Coronavirus Disease 2019

Multisystem Inflammatory Syndrome in Children
(MIS-C)


Updates
  • COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) Webinar Recorded on 6-10-20. Hosted by Children’s Hospital Los Angeles. To view the recording or download the slides, click here.
  • CDC Webinar Multisystem Inflammatory Syndrome in Children (MIS-C) Webinar recorded on 05-18-20. Webinar Recording
  • WHO Scientific Brief Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Note the WHO Case Definition differs from the CDC definition which is being used by LAC DPH. Brief
Clinical Features

There have been reports of children presenting with severe inflammatory syndrome and laboratory-confirmed COVID-19 or an epidemiological link to a COVID-19 case in New York, the UK, Italy, and other countries.

The reports include illness with features of toxic shock syndrome and atypical Kawasaki disease. The clinical presentations vary, depending on the affected organ system involved (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic). Features have included persistent fever, rash, abdominal pain, vomiting, or diarrhea, conjunctivitis, peripheral edema and extremity pain, hypotension, and signs of cardiac inflammation. Respiratory symptoms were not present in all cases. Inflammatory markers were elevated.

Many of these children tested negative for COVID-19 initially but on follow-up testing are positive for COVID-19, especially by serology.

CDC Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)
  • An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, 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

 iFever ≥38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
iiIncluding, 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

NOTE:

  • 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
Referral
Providers are advised to immediately refer patients with a picture of toxic shock or Kawasaki Disease to a specialist in pediatric infectious disease, rheumatology, and/or critical care, as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Providers are advised to immediately refer patients with a picture of toxic shock or Kawasaki Disease to a specialist in pediatric infectious disease, rheumatology, and/or critical care, as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications.
Reporting

Report cases that meet the CDC definition of Multisystem Inflammatory Syndrome in Children (MIS-C) by phone within 1 working day. 

  • Los Angeles County DPH Acute Communicable Disease Control: Call 888-397-3993 or 213-240-7821
  • Long Beach Health and Human Services: Call 562-570-4302.
  • Pasadena Public Health Department: Call 626-744-6089. Fax to 310-605-4274

Further Information
  • COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) Webinar Recorded on 6-10-20. Hosted by Children’s Hospital Los Angeles. To view the recording or download the slides, click here.
  • CDC Health Advisory: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 (5-14-20) Advisory 
  • CDC Webinar Multisystem Inflammatory Syndrome in Children (MIS-C) Webinar recorded on 05-18-20. Webinar Recording
  • LAC DPH Health Alert: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 Note: the case definition in this LAHAN is superseded by the 5/14/20 CDC HAN above. (5-12-20) Alert
  • Kawasaki information LAC DPH webpage  CDC webpage
  • CDC webpage For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. CDC Webpage
Publications
  • Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Royal College of Paediatrics and Child Health Guidance
  • Hyperinflammatory shock in children during COVID-19 pandemic. Lancet (5-7-20) doi: 10.1016/S0140- 6736(20)31094
  • An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet (5-13-20) doi: 10.1016/ S0140- 6736(20)31129-6


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  • Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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