Judith Persichilli, Commissioner of the New Jersey Department of Health, announced today the addition of two more cases of Multisystem Inflammatory Syndrome in Children (MIS-C) bringing the state’s total to 55. The 55 children range in age from 1-18 years old. All but two have been released from the hospital. All 55 children have either been confirmed to have COVID-19 or antibodies showing the were infected. Although it is not known where all 55 children reside, the racial breakdown is as follows: 12% white, 34% black, 40% Hispanic, 6% Asian and 4% are characterized as “other”.
This concerning syndrome has had an increased spike in cases since the pandemic began. Multisystem Inflammatory Syndrome, or MIS-C (C for children), is a novel association with coronavirus, as areas with high prevalence of infection have seen increased numbers of cases within the pediatric population. As mentioned, New Jersey currently has 55 total cases. The case count is up from 43 cases of MIS-C in mid-June. There have been no deaths recorded due this syndrome currently, and two cases still remain in the hospital. Although this is a novel association with coronavirus it is thought to not be by any means a new disease process. It is brought about by the body’s inflammation response to a viral illness.
What are the symptoms?
The most common symptoms that a child will present with are fever, vomiting, abdominal pain, diarrhea, red eyes, and a rash. The best model we have right now to describe this syndrome is another inflammatory syndrome known as Kawasaki disease (this will be explained in the next paragraph). All of this is mediated by the adaptive immune system within the body, rather than a direct attack by virus.
Is it a new disease or is it a reaction to an infection?
The adaptive immune system in mammals exists specifically to defend against intruders within the walls of the body. When something foreign, whether a bacteria or a virus or in some cases a fungus, enters the body, the proteins that make up its outer components are recognized as being foreign to what is usually present. This cues up the adaptive immune system, starting with T cells. T cells recognize that the foreign presence does not belong there, and switches into a data-gathering cell for the production of antibodies. Antibodies themselves are a sketch of what the foreign intruder looks like that gets attached to the invader, which allows for cells that have had no exposure with it to still be able to recognize it. This is a highly effective means of clearing foreign substances in the body, but it is not foolproof. If a bacteria, virus, or other foreign presence looks too similar to something that already exists in the body, then the immune system can be crossed, and start marking things that should not be attacked in the body for immune system removal. In the case of Kawasaki, this is the inner lining of the blood vessels.
The most common cause of Kawasaki is thought to be a viral illness, although physicians and experts still are unsure about how this disease starts. It is most common in patients under 5 years old, although cases can be seen up into the 10-13 year range, with 21 years considered to be the cutoff where it is unlikely to happen. The most common presenting symptoms are persistent fever (5 days is usually considered persistent) and abdominal pain, both of which should be apparent in a child. A rash is also common, although not always present (rash is recorded in about 50% of patients). It will usually follow the illness, so a cough or flu-like symptom in the days leading up to the fever can be useful in suspecting this syndrome. In the case of MIS-C, all children in NJ tested positive for either the virus itself or, more commonly, antibodies to the virus indicating that they contracted it sometime in the last two weeks.
If your child seems to have a persistent fever, abdominal pain or is acting more tired than usual, it is important to call your physician to report these symptoms and allow them to make a clinical decision whether your child should be brought in for examination. This condition can be managed within the hospital but requires monitoring that would be too much to do on an outpatient basis.
How do we deal with MIS-C?
While MIS-C is being defined by experts as being a separate entity from Kawasaki disease, it is generally agreed upon to be along the same lines of their process. The cases of MIS-C are thought to be exceedingly rare, but serious when they do occur. That is why prompt recognition of these symptoms is important to ensure the best outcome for your child. Although a child who gets COVID-19 is still most likely to not have any interaction with this syndrome, the leading preventative measure is still to prevent yourself or your family from contracting COVID-19 in the first place. This requires maintenance of social distancing, proper handwashing, and taking precautions when necessary.