Multisystem Inflammatory Syndrome in Children (MIS-C) - HAN
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Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)
PURPOSE
This document aims to ensure that clinicians are aware of current guidance regarding Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19), including the case definition and guidance on reporting to local health departments.
BACKGROUND
ESSENTIAL ACTIONS
TESTING
This document aims to ensure that clinicians are aware of current guidance regarding Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19), including the case definition and guidance on reporting to local health departments.
BACKGROUND
- Clinicians in the United Kingdom, New York City and New York State have reported cases of children with multisystem inflammatory syndrome (many of whom tested positive for SARSCoV-2 infection by RT-PCR or serologic assay). Additional reports of children presenting with severe inflammatory syndrome with a laboratory-confirmed case of COVID-19 or an epidemiological link to a COVID-19 case have been reported by authorities in other countries.
- On May 14, 2020, the Centers for Disease Control (CDC) issued a Health Advisory regarding a multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19), along with a case definition for this syndrome.
- There is limited information currently available regarding the risk factors, pathogenesis, clinical course, and treatment for MIS-C.
ESSENTIAL ACTIONS
- All health care providers should maintain a high index of suspicion for MIS-C.
- Suspected cases of MIS-C should be referred immediately to a tertiary care center with a pediatric intensive care unit (PICU).
- Tertiary care centers are asked to consider a collaborative approach in the management of these patients by convening a multispecialty committee (comprised of pediatric critical care, cardiology, hematology, infectious disease, and rheumatology/immunology) that provides coordinated clinical care guidance for each patient while (1) confirming patients meet the case definition, and (2) ensuring that appropriate diagnostic and treatment resources are readily available for this patient population.
- Hospital infection preventionists should be notified immediately upon recognition of patients meeting case definition to initiate public health reporting.
TESTING
- In suspected cases of MIS-C, strongly recommend the following additional laboratory testing due to the potential for myocardial involvement: BNP and Troponin.
- If the BNP and/or Troponin levels are elevated, initiate transfer to a tertiary care center with a PICU.
- Hospitals must assess for current or recent SARS-COV-2 infection by performing a combination of RT-PCR, antigen test and/or serology (as available) in patients who are under 21 years of age and present with symptoms compatible with MIS-C associated with COVID-19.
Latest Data
Epidemiological Trends As Of June 30, 2022
94 |
0 |
Monthly Chicago MIS-C cases and COVID-19 cases, March 2020 through June 2022
Note: COVID-19 cases were counted based on specimen collection date. MIS-C cases were counted based on MIS-C illness onset date, fever onset date if illness onset date was unknown, or hospital admission date if both fever and illness onset dates were unknown.
Characteristics of Reported MIS-C Patients
MIS-C Patients by Age Group
MIS-C Patients by Sex
| N | % | |
|---|---|---|
| Male | 60 | 64% |
| Female | 33 | 36% |
MIS-C Patients by Race & Ethnicity
| N | % | |
|---|---|---|
| Black, non-Latinx | 50 | 53% |
| Latinx | 34 | 36% |
| White, non-Latinx | 6 | 6% |
| Asian, non-Latinx | 1 | 1% |
| Unknown | 3 | 3% |
Indicators of Illness Severity
| N | % | |
|---|---|---|
| ICU admission | 69 | 73% |
| Non-invasive ventilation | 6 | 6% |
| Mechanical ventilation | 11 | 12% |
| Received vasoactive medications | 48 | 51% |
Vaccination Status*
| N | % | ||
|---|---|---|---|
| Unvaccinated status | Eligible for vaccine at time of illness | 32 | 34% |
| Unvaccinated status | Not eligible for vaccine at time of illness | 59 | 63% |
| Vaccinated status | Partially vaccinated | 1 | 1% |
| Vaccinated status | Fully vaccinated, not boosted | 2 | 2% |
| Boosted | 0 | 0% |
*Status reflects vaccination history at time of illness onset. All cases were unvaccinated at the time of illness onset.
Partially vaccinated means a person has received only one dose of a two-dose COVID-19 vaccine primary series.
Fully vaccinated, not boosted means a person has received all recommended doses in their primary series of COVID-19 vaccine but has not received a booster dose of vaccine.
Boosted means a person is fully vaccinated and has received a booster dose of COVID-19 vaccine.
For current COVID-19 vaccination recommendations and schedule see: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#recommendations
Partially vaccinated means a person has received only one dose of a two-dose COVID-19 vaccine primary series.
Fully vaccinated, not boosted means a person has received all recommended doses in their primary series of COVID-19 vaccine but has not received a booster dose of vaccine.
Boosted means a person is fully vaccinated and has received a booster dose of COVID-19 vaccine.
For current COVID-19 vaccination recommendations and schedule see: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#recommendations
Previous Data:
How to Report Suspect Cases of MIS-C
1
Case Report Form: Fill the case report form as completely as possible, scan and upload the form to CDPH y using the following REDCap Project: https://redcap.link/misc_afm. REDCap is a secure platform to share documents with CDPH. If you need support filling out the form, please email maria.joseph@cityofchicago.org and indicate a point of contact and direct phone number for our investigators to reach you to obtain appropriate medical records to submit the form to CDC. Ideally, the case report form includes information on patient discharge but notification of the suspect case should occur right away.
2
I-NEDSS entry: Enter suspect MIS-C cases into the COVID-19 I-NEDSS module – subsection “Multisystem Inflammatory Syndrome”. There does not have to be a positive COVID test in order to enter into the module. It can be an epi link, COVID-like illness, or a positive molecular, antigen, or antibody test. If your lab or a commercial send out lab does not have the ability to run serologic testing, consider drawing serum and saving it prior to any treatments.
Case Definition
CDC Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)
Additional Comments
- An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms
*Fever >38.0oC for >24 hours, or report of subjective fever lasting >24 hours
**Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin
Additional Comments
- Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
- Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection
Resources
Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) Interim Guidance issued July 2, 2020, reissued September 24, 2021
Case Reporting Form For MIS-C
Instructions for Case Reporting Form for MIS-C
MIS-C Illinois Clinical Pathway issued July 31, 2020
HAN 9/22/21- MIS-C Annual Report (April 2020 to June 2021) Key Messages and Action Items
MMWR Morb Mortal Wkly Rep: Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years published January 14, 2021
MMWR Morb Mortal Wkly Rep: COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020 published August 14, 2020
MMWR Morb Mortal Wkly Rep: SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020 published September 15, 2020
Case Reporting Form For MIS-C
Instructions for Case Reporting Form for MIS-C
MIS-C Illinois Clinical Pathway issued July 31, 2020
HAN 9/22/21- MIS-C Annual Report (April 2020 to June 2021) Key Messages and Action Items
MMWR Morb Mortal Wkly Rep: Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years published January 14, 2021
MMWR Morb Mortal Wkly Rep: COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020 published August 14, 2020
MMWR Morb Mortal Wkly Rep: SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020 published September 15, 2020
MIS-C Reporting
For Clinical Questions Or To Report Suspect Cases, Contact:
The CDPH Disease Reporting Hotline at 312-743-9000
*After hours, weekends, and holidays, please call 311 and ask for the communicable disease physician on-call (or call 312-744-5000 if outside the City of Chicago)
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Handouts for Parents Source: The Center for Disease Control and Prevention