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COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020
Insights
Multisystem inflammatory syndrome in children (MIS-C) emerged during the COVID-19 pandemic, presenting with hyperinflammatory shock. Early recognition and reporting are crucial for understanding and treating this condition in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Critical Care Medicine
Background:
- A novel hyperinflammatory syndrome in children, termed multisystem inflammatory syndrome in children (MIS-C), emerged during the COVID-19 pandemic.
- Initial reports from England described pediatric patients with shock and features resembling Kawasaki disease and toxic shock syndrome, temporally linked to SARS-CoV-2 infection.
- The Centers for Disease Control and Prevention (CDC) issued a Health Advisory to guide clinicians in identifying and reporting suspected MIS-C cases in the U.S.
Purpose of the Study:
- To summarize the clinical manifestations and epidemiological characteristics of reported MIS-C cases in the United States.
- To highlight the overlap in clinical presentations between MIS-C and acute COVID-19 or Kawasaki disease.
- To emphasize the importance of clinician awareness and reporting for improved understanding and management of MIS-C.
Main Methods:
- Analysis of case reports submitted to the CDC from clinicians nationwide.
- Categorization of MIS-C patients based on clinical presentation, including those with shock and cardiac dysfunction, and those with overlapping features.
- Review of demographic, clinical, and outcome data for hospitalized MIS-C patients.
Main Results:
- As of July 29, 570 U.S. MIS-C cases meeting the case definition were reported to the CDC.
- A significant proportion (35.6%) presented with severe illness characterized by shock, cardiac dysfunction, and elevated inflammatory markers, with positive SARS-CoV-2 tests.
- Hospitalization was common (median 6 days), with high rates of intensive care unit (ICU) admission (63.9%) and a mortality rate of 1.8% (10 deaths).
Conclusions:
- MIS-C represents a serious post-infectious complication of SARS-CoV-2 in children, requiring prompt medical attention.
- Clinical presentations of MIS-C are diverse, ranging from severe shock to features overlapping with acute COVID-19 and Kawasaki disease.
- Continued surveillance and reporting are essential for characterizing MIS-C, facilitating early diagnosis, and optimizing treatment strategies.
Abstract:
In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients' signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2-4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition,† and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2-4), had a less severe clinical course, or had features of Kawasaki disease.§ Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.
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