This article first appeared in The conversation†
One of the rare complications of COVID in children is a inflammatory disease called pediatric inflammatory multisystem syndrome (PIMS-TS) that occurs in the weeks following infection with SARS-CoV-2 (the virus that causes the disease).
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It is also called multisystem inflammatory syndrome in children (MIS-C).
Two years after the first reported cases of this complication, approximately 120 children have been diagnosed in Australia†
Pediatric inflammatory multisystem syndrome is actively monitored by a surveillance system for children’s hospitals in Australia called PAEDSincluding eight children’s hospitals.
PAEDS estimates that the syndrome affects about one in 2,500 children infected with COVID. However, the rate may lower after infection with the Delta or Omicron variant compared to the parent strain.
What it looks like in children
For most children, the COVID infection is mild – even more so for the Omicron variant. It’s bad unlikely a child has to be hospitalized because of an infection.
However, a small number of children experience an inflammatory disease that usually begins within the first six weeks after the COVID infection.
We don’t know exactly why, but the body “turns on an inflammatory response” and this inflammation occurs in several parts (systems) of the body at once: the skin and eyes, the gastrointestinal tract, the heart, the lungs, the kidneys, the brain . These children almost always require hospitalization.
The inflammation can cause several symptoms and often several symptoms are seen at the same time. This one Involving†
- fever – usually longer than three days
- vomit
- diarrhea
- stomach ache
- headache
- conjunctivitis – red, watery eyes
- skin rash
- lymphadenopathy – swollen lymph nodes in the neck or other places around the body
- sore throat
- cough
The symptoms are similar to another inflammatory condition in children called Kawasaki diseasewith which the multisystem inflammatory syndrome was compared early.
Unlike Kawasaki disease, which occurs most often in infants, this condition most often occurs in school-age children, involves gastrointestinal symptoms, and shows slightly different changes on blood tests.
These symptoms can occur with other illnesses, so it’s important for parents and doctors to know when to seek specialist care.
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What should parents pay attention to?
If your child has a fever for more than three days in the two to six weeks following a COVID infection, especially if they also have red eyes, skin rashes, and abdominal pain, it’s possible that the symptoms are due to multisystem inflammatory syndrome.
In this situation, it is important to get medical attention for your child to understand what may be causing the symptoms. These symptoms can also be caused by other viruses or bacterial infections.
Blood tests will usually need to be done to look for markers of inflammation such as: C-reactive protein†
Blood tests also show changes in blood cell counts (including low platelet and white blood cell counts) and slight elevations in liver enzyme levels, all of which indicate inflammation.
Doctors will also be vigilant because inflamed blood can be more prone to forming clots, seen in some cases†
Most of the children examined will also have a heart ultrasound to assess how well the heart is functioning and to look for a complication involving changes (widening) in the arteries of the heart. Changes in heart arteries occur in: 8-24 percent cases of multisystem inflammatory syndrome.
So far, we don’t know what predisposes some children to develop the condition after COVID infection. So we cannot predict which children are at increased risk.
Should parents be concerned?
The multisystem inflammatory syndrome can make children very unwell, and children with the syndrome must be cared for in hospital.
The good news is that we have anti-inflammatory treatments that are very effective in treating children with these symptoms. Doctors across Australia are sharing their experiences and expertise in caring for children with the condition.
Children are treated with drugs commonly used to treating Kawasaki diseaseincluding steroids and intravenous immunoglobulin.
These drugs reduce the body’s excessive immune response, lower fever and inflammation, and allow heart function to return to normal.
It’s also reassuring that almost all children will recover without complications, even if they feel very unwell initially.
If your child has been diagnosed with multisystem inflammatory syndrome, you should wait until he or she has fully recovered and then discuss with your doctor whether you should continue with COVID vaccination if they have not already been vaccinated.
Researchers are still investigating the risk of vaccination causing another inflammatory event.
Vaccination remains the best protection
Preliminary data from the U.S. Centers for Disease Control indicates that two doses of the Pfizer COVID vaccine may protect children from developing multisystem inflammatory syndrome after COVID infection (roughly 80 percent protective in children aged 5-11 years and about 90 percent protective in adolescents aged 12-18 years).
Pediatric inflammatory multisystem syndrome is a rare but potentially serious event following COVID infection.
do our best to prevent infection through the use of vaccines and other public health measures remains vital to protect everyone in our society.
Nicholas Wood is Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney; Philip Britton is Associate Professor, Child and Adolescent Health, University of Sydney
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