This 2020 electron microscope made available by the U.S. Centers for Disease Control and Prevention image shows the spherical coronavirus particles from the first U.S. case of COVID-19. On Monday, May 4, 2020, New York City health authorities issued an alert to doctors about severe inflammatory condition possibly linked with COVID-19 has been found in a cluster of U.S. children in New York City after first being reported in Europe. On Wednesday, New York said 64 potential cases had been reported to the state. Fever, abdominal pain and skin rashes are common symptoms of the unnamed condition, which has features similar to Kawasaki disease and toxic shock syndrome.
United States Center for Disease Control and Prevention (CDC) has issued an alert that a disease appearing in children in recent weeks may be linked to coronavirus. The disease in question is being referred to as -- MIS-C (Multisystem Inflammatory Syndrome in Children). It was first reported in April in UK, but since then, cases have appeared in other countries including the US.
“MIS-C also should be considered in pediatric deaths with evidence of SARS-CoV-2 [the virus that causes COVID-19]. Health officials and specialists are monitoring the condition closely to learn more about risk factors and clinical course,” the CDC notice reads.
Symptoms of MIS-C include fever, abdominal pain, diarrhea, vomiting, skin color changes, rashes and labored breathing.
A 9-year-old boy in France who had earlier tested positive for coronavirus has died due to MIS-C. This is the first casualty in France linked to this particular inflammatory disease.
New York Governor Andrew Cuomo had reported a week earlier that 3 children in the state had died of the disease. He also later went on to say that there are over 100 known cases of this illness in New York.
According to the American Academy of Pediatrics, “clinicians should report suspected cases to their state, local or territorial health departments even if the patient also fulfills all or part of the criteria for Kawasaki disease.”
“Parents really shouldn’t be afraid to take their child to their pediatrician if they’re worried they’re sick. They should also, of course, make sure they are keeping up on their well-child care and their vaccinations. The diseases we prevent with vaccines are actually much more severe in children than COVID-19, so we want to make sure to protect children from those diseases," said Sean T. O'Leary, a member of the American Academy of Pediatrics Committee.
Background of MIS-C
On April 26, 2020, clinicians in the United Kingdom (UK) recognized increased reports of previously healthy children presenting with a severe inflammatory syndrome with Kawasaki disease-like features.1 The cases occurred in children testing positive for current or recent infection by SARS-CoV-2, the novel coronavirus that causes COVID-19, based on reverse-transcriptase polymerase chain reaction (RT-PCR) or serologic assay, or who had an epidemiologic link to a COVID-19 case. Patients presented with a persistent fever and a constellation of symptoms including hypotension, multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic) involvement, and elevated inflammatory markers.2 Respiratory symptoms were not present in all cases.
Eight cases, including one death, from the UK were described in a recent publication.3 In the limited sample of 8 children, it was reported that 75% of the patients were of Afro-Caribbean descent and 62.5% were male. The report also indicated that all 8 patients tested positive for SARS-CoV-2 through antibody testing, including the patient that died.3
During March and April, cases of COVID-19 rapidly increased in New York City and New York State. In early May 2020, the New York City Department of Health and Mental Hygiene received reports of children with multisystem inflammatory syndrome. From April 16 through May 4, 2020, 15 patients aged 2-15 years were hospitalized, many requiring admission to the intensive care unit. As of May 12, 2020, the New York State Department of Health identified 102 patients (including patients from New York City) with similar presentations, many of whom tested positive for SARS-CoV-2 infection by RT-PCR or serologic assay. New York State and New York City continue to receive additional reports of suspected cases.
Additional reports of children presenting with severe inflammatory syndrome with a laboratory-confirmed case of COVID-19 or an epidemiological link to a COVID-19 case have been reported by authorities in other countries.4
It is currently unknown if multisystem inflammatory syndrome is specific to children or if it also occurs in adults.
There is limited information currently available about risk factors, pathogenesis, clinical course, and treatment for MIS-C. CDC is requesting healthcare providers report suspected cases to public health authorities to better characterize this newly recognized condition in the pediatric population.
CDC's Recommendations
Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to their local, state, or territorial health department.
