The University of Michigan doctor answers mother and father’ questions about the dangerous COVID condition in children
ANN ARBOR – Although children are largely spared developing serious illness from COVID-19 over time, states are reporting more cases of a rare condition developing in children called Multi-System Inflammatory Syndrome, or MIS-C.
The disease causes severe inflammation of vital organs and tissues and, if left untreated, can be life-threatening.
The first cases occurred in the US and Europe in May 2020. Almost a year later, 48 states have documented cases of the serious illness.
Pediatric Hospital Physician at Michigan Medicine CS Mott Children’s Hospital, Christine Mikesell helped develop MIS-C clinical guidelines for the healthcare system.
The university recently published these Q&A in which Mikesell addresses parents’ concerns about MIS-C:
Mikesell: MIS-C is an extreme immune response to COVID-19 that is characterized by shock, fever, and multiple organ inflammation. It can cause severe inflammation in the heart, lungs, blood vessels, kidneys, digestive system, brain, skin, or eyes.
This condition initially appeared to be seen only in children who had recovered weeks after recovering from COVID-19 and who tested positive for antibodies. But now we also see cases where there is an overlap. Children have shown signs of MIS-C at the same time as the positive COVID-19 test.
At this point in time, there are many more questions than answers about MIS-C, including its cause and risk factors. The number of cases is so low that it is difficult to distinguish which children are at the highest risk.
Several research studies, including my colleagues at Michigan Medicine, are examining MIS-C cases to learn more about the cause, risk factors, and ways to improve diagnosis and treatment.
Mikesell: Earlier in the pandemic, urban centers saw the highest numbers in cities like Detroit and New York. But lately, after the waves of the holiday season, we’ve heard uptrends in states like California, Illinois, and Georgia. We believe this reflects the global increase in our total numbers and a reflection of where COVID-19 has been more active.
This is still a relatively rare condition, affecting two in 100,000 children or less than 0.01% of the population.
Mikesell: It can be alarming for parents to see headlines focused on critically ill children. But this condition can be treated, and many children who develop MIS-C do not get critically ill or require intensive care. Most importantly, the majority of children treated for MIS-C make a full recovery.
However, there are rarer cases that have resulted in organ failure and death. The Centers for Disease Control have reported approximately 2,617 cases of MIS-C in the US, with a total of 33 deaths.
Long-term effects are largely unknown, but a five-year study supported by the National Institutes of Health and the National Institute of Heart, Lung, and Blood is tracking 600 children with MIS-C through 2025 to track long-term results. A recent study from Boston suggests that some children hospitalized with MIS-C may also have neurological symptoms, but most of them were temporary.
“This disease can be treated, and many children who develop MIS-C do not get critically ill or require intensive care. Most importantly, the majority of children treated for MIS-C recover, ”she said.
Most children need to see a cardiologist and an infectious disease doctor to identify possible coronary artery problems.
Mikesell: This condition affects children and adolescents between the ages of 1 and 14, with the most common ages being between 9 and 12 years. But we’ve seen this happen in older teens and young adults in their early twenties as well.
More MIS-C cases are also reported among Hispanic and black populations. The CDC reports that 66% of reported cases occurred in children who are Hispanic or Latin American (842 cases) or black, non-Hispanic (746 cases). We keep learning more, but this could be a reflection of the higher overall COVID. 19 cases among these parishes.
Mikesell: In general, all children with MIS-C have a fever for more than a day, which can last two to four days, sometimes with severe flu-like symptoms. Your fever will usually not respond to antipyretic drugs.
Parents should call their doctor if their child has this type of persistent fever and appears tired, ill, or has anorexia.
Other symptoms vary from child to child. However, in general, younger children also seem more likely to have a sunburn-like rash, bloodshot eyes, swollen hands and feet, chapped lips, a swollen tongue, congestion, and swollen lymph nodes.
Teenagers and teenagers tend to experience more of the associated gastrointestinal symptoms such as diarrhea, vomiting, nausea, abdominal pain or a swollen stomach along with headaches and general lethargy.
But every child is different and parents should see a doctor if their child has a combination of these symptoms in addition to a fever. Symptoms can progress quickly.
Mikesell: MIS-C presents itself similarly to another rare condition known as Kawasaki disease, which causes swelling in the walls of blood vessels throughout the body, which increases the risk of aneurysms, blood clotting, gastrointestinal problems, kidney injuries, neurological Symptoms or painful inflammation increase heart function.
Doctors have built on what they know about Kawasaki disease to treat MIS-C. This includes high-dose aspirin, fluids, and various medications used to treat inflammation. In severe cases, children may need to be treated in the pediatric intensive care unit.
We hope that more data and research will help us improve treatment options.
Mikesell: When we first heard about MIS-C, our hospital set up a task force that included experts from a variety of disciplines, including emergency room, infectious diseases, immunohematology, cardiology, and rheumatology.
This team monitored new data and studies, and continued to learn about MIS-C from colleagues at centers receiving the highest number of cases and how patients presented themselves in our clinics and emergency rooms.
Our goal was to develop guidelines that will help us record all patients who are at risk of developing this syndrome.
We set a low threshold for any child who has had a fever for more than 24 hours. They were monitored for MIS-C and given further tests if they had accompanying symptoms
Mikesell: The best protection against MIS-C is to follow recommended measures to minimize exposure to COVID-19. This includes wearing masks, frequent hand washing, social distancing, and not being around people from multiple households.
Mikesell: Most children who become infected with SARS-CoV-2 have mild or no symptoms. We’re still learning why some children develop more severe symptoms like MIS-C than others, but serious COVID-19 illness in children is still rare.
Approximately 1% of the children with a known case of COVID-19 were hospitalized and 0.01% have died.
Babies under one year of age may be at greater risk of developing serious illnesses, as well as those with some underlying medical conditions, including asthma or chronic lung disease, diabetes, genetic or neurological disorders, sickle cell and congenital heart disease, obesity, a compromised immune system, or medical complexity, according to the CDC.
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