Breaking News – The CDC issued a Health Alert Network advisory with a case definition on what they are now calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). (see below)
Kids aren’t supposed to get serious COVID-19 symptoms, right?
As we are learning more and more about SARS-CoV-2, that at least seems to be holding true.
That doesn’t mean that kids are unaffected though.
Remember, it is still thought that kids get asymptomatic infections that they can spread to everyone else. And tragically, they sometimes get life-threatening infections.
What is the COVID-19 Multi-System Inflammatory State?
What else are we seeing when kids get SARS-CoV-2?
As they reassure parents that “serious illness as a result of COVID 19 still appears to be a very rare event in children,” the Paediatric Intensive Care Society issued a statement discussing an NHS England email alert about kids presenting with a type of multi-system inflammatory disease.
“The alert indicated ‘the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation’.”PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease
This statement follows the release of a study in Hospital Pediatrics, COVID-19 and Kawasaki Disease: Novel Virus and Novel Case, that discussed a similar case.
“We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms.”Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
And an alert of more frequent cases of Kawasaki disease in France and Italy.
“In several Italian centers, where the incidence of Covid-19 was higher – Professor Ravelli told ANSA – more frequent cases of Kawasaki disease have occurred than we have observed before the arrival of the coronavirus.”Coronavirus: Prof. Ravelli, investigation of Kawasaki disease report (google translated)
And New York.
“The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17-May 1,2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock).”2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19
Following a report of 15 cases in New York City, the New York State Department of Health issued an advisory to healthcare providers about 64 potential cases throughout the state.
And there is now an alert from the CDC on what they are calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).
Most people will find the MIS-C case definition more helpful than the new name.
Also helpful is a recommendation to “report suspected cases to their local, state, or territorial health department.”
“This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.”Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children
So what does this mean?
It likely means that we might be able to add SARS-CoV-2 to the list of possible viruses that can trigger Kawasaki disease.
Or everyone might just be more aware of Kawasaki disease, as there are typically at least 3,000 to 5,000 cases in the United States each year.
“Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD.”Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
And continue to be reassured that “serious illness as a result of COVID-19 still appears to be a very rare event in children.”
“If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care,as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin”2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19
Still, everyone should be on the alert for more cases of Kawasaki right now.
More on COVID-19 in Kids
- Kids and COVID-19
- Why Are Social Distancing Kids Still Getting Sick?
- When to Call Your Pediatrician – COVID-19 Edition
- Can Vaccines Cause Kawasaki Disease?
- CDC – Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)
- PICS Statement regarding novel presentation of multi-system inflammatory disease
- 2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19
- Governor Cuomo Directs the New York State Department of Health to Issue an Advisory Regarding Inflammatory Disease in Children Potentially Related to COVID-19
- Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children
- Top NYC Pediatrician Warns of ‘Alarming New Information’ About COVID-19 and Kids
- Protecting Ontario’s Children with COVID-19
- Massachusetts among 13 states reporting cases of Kawasaki syndrome
- Study – COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
- Study – Possible involvement of infection with human coronavirus 229E, but not NL63, in Kawasaki disease
- Study – Concurrent Respiratory Viruses and Kawasaki Disease.
- What is the new illness affecting children, and is it linked to coronavirus?
- Coronavirus: prof.Ravelli, indagine relazione morbo Kawasaki
- MMWR – Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020
- CDC – COVID-19 Information for Pediatric Healthcare Providers
- Study – SARS-CoV-2 Infection in Children
- Study – Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China
- Kawasaki Disease Foundation
- CDC – Kawasaki disease case definition
- Kawasaki Disease