MIS-C in Children per the CDC

 What we know about MIS-C

Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.

 Contact your child’s doctor, nurse, or clinic right away if your child is showing symptoms of MIS-C:

• A fever AND any of the following signs and symptoms:
  • Abdominal (gut) pain
  • Bloodshot eyes
  • Chest tightness/pain
  • Diarrhea
  • Feeling extra tired
  • Headache
  • Low blood pressure
  • Neck pain
  • Rash
  • Vomiting

Be aware that not all children will have all the same symptoms.

 If someone is showing any of these signs, seek emergency medical care immediately:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

This list does not include all possible symptoms. Please call a medical provider for any other symptoms that are severe or concerning to you.

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

 Doctors may do certain tests to look for inflammation or other signs of disease. These tests might include:

• Blood tests
• Chest x-ray
• Heart ultrasound (echocardiogram)
• Abdominal ultrasound

Doctors may provide supportive care for symptoms (medicine and/or fluids to make your child feel better) and may use various medicines to treat inflammation. Most children who become ill with MIS-C will need to be treated in the hospital. Some will need to be treated in the pediatric intensive care unit (ICU).

Parents or caregivers who have concerns about their child’s health, including concerns about COVID-19 or MIS-C, should call a pediatrician or other healthcare provider immediately. Healthcare providers can follow CDC recommendations to keep children and their parents or caregivers safe if an in-person visit is needed.

 CDC is still learning about MIS-C and how it affects children, so we don’t know why some children have gotten sick with MIS-C and others have not. We also do not know if children with certain health conditions are more likely to get MIS-C. These are among the many questions CDC is working to try to understand.

All CDC recommendations are based on the best data and science available at the time, and we will update them as we learn more.

Based on what we know now about MIS-C, the best way you can protect your child is by taking everyday actions to prevent your child and the entire household from getting the virus that causes COVID-19.

Distributed via the CDC Health Alert Network
May 14, 2020, 4:45 PM ET
CDCHAN-00432 

The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome. 

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.

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.

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.

 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.

For additional information, please contact CDC’s 24-hour Emergency Operations Center at 770-488-7100. After hour phone numbers for health departments are available at the Council of State and Territorial Epidemiologists website (https://resources.cste.org/epiafterhoursexternal icon).

An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND

• No alternative plausible diagnoses; AND
• Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

iFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
iiIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin

Additional comments

• Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
• Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection

 1https://www.cdc.gov/kawasaki/index.html
2Royal College of Paediatrics and Child Health Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19, https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdfpdf iconexternal icon.
3Riphagen S, Gomez X, Gonzales-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020. Advance online publication, doi: 10.1016/S0140-6736(20)31094 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltextexternal icon
4Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, Bonanomi E, D’Anitga L. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020. Advance online publication, doi: 10.1016/ S0140-6736(20)31129-6 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltextexternal icon

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES