CDC: Multisystem Inflammatory Syndrome in Children (MIS-C) - Update & Upcoming COCA Call

Credit CDC Infographic

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While healthy younger adults, adolescents, and children appear far less susceptible to severe COVID-19 disease than older people, or those with comorbidities, they aren't immune to infection.  The number of pediatric fatalities is small, but the CDC currently lists nearly 30 children in the United States under the age of 15 who have succumbed to the virus. 

As we've seen with pediatric influenza deaths, this is likely an under count. 

Eleven weeks ago (April 27th), we saw the first alarm raised (see PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication) in the UK on children with a severe inflammatory syndrome similar to Kawasaki Disease, which seemed to be linked COVID-19 infection.

Less than a week later, the Royal College of Paediatrics and Child Health published a case definition and preliminary guidance on the treatment of this condition (see RCPCH: Case Definition For Pediatric Inflammatory Syndrome).

• In early May, the New York City Health department released a HAN Alert On Pediatric Multi-System Inflammatory Syndrome, announcing 15 suspected cases. Two days later, New York State would issue their own advisory, raising the number suspect cases to 64.

• A week later the CDC would issue their first alert (see CDC HAN: Multisystem Inflammatory Syndrome In Children (MIS-C)), which was followed up with a CDC COCA Call : Multisystem Inflammatory Syndrome in Children (MIS-C) four days later.

The CDC describes the syndrome on their MIS-C website as:

What is 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. Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. We do not yet know what causes MIS-C. However, many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19.

In Early June we looked at a study -  BMJ: Multisystem Inflammatory Syndrome in Children During the Covid-19 Pandemic - Paris, France - which found that a high proportion of cases had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry. 

There is still much we don't know about this syndrome, and its treatment, but next Thursday the CDC will provide an update for clinicians on what has been learned to date in a COCA Call. 

These presentations are of greatest interest to clinicians and healthcare providers, and this is likely to be a well attended event.  An archived video is generally posted within 24 hours, to allow those who were not able to attend the live stream access. 

Clinical Management of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

Overview

During this COCA Call, clinicians will learn about clinical management of multisystem inflammatory syndrome in children (MIS-C) associated with Coronavirus Disease 2019 (COVID-19). Clinicians will share their experiences treating patients with MIS-C, present treatment details from published literature on patients with MIS-C, and provide an overview of the treatment guidelines published by the American College of Rheumatology.

Presenters

Ermias Belay, MD
MIS-C Team Lead
COVID-19 Response
Centers for Disease Control and Prevention

Eva Cheung, MD
Assistant Professor of Pediatrics – Divisions of Pediatric Cardiology and Critical Care Medicine
Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children’s Hospital

Matthew Oster, MD, MPH
CDC COVID-19 Response, MIS-C Team
Associate Professor of Pediatrics
Children’s Healthcare of Atlanta, Sibley Heart Center
Emory University School of Medicine

Adriana Tremoulet, MD
Professor of Pediatrics and Associate Director of the Kawasaki Disease Research Center
University of California, San Diego and Rady Children’s Hospital San Diego

Call Details

When: Thursday, July 16, 2020,
2:00 p.m. to 3:00 p.m. (Eastern Time)

Webinar Link:
https://www.zoomgov.com/j/1612204810external icon

Dial In:
US: +1 669 254 5252 or +1 646 828 7666
International numbersexternal icon

iPhone one-tap:
US: +16692545252,,1612204810# or +16468287666,,1612204810#

Webinar ID: 161 220 4810Add to Calendar

The CDC has an infographic on MIS-C that provides a snapshot of who tends to develop this syndrome, and where cases have been identified across the United States. Disappointingly, the data is only current through May 20th, although the CDC has posted a notice they will update these numbers soon. 

Note: this is just a portion of the infographic. Follow this link to see it in its entirety and a text version of the data. 

Statistically the numbers remain reassuringly low, but it is likely that hundreds more children have been hospitalized by now - and some percentage (est. 2%) of those have died - from this little understood syndrome which is linked to COVID-19.   

 

There is also very little data available on the long-term impacts of MIS-C on survivor's health. 

Learning more about this MIS-C syndrome - its true incidence, treatment options and expected outcomes - becomes all the more important now that many states have announced plans to reopen schools next month.  

Hopefully - with the average age of COVID-19 cases dropping precipitously this summer - we'll get more data soon, so that parents and local school officials can make reasonably informed decisions on how and when kids can safely go back to school.  

 

Making high impact decisions based on limited data is always risky, and when it involves the health and well being of our children, we need to do everything we can to get it right.