Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data

Abstract

This is a Brighton Collaboration Case Definition of the term “Multisystem Inflammatory Syndrome in Children and Adults (MIS-C/A)” to be utilized in the evaluation of adverse events following immunization. The case definition was developed by topic experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for SARS-CoV-2. The format of the Brighton Collaboration was followed, including an exhaustive review of the literature, to develop a consensus definition and defined levels of certainty. The document underwent peer review by the Brighton Collaboration Network and by selected expert external reviewers prior to submission. The comments of the reviewers were taken into consideration and edits incorporated into this final manuscript.

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

“…MIS-C is a critical illness in children and adolescents, appearing several weeks afte initial infection [6][7][8][9]. Thus far, no universally agreed upon approach is available for thi syndrome [9] and, to the best of our knowledge, no one has previously described glu cose-insulin metabolic disorders in a pediatric population affected by MIS-C. Analyzin our cohort of 30 pediatric patients affected by MIS-C, we noted that IR, glycemic fluctua tions and/or hyperglycemia can occur.…”

“…During the pandemic children have been less affected than adults and SARS-CoV-2 was in most cases asymptomatic or with mild symptoms [3][4][5]. However, the development of a severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection has been reported [6][7][8][9]. As stated by the Center of Diseases Control and Prevention (CDC), the definition of MIS-C requires patients to be less than 21 years and to have evidence of either recent/current SARS-CoV-2 infection or exposure within the 4 weeks prior to the onset of symptoms, the presence of documented fever, elevated markers of inflammation, at least two signs of multisystem involvement, and finally, lack of an alternative diagnosis (e.g., bacterial sepsis, toxic shock syndrome) [10].…”

“…Even though MIS-C represents a critical health condition associated with SARS-CoV-2 infection [6][7][8][9], data evaluating glucose disorders have not previously described. This exploratory study was conducted to evaluate the impact of MIS-C on glycemic patterns in pediatric patients admitted to Vittore Buzzi Children's Hospital in Milan, Italy, during the pandemic.…”

Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information

“…A multisystem inflammatory illness has been observed in children and in some adults following acute infection with SARS-CoV-2. This syndrome, called multisystem inflammatory syndrome in children (MIS-C) and in adults (MIS-A), 43 is characterized by hyperinflammation and can begin subsequent to host clearance of active SARS-CoV-2 infection. 42 This condition is rare, with estimates of two in every 100,000 children in a descriptive analysis of MIS-C cases in New York State.…”

“…The second category includes Multisystem Inflammatory Syndrome in Children (MIS-C) and in adults (MIS-A), a less common presentation of SARS-CoV-2 infection characterized by hyperinflammation that can appear 4-6 weeks after viral infection. 43 The third category describes late sequelae. 42 In terms of defining study cohorts, adherence with this definition would therefore require a clinical diagnosis, rather than a SARS-CoV-2 test alone, in order to distinguish MIS-C/A and COVID-19.…”