This week’s article will discuss a complication of COVID-19 in kids called MIS-C. We are still learning about MIS-C. As with all these newspaper articles the information may change as we get more data. I do each week survey the most recent entries into the medical literature on a subject and take this information into account with the body of knowledge that is well established. Please understand however with subjects such as the Omicron variant what we understand may change rapidly.
Information presented in these articles is intended to provide a medical perspective - the articles are not intended as a political statement for or against any public policy. Statements in these articles should be considered coming from myself, not from any organization I represent or my employer.
What is MIS-C?
Multisystem inflammatory syndrome in children is a condition that has been identified in children who have had COVID-19. MIS-C is an inflammatory syndrome which may involve many organs and tissues at the same time — such as the heart, lungs, blood vessels, kidneys, digestive system. There is much we are still learning about this syndrome, but it is thought there is a problem with how the immune system is being regulated.
How common is MIS-C? How sick can kids get?
Pediatric Critical Care specialist Christopher Maloney, MD, PhD reports that they have had 92 kids with MIS-C at Children’s Hospital & Medical Center in Omaha. Dr. Maloney says they have cared for children with a wide range of symptoms. They have seen patients with just general inflammatory respiratory or gastrointestinal symptoms to severe cardiac inflammation requiring ECMO. In extracorporeal membrane oxygenation (ECMO), blood is pumped outside of the body to a heart-lung machine.
In the United States; as of January 3rd, there have been 6,431 cases that have been reported by state health departments that have fully met the definition for MIS-C (some other cases are still under investigation). Fortunately, most kids have survived MIS-C. There have been only 55 deaths from MIS-C. Overall in the United States there have been 862 pediatric COVID-19 deaths as of January 15th.
Will children infected with the Omicron variant be more or less likely to suffer from MIS-C?
Pediatric Critical Care specialist Christopher Maloney, MD, PhD expects that we will continue to see kids getting sick with MIS-C. However, Dr. Maloney; and many other experts, are saying that it is difficult to predict how many kids will suffer from MIS-C that were infected with Omicron.
MIS-C afflicts a child generally 2-6 weeks after they were infected with COVID-19; therefore, we may not know for a few weeks if MIS-C will be more or less common to strike kids who have been infected by the Omicron variant.
What we do know is that the number of new pediatric admissions to the hospital for COVID-19 is rising dramatically in our region. Kids are at a lower risk of hospitalization compared to adults. However, we are seeing a tremendous increase in kids being admitted to hospitals in our region and overall for the nation. Over the last 2-3 weeks we have had rates that are more than double that of any time during the pandemic. This is measured in terms of new hospital admissions of confirmed COVID-19 for Nebraska, Iowa, Kansas, and Missouri (HHS Region 7).
What are the signs and symptoms of MIS-C?
Persistent fevers are a defining characteristic of MIS-C. A majority of kids with MIS-C will also suffer from some sort of gastrointestinal symptom such as severe abdominal pain, vomiting or diarrhea. Kids might have confusion, irritability and may be difficult to keep awake. Parents may also note a sunburn like rash, red swollen tongue or red eyes.
The heart and blood vessels may be affected with various signs and symptoms such as low blood pressure, chest pain and trouble breathing. Headaches and more severe neurological symptoms can be experienced by many kids with MIS-C.
Children may have a number of severe lab abnormalities. They can have low blood cell counts, high inflammatory markers and signs of organ failure. Labs sometimes show blood clotting problems. Labs may have an elevation of a substance that is used to diagnose heart attacks and there may be other heart abnormalities diagnosed on tests such as electrocardiograms and echocardiograms.
Kids generally develop MIS-C 2-6 weeks after they are infected. A minority of kids may begin having symptoms later than 6 weeks and for some their COVID-19 symptoms will overlap with the onset of MIS-C. It is however common that children with MIS-C would have had no or few symptoms of COVID-19.
Does MIS-C only occur in children with underlying medical conditions?
No. Most children with MIS-C do not have any reported underlying medical conditions, but of the children with MIS-C who do report an underlying medical condition, obesity is the most common.
Can MIS-C be prevented?
There is good news. A study that was made public online in the MMWR on January 7, 2022, showed that simply being vaccinated prevented severe MIS-C. In this large study involving 24 US hospitals, vaccination reduced risk of MIS-C over 90% and no vaccinated kid needed life support. Sadly, 38 unvaccinated children did require life support. This analysis included only those that were old enough to have been vaccinated during the period of time the data was being collected. The American Academy of Pediatric strongly recommended parents to vaccinate their children 5 years and older against COVID-19. To find a location and time go to vaccines.gov.
Russ Coash, PA-C
COVID-19 Resources
Children’s Hospital & Medical Center (Omaha)
COVID-19 Resource Center For Families
childrensomaha.org/covid-19-resource-center-for-families/
Children’s COVID-19 Helpline 402-955-3200
American Academy of Pediatrics
healthychildren.org
Children’s Hospital of Philadelphia Vaccine Education Center
YouTube videos “Vaccine Makers Project”
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