Explained: What is MIS-C, a post COVID-19 complication in children?

Reports of a post COVID complication, which can affect multiple organs, in children have raised concerns in recent days.  Firstpost spoke to two senior doctors in Maharashtra to understand the condition, its symptoms and the signs parents need to watch out for. What is MIS-C? According to the Indian Academy of Pediatrics’ (IAP) statement dated 22 May, Multisystem Inflammatory Syndrome in Children  (MIS-C) may be seen in some cases, after 2-6 weeks of asymptomatic or symptomatic COVID-19 infection due to immune dysregulation. Dr Yogesh Kumar Gupta, pediatrician in Bangalore’s Fortis Healthcare had told news agency PTI that MIS-C is an outcome of a reaction in the body against the antigen developed to counter the coronavirus infection. “Active COVID infection is not something we are worried about because most of them are mildly to moderately symptomatic but once they recover and once they have antibodies in them, then these antibodies are somehow reacting in children. It’s like an allergy or reaction in their body,” the child specialist explained. “I won’t say it’s (MIS-C) dangerous or life-threatening but, of course, sometimes it affects children badly. It can affect organs like heart, liver and kidney in children,” he said, adding that it is a documented entity in other countries after the peak of COVID-19 was over. How prevalent is it? Doctors said MIS-C is rare and mostly occurs in teenagers. According to the IAP, the incidence of MIS-C is 12 cases per 1,00,000 population. Speaking to Firstpost, Dr Ankit Gupta, lead paediatric critical care specialist at the Wockhardt Hospital at Mira Road near Mumbai, said there isn’t exact data on the prevalence, but as per western literature, MIS-C occurs in 1-2 percent of children who get COVID-19 infection. According to Dr Tushar Parikh, consultant neonatologist and paediatrician at Motherhood Hospital in Pune’s Kharadi, MIS-C is not a very common complication and is more commonly seen in adolescents than in younger children. “(In children) less than six years, it is less common. It is almost twice as common in children aged six to 12 and thrice in children in the age group of 12 to 18,” the Pune-based doctor said. It is slightly more prevalent in children with obesity, he added. “We are seeing MIS-C patients in all below-18 age groups, probably because Wockhardt is a tertiary care research centre, but literature says teenagers are at higher risk,” said Gupta. “Approximately 20 to 25 MIS-C cases were admitted (to Wokchardt) in the second wave till 29 May,” he said. He added that MIS-C cases start coming up 2-4 weeks after the peak of the COVID infection. Parikh said that more children were coming with MIS-C in May because many children developed COVID-19 in the month of April. According to Dr Giridhara R Babu, epidemiologist at the Public Health Foundation of India and member of the Karnataka COVID Technical Advisory Committee member, the hospital-based prevalence is not the right parameter for population-level parameter. “But that does not take away the importance of studying this (MIS-C). Even if it is a small percentage, this needs thorough investigation. A clear understanding is needed ahead of the next wave,” Babu had told PTI in May. What are its symptoms? According to Parikh, MIS-C type features include reappearance of fever, rashes all over the body and generalized weakness while some may have low blood pressure and oxygen, three-four weeks after actual presentation of COVID symptoms. “Children present with high grade fever, rashes, general weakness and specific organ involvement leading to drop in blood pressure and difficulty in breathing requiring ICU care sometimes. The first illness (COVID-19) may be very mild or undetectable but still children may have higher illness as MIS-C later on”. Pain in the abdomen is also a common presentation and was thought to be appendicitis, which was ruled out through sonography and we realized that patient has past COVID infection with inflammatory markers, Parikh said. Dr Gupta also included conjunctivitis, gastro-intestinal symptoms, and swelling and redness in the neck as symptoms. Many times, children become irritable, lethargic, he added. What signs should parents watch out for? Parents need to watch out for continued-high grade fever.  “Fever for more than 4-5 days should raise an alarm,” said Gupta. Parikh added that parents need to watch out for MIS-C and specified that they should see a doctor if their child has more than 100 degree fever for three days, along with rashes. MIS-C can be a sequelae  (a condition which results from a previous disease) of COVID-19 infection in the child, he said. “Later on, if the disease progresses, the blood pressure goes low, they go into shock, the urine output decreases they go into multi-organ failure,” Gupta said but reassured that most children recover with timely treatment. The IAP has also said that it is a treatable condition with a good outcome if diagnosed early.” Also, most children suffering from MIS-C cannot transmit the infection to others,” it said. Parikh informed that there are treatment guidelines depending on whether the condition is mild, moderate or severe. “It also depends on the involvement of the heart and coronaries, whether ICU admission is required or they can be managed in wards. The treatment arm is mainly controlling inflammation as there is inflammation in multiple organs of the body, including heart lungs kidneys skin intestines and eyes. A particular child may have a particular organ affected against the other. Not all organs are involved but when more than two organs are involved, it is called as MISC, he said. The treatment involves use of steroids and IV immunoglobulin,” he said. What has the Centre said about it? Addressing a press conference in the beginning of June, Dr VK Paul, NITI Aayog Member (Health), said the syndrome has been seen post-COVID among children and a national group has been formed to look into the pediatric complications related to the infection. The post-COVID syndrome is a unique disease seen among children and guidelines have been established for understanding its development, he said. “Multi-system inflammatory syndrome does not have a difficult treatment but it must be timely,” Paul said. Terming MIS-C serious complication in coronavirus patients, the Centre on 2 June asked states and Union Territories to share data on new cases of MIS-C being recorded, as the condition is not being routinely reported through the integrated disease surveillance portal (IDSP) or any other portal, reported The Indian Express. The Union health ministry also asked states and UTs to identify secondary and tertiary care institutes with expertise and facilities to deal with the disease, the report said. With inputs from PTI