del Rocío University Hospital, Sevilla; COPEDICAT research network: Antoni
Soriano-Arandes and Jacques Rivière - Hospital Universitari Vall d'Hebron; Pilar Villalobos - Fundació
Salut Empordà, Figueres; Marc García Lorenzo – Hospital Universitari Sant Joan de Reus, Tarragona;
Anna Gatell - Equip Territorial de Pediatria Garraf-Alt Penedès, Barcelona; Abel Martinez-Mejias -
Consorci Sanitari de Terrassa, Barcelona; Borja Guarch-Ibañez - Hospital Universitari Josep Trueta,
Girona; Carlos Herrero - Hospital de Barcelona, Barcelona; Anton Foguet - Hospital d’Olot i Equip
Pediàtric Territorial Garrotxa i Ripollès, Girona; Fernando Paredes and Núria Visa-Reñé - Hospital
Universitari Arnau de Vilanova, Lleida; Gloria Ruiz - Equip de Pediatria dels Pirineus, Alt Urgell i Pallars,
Lleida; Isabel Aguilar - ABS Sant Boi del Llobregat, Barcelona; Maria Esteller - CAP Aldea-Camarles-
l'Ampolla, Tarragona; Montse Ruiz - Hospital Universitari de Vic, Barcelona; Nuria Lopez - Hospital
Universitari del Mar, Barcelona; Romina Conti - Consorci Corporació Sanitària Parc Taulí de Sabadell,
Barcelona; Rosa Maria Pino - Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat,
Barcelona; Teresa Fenollosa - Gran Sol de Badalona, Barcelona; Emiliano Mora - Hospital Universitari
Mútua de Terrassa, Barcelona; Sonia Brio - Hospital de la Santa Creu I Sant Pau, Barcelona; Maria
Coma, Hospital Universitari Joan XXIII, Tarragona.
Sweden: Petter Brodin - Karolinska Institute, Stockholm
Switzerland: Johannes Trück - University Children's Hospital Zurich, University of Zurich; Géraldine
Blanchard Rohner - Geneva University Hospitals and University of Geneva; Michael Buettcher - Lucerne
Children‘s Hospital
The Netherlands: Emmeline Buddingh, Leids Universitair Medisch Centrum, on behalf of the COPP-
consortium: Leids Universitair Medisch Centrum: Gertjan Lugthart, David Slotboom, Anne Verbeek,
Danielle Brinkman, Petra Hissink Muller, Erik von Asmuth; Erasmus MC: Miriam Mooij, Corinne
Buysse, Rianne Oostenbrink, Pieter Fraaij, Naomi Ketharanathan; AUMC: Simone Hashimoto,
Caroline Brackel, Mariken Gruppen, Taco Kuijpers, Merlijn vd Berg, Martijn vd Kuip, Suzanne
Terheggen-Lagro; Maastricht UMC+: Manouk van der Steen, Michiel Bannier; Universitair Medisch
Centrum Groningen: Liesbeth Scholvinck, Wineke Armbrust, Elizabeth Legger; Albert Schweitzer
Ziekenhuis: Ankie Lebon, Radboud UMC: Koen van Aerde, Ronald Petru, Saskia de Wildt; Amphia
Ziekenhuis: Sanne Hammer; Máxima MC: Lonneke van Onzenoort; Zuyderland Medisch Centrum:
Han Hendriks; Isala: Jolita Bekhof; Spaarne Gasthuis: Marlies van Houten; Bernhoven: Jan van der
Linden; Franciscus Gasthuis & Vlietland: Gerdien Tramper; Maasstad Ziekenhuis: Michael
Groeneweg, Xandra van den Tweel; Hagaziekenhuis (Juliana kinderziekenhuis): Esther Peeters,
Denise Rook, Mirjam van Veen; HMC: Jantien Bolt; Groene Hart Ziekenhuis: Helma van Gameren;
Meander Medisch Centrum: Margot Ernst-Kruis; UMC Utrecht: Joanne Wildenbeest, Joris van
Montfrans, Tom Wolfs, Bas Vastert; Alrijne Ziekenhuis: Anjali Kooter-Bechan; Martini Ziekenhuis:
Arvid Kamps; Bravis ziekenhuis: Stephanie de Crom, Christiaan van Woerden; Catharina Ziekenhuis:
Carien Miedema; Prinses Máxima Centrum voor Kinderoncologie: Wim Tissing; Slingeland
Ziekenhuis: Monique Jacobs, Elisabeth-TweeStedenziekenhuis: Charlie Obihara; Gelre Ziekenhuizen:
Annemarie Oudshoorn; St Jansdal Ziekenhuis: Annette Vernooij; Canisius-Wilhelmina Ziekenhuis:
Ingeborg Barts; Dijklander Ziekenhuis: Yolande Thomasse; Ommelander Ziekenhuis Groningen:
Bettina Auffarth; ZorgSaam Ziekenhuis: Joyce Goris; BovenIJ Ziekenhuis: Venje Boonstra; Curacao
Medical Center: Lindy Janssen, Shirley Lo-A-Njoe; Deventer Ziekenhuis: Jenneke Homan-van der
Veen; Elkerliek Ziekenhuis: Marianne Faber, Mijke Breukels; Zaans Medisch Centrum: Maarten
Rijpert, Leontien van der Aa; Tergooiziekenhuizen: Karin Miedema
Turkey: Betul Sozeri - University of health sciences, Istanbul; Gülçin Otar Yener - Şanlıurfa Research
and Education hospital; Yasemin Ozsurekci - Hacettepe University Ihsan Dogramaci Children's Hospital,
Ankara; Aslinur Ozkaya-Parlakay - Ankara City Hospital; Benhur Cetin - Erciyes University, Kayseri,
Turkey
United Kingdom: Ashish Chikermane - Birmingham Children's Hospital; Julia Kenny - Evelina London
Children's Hospital; Stefania Vergnano - Bristol Royal Hospital for Children; Simon Drysdale - St
George's University of London, London, UK; Karyn Moshal - Great Ormond Street Hospital for Children
NHS Foundation Trust, London
Uruguay: Federica Badia De Ferrari - Facultad Medicina Universidad Republica, Montevideo
United States of America: Duraisamy Balaguru - MassGeneral Hospital for Children, Boston, MA;
Matthew Oster - Children's Healthcare of Atlanta, Atlanta, GA, Emory University School of Medicine,
Atlanta, GA; Ashraf Harahsheh and Claire O’Connell Boogaard - Children’s National Hospital; George
Washington University School of Medicine & Health Sciences; NW Washington; Jocelyn Ang - Children's
Hospital of Michigan, Detroit, Michigan, Department of Pediatrics, Central Michigan University College
of Medicine, Mt. Pleasant, Michigan; Yonca Bulut - UCLA, Los Angeles, California; Tyler Harris - UPMC
Children's Hospital of Pittsburgh; Kirsten Dummer - Rady Children's Hospital, UC San Diego; Moshe
Arditi - Cedars Sinai Medical Center, Los Angeles
