Multisystem inflammatory syndrome in children (MIS-C) and the coronavirus pandemic: Current knowledge and implications for public health

Rafferty, Megan; Burrows, H. Jackson; Joseph, Jake P.; Leveille, Jennifer M.; Nihtianova, Snejana; Amirian, E. Susan

doi:10.1016/j.jiph.2021.01.008

Cited by 81 publications

(144 citation statements)

References 32 publications

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“…However, most studies have not described the correlation between racial background and susceptibility to MIS-C associated with pre-existing conditions. Majority of the studies did not report any comorbidities associated with MIS-C [37]. However, one early report showed that, among patients with pre-existing conditions, 10-39% were obese and 5-18% have a history of asthma [9].…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

Kurup

Burgess

Tine

et al. 2021

J. Racial and Ethnic Health Disparities

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A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection. Epidemiologic data and case studies have indicated that children are less susceptible to more severe clinical features of SARS-CoV-2 infection, a finding that may be due to differences in the cytokine response generated by the innate immune system, high amounts of ACE-2 which maintain homeostatic functions by preventing inflammation, and trained immunity acquired from regular vaccinations. Despite these protective mechanisms, children are still susceptible to severe complications, such as MIS-C. The racial disparities seen in MIS-C are extremely apparent, and certain populations are more affected. Most specifically, 33% of MIS-C patients are Hispanic/Latino, and 30% Black. Current studies published on MIS-C do not detail whether certain symptoms are more present in certain racial/ethnic groups. Knowledge of these disparities could assist health care professionals with devising appropriate strategies for post-acute SARS-CoV-2 infection follow-up in children as well as vaccine distribution in specific communities to help slow the spread of SARS-CoV-2 infection, and ultimately reduce the potential for complications such as MIS-C.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

Kurup

Burgess

Tine

et al. 2021

J. Racial and Ethnic Health Disparities

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“…In our series, the median age was 8.8 years. Rafferty et al, based on the available studies, reported that the median age of children who developed MIS-C varied from seven to 10 years [ 3 ]. The most common clinical presentation was persistent fever along with dermatological, mucocutaneous and gastrointestinal features, similar to other reports [ 10 , 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…MIS-C is a rare complication that appears to be linked to COVID-19 and develops as a result of an, as yet, unspecified immune dysregulation with an excessive inflammatory response [ 3 , 4 , 5 ]. Several reports have suggested that children could still develop MIS-C despite an asymptomatic and mild course of SARS-CoV-2 [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Case Series of Multisystem Inflammatory Syndrome (MIS-C) in Children during the SARS-CoV-2 Pandemic in Latvia

Racko

Smane

Klavina

et al. 2021

Clinics and Practice

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The total number of COVID-19 positive cases in Latvia has escalated rapidly since October 2020, peaking in late December 2020 and early January 2021. Children generally develop COVID-19 more mildly than adults; however, it can be complicated by multisystem inflammatory syndrome in children (MIS-C). This case study aims were to assess demographic characteristics and the underlying medical conditions, and clinical, investigative and treatment data among 13 MIS-C patients using electronic medical records. All 13 had acute illness or contact with someone who was COVID-19 positive two to six weeks before MIS-C onset. Only five of the 13 were symptomatic during the acute COVID-19 phase. The median age was 8.8 years; 11/13 patients were male, 10/13 had been previously healthy, and all 13 patients tested positive for SARS-CoV-2 by RT-PCR or antibody testing. The most commonly involved organ systems were the gastrointestinal (13/13), hematologic (13/13), cardiovascular (13/13), skin and mucosa (13/13), and respiratory (12/13) ones. The median hospital stay was 13 (interquartile range, 11 to 18) days; 7/13 patients received intensive care, 6/13 oxygen support, and 5/13 received inotropic support. No deaths occurred. During the current pandemic, every child with a fever should have a clearly defined epidemiological history of COVID-19, a careful clinical assessment of possible multiple organ-system involvement, with a special focus on children with severe abdominal pain and/or skin and mucocutaneous lesions.

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“…MIS-C typically presents with fever lasting more than 4 days [1,12,16] as the universal characteristic. Gastrointestinal symptoms [1,3,12] may also present as the first symptoms [24]. These include abdominal pain, vomiting [1,3,12], and diarrhea [24].…”

Section: Multisystem Inflammatory Syndrome In Children (Mis-c)mentioning

confidence: 99%

COVID-19 Transmission in Children: Implications for Schools

Mendoza-Torres¹,

Torres²,

Rosales-Rada³

et al. 2022

Primary Health Care

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The COVID-19 pandemic poses multiple issues of importance to child health including threats to physical health and disruption of in-school learning. This chapter reviews what is currently known about COVID-19 epidemiology, presentation, pathophysiology, case definitions, therapies, and in-school transmission in children. COVID-19 has some unique characteristics in children including the rare yet severe Multisystem Inflammatory Syndrome in Children (MIS-C) that may be related to acquired immune responses. There are limited studies to date to define therapeutic guidelines in children, however consensus recommendations from multiple organizations are summarized including the use of immunomodulatory therapies (intravenous immunoglobulin, steroids, anakinra and tocilizumab), antiplatelet (aspirin) and anti-coagulant (low molecular weight heparin) therapies. Finally, considerations for safe return to the classroom are discussed including strategies for optimized student to teacher ratios, hand washing, social distancing, sibling pairing and staged re-opening strategies.

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Multisystem inflammatory syndrome in children (MIS-C) and the coronavirus pandemic: Current knowledge and implications for public health

Cited by 81 publications

References 32 publications

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

Case Series of Multisystem Inflammatory Syndrome (MIS-C) in Children during the SARS-CoV-2 Pandemic in Latvia

COVID-19 Transmission in Children: Implications for Schools

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