COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Abstract

, 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 * https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatricmultisystem-%20inflammatory%20syndrome-20200501.pdf. † The MIS-C case definition included a patient aged <21 years with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem organ involvement (cardiovascular, dermatologic, gastrointestinal, hematologic, neurologic, renal, or respiratory) who tested positive for SARS-CoV-2 or had exposure to COVID-19. https:// www.cdc.gov/mis-c/hcp/. § Kawasaki disease is an acute febrile illness of unknown cause, primarily affecting children, and associated with fever, rash, conjunctivitis, redness in the mouth, cracked lips, and swollen lymph nodes, feet, and hands.

COVID-19 Trends Among School-Aged Children — United States, March 1–September 19, 2020

“…† † † Acute COVID-19 and † † † https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/otherat-risk-populations.html. multisystem inflammatory syndrome in children (MIS-C) have been reported to disproportionately affect Hispanic and Black children (3,4). Implementing multiple, concurrent mitigation strategies and tailored communications about the importance of promoting and reinforcing behaviors that reduce spread of COVID-19 (e.g., wearing masks, maintaining a social distance of ≥6 feet, and frequent handwashing) can reduce COVID-19 spread in schools and communities.…”

Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

“…It is becoming apparent that MIS-C can present both in children with acute SARS-CoV-2 infection and in the post-acute or convalescent phase of infection. A large case series of 565 children with MIS-C across North America has been recently reported by the Centers for Disease Prevention and Control (CDC), which used latent class analysis to identify three classes of MIS-C 33. Class 1 predominantly comprises patients who were antibody positive and polymerase chain reaction negative for SARS-CoV-2, with multiple systems involved, a strong association with cardiac complications, and a greater likelihood of having received intravenous immunoglobin and corticosteroids.…”

Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review

“…Fourth, multisystem inflammatory syndrome, a severe pediatric condition associated with COVID-19, was not specified during data extraction. Although the condition is rare, with a total of 570 reported to the CDC as of July 2020, it is possible that signs and symptoms of multisystem inflammatory syndrome in one or more samples included in our analysis could have altered our results [62]. Fifth, although this study aggregates evidence sufficiently to achieve a power of 0.75-0.85 for comparisons of asymptomatic and symptomatic or younger and older children, some subgroup comparisons performed using Fisher's exact test were unable to achieve this level of power, ranging from as low as 0.15 for GGO comparisons in asymptomatic vs. symptomatic children below 10 years to as high as 0.90 for GGO comparisons in above vs. below age 10 in asymptomatic children.…”