COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves

Abstract

Multisystem inflammatory syndrome of children (MIS-C) continues to be a highly concerning diagnosis in those recently infected with SARS-CoV-2. The diagnosis of MIS-C cases will likely become even more challenging as vaccine uptake and natural immunity in previously infected persons leads to lower circulating rates of SARS-CoV-2 infection and will make cases sporadic. Febrile children presenting with cardiac dysfunction, symptoms overlapping Kawasaki disease or significant gastrointestinal complaints warrant a thorough screen in emergency departments, urgent care centers, and outpatient pediatric or family medicine practices. An increased index of suspicion and discussion regarding higher level of care (transferring to pediatric tertiary care centers or to intensive care) continue to be recommended. Herein we outline a broad approach with a multidisciplinary team for those meeting the case definition, and believe such an approach is crucial for successful outcomes.

Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation, from the 2021 European Conference on Infections in Leukaemia (ECIL 9)

“…Considering the polyclonal antibody response of natural infection against spike surface proteins (including receptor binding domain proteins) and nucleocapsid proteins, the use of serological test specific for spike proteins or nucleocapsid protein can help distinguish between a previous exposure to infection or to a vaccine-spike-protein based response. The determination of antibody against nucleocapsid protein is also part of differential diagnosis of MIS-C [ 55 – 57 ].…”

Robust humoral immune response after boosting in children with Multisystem Inflammatory Syndrome in Children

“…1 ) . All were treated with IVIG, methylprednisolone and anakinra, received aspirin, and completed steroid tapers following our published protocol [1] . All of the cases of MIS-C in this study met the MIS-C CDC definition and were reported to the New York State Public Health Department.…”

“…Multisystem Inflammatory Syndrome in Children (MIS-C), is marked by high inflammatory markers, organ dysfunction, and symptomatic overlap with inflammatory conditions such as Kawasaki disease [1] . Early in the pandemic it was unclear if vaccination should be encouraged for those who recovered from MIS-C.…”

The COVID-19 pandemic in children and young people during 2020-2021: Learning about clinical presentation, patterns of spread, viral load, diagnosis and treatment

“…The diagnosis of MIS-C cases will likely become even more challenging after vaccine uptake or natural acquired immunity [ 110 , 112 ]. It is unclear why the disease progresses to severe MIS-C in some children, although they have anti-SARS-CoV-2 antibodies.…”