CDC issues preliminary information on MIS-C

May 15, 2020

The Centers for Disease Control and Prevention (CDC) has released an advisory for the newest issue in pediatric COVID-19 cases: multisystem inflammatory syndrome in children (MIS-C).

The Centers for Disease Control and Prevention (CDC) has issued a health advisory for multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.1

The condition was first reported by clinicians in the United Kingdom on April 26, 2020. Kawasaki disease-like symptoms were reported in children who previously had been healthy. The children had tested positive for current or recent infection by SARS-CoV-2. They presented with persistent fever and a variety of symptoms including elevated inflammatory markers, multiorgan involvement, and hypotension. Not all cases had respiratory symptoms. Cases of MIS-C were reported to the New York City Department of Health and Mental Hygiene in early May, and as of May 12, 2020, there were 102 children identified.

The current case definition for MIS-C is:

·      A patient aged younger than 21 years who presents with fever, laboratory evidence of inflammation, and evidence of clinically severe illness that requires hospitalization along with multisystem organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurologic); and

·      No alternative diagnoses that are plausible; and

·      Testing positive for current or recent SARS-CoV-2 infection by reverse-transcriptase polymerase chain reaction, serologic assay, or antigen test, or the patient had exposure to a COVID-19 case within the 4 weeks prior to the onset of symptoms

The CDC says that clinicians who have cared for or are caring for patients aged younger than 21 years who meet the MIS-C criteria should report the suspected cases to local, state, or territorial health departments. Patients who meet full or partial criteria for Kawasaki disease also should be reported if they meet the case definition for MIS-C. In pediatric deaths that have evidence of COVID-19, MIS-C should be considered.

Currently it is unknown whether MIS-C is specific only to children after exposure to COVID-19 or if it also occurs in adults.

The CDC’s emergency announcement was distributed to state and local health officers, epidemiologists, laboratory directors, public information officers, and clinician organizations across its Health Alert Network.

References:

1. Centers for Disease Control and Prevention. Emergency preparedness and response; Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). May 14, 2020. Accessed May 15, 2020. https://emergency.cdc.gov/han/2020/han00432.asp