Doctors at University Hospitals Rainbow Babies & Children’s Hospital (UH Rainbow) have formed a multidisciplinary working group to diagnose and treat the newly recognized inflammatory disorder the CDC named Multisystem Inflammatory Syndrome in Children (MIS-C). The plan includes a comprehensive algorithm, future monitoring and rapid data sharing to ensure patients are diagnosed and appropriately treated as soon as possible.
Multiple children’s hospitals and related institutions will be participating in the effort to better understand MIS-C, in concert with the existing emergency medicine collaboration through the Eastern Great Lakes Pediatric Consortium for Disaster Response (EGLPCDR). Launched last fall, the EGLPCDR is led by UH Rainbow with support from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary of Preparedness and Response.
Cases of MIS-C were first reported in April by United Kingdom physicians who were treating previously healthy children for a severe inflammatory syndrome that resembles Kawasaki disease. According to the Centers for Disease Control New York City has documented 15 similar cases between April 16 and May 4. UH Rainbow has treated one confirmed case, and four others are currently under investigation. Most of these children tested positive for COVID-19 antibodies.
“The cause of this syndrome is not yet clear, but there appears to be an epidemiological link to Covid-19,” says Amy Edwards, MD, FAAP, Associate Medical Director of Women’s and Children’s Infection Control at UH Rainbow and lead investigator for UH Rainbow’s MIS-C working group that includes experts from 10 pediatric specialties. Dr. Edwards says MIS-C seems to be affecting children of all ages, and the primary symptoms include fever, gastrointestinal issues, and rash.
In the last several weeks, UH Rainbow has seen a 5% increase in children testing positive for the novel coronavirus, and nearly a third of those patients are asymptomatic. “We want families to know children can and are becoming infected with COVID-19, and often they don’t have symptoms,” says Claudia Hoyen, MD, Director of Pediatric Infectious Disease at UH Rainbow. “I recommend to parents, as summer camps and activities begin, to balance the risks with what’s best for the family, and to continue practicing physical distancing and hand hygiene as often as possible.”
MIS-C is rare and resembles another illness primarily diagnosed in children called Kawasaki Disease. “What we are seeing is the child’s natural immune system gets ramped up and starts to attack other organs in their body, causing what we call multi-organ system dysfunction, or shock, where the body can’t take of what it needs to because of the inflammation,” says James Strainic, MD, director of the fetal heart center at UH Rainbow, and a member of the MIS-C working group.
Early identification is key. “The majority of these children recover just fine, however like most illnesses often the sooner we are able to diagnose the patient the less aggressive of treatment is required and we see a faster recovery,” says Dr. Edwards. The MIS-C working group at UH Rainbow includes representation from the following pediatric specialties:
- Infectious Diseases
- Intensive Care
- Emergency Medicine
- Hospital medicine
Processes and procedures are underway to share MIS-C data at the local, regional and national level, through the Ohio Department of Health and CDC. UH Rainbow plans to participate in a multi-institutional trial. “The broader we can share data with our colleagues across the country the more we can learn about this new disease, and ultimately find ideal diagnostics and treatments,” says Dr. Strainic.
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