Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

[niman]

Fifteen cases compatible with multi-system inflammatory syndrome have been identified in children in New York City hospitals.

• Characterized by persistent fever and features of Kawasaki disease and/or toxic shock syndrome; abdominal symptoms common

• Cases may require intensive care unit admission for cardiac and/or respiratory support

• Polymerase chain reaction testing for SARS-CoV-2 may be positive or negative

• Early recognition and specialist referral are essential, including to critical care if warranted

• Immediately report cases to the New York City Health Department’s Provider Access Line: 866-692-3641

 

https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-pediatric-multi-system-inflammatory-syndrome.pdf

[niman]

May 4, 2020

Dear Colleagues,

A pediatric multi-system inflammatory syndrome, recently reported by authorities in the United Kingdom, 1 is also being observed among children and young adults in New York City and elsewhere in the United States. Clinical features vary, depending on the affected organ system, but have been noted to include features of Kawasaki disease or features of shock; however, the full spectrum of disease is not yet known. Persistent fever and elevated inflammatory markers (CRP, troponin, etc.) have been seen among affected patients. Patients with this syndrome who have been admitted to pediatric intensive care units (PICUs) have required cardiac and/or respiratory support. Only severe cases may have been recognized at this time.

The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17- May 1, 2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock). All patients had subjective or measured fever and more than half reported rash, abdominal pain, vomiting, or diarrhea. Respiratory symptoms were reported in less than half of these patients. Polymerase chain reaction (PCR) testing for SARS-CoV-2 has been positive (4), negative (10), and initially indeterminate and then negative (1). Six patients with negative testing by PCR were positive by serology. More than half of the reported patients required blood pressure support and five required mechanical ventilation. No fatalities have been reported among these cases.

If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care, as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications.

Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin. Consistent with the NYC Health Code Article 11, which requires reporting of outbreaks and suspected outbreaks of syndromes of known or unknown etiology and of unusual manifestations of disease of public health interest, any patient who meets the following criteria should immediately be reported to the NYC Health Department by calling the Provider Access Line at 866-692-3641:

• Less than 21 years old, with persistent fever (four or more days), and either incomplete Kawasaki disease, typical Kawasaki disease, and/or toxic shock syndrome-like presentation; and

• No alternative etiology identified that explains the clinical presentation (note: patients should be reported regardless of SARS-CoV-2 PCR test result).

Thank you for your ongoing collaboration.

Sincerely, Demetre C. Daskalakis, MD, MPH

Deputy Commissioner Division of Disease Control

New York City Health Department

1 Pediatric Intensive Care Society. PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease. April 27, 2020. Available at https://picsociety.uk/wpcontent/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf 

[niman]

15 Children Are Hospitalized With Mysterious Illness Possibly Tied to Covid-19

The health authorities in New York City issued an alert saying that the children had a syndrome that doctors do not yet fully understand.

 

 

 

 

The boardwalk in the Rockaways in Queens. Children are less likely to become seriously ill with Covid-19 than adults. But some do.Credit...Kirsten Luce for The New York Times

By Joseph Goldstein

• May 5, 2020Updated 7:55 a.m. ET
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Fifteen children, many of whom had the coronavirus, have recently been hospitalized in New York City with a mysterious syndrome that doctors do not yet fully understand but that has also been reported in several European countries, health officials announced on Monday night.

 

Many of the children, ages 2 to 15, have shown symptoms associated with toxic shock or Kawasaki disease, a rare illness in children that involves inflammation of the blood vessels, including coronary arteries, the city’s health department said.

 

None of the New York City patients with the syndrome have died, according to a bulletin from the health department, which describes the illness as a “multisystem inflammatory syndrome potentially associated with Covid-19.”

 

Reached late Monday night, the state health commissioner, Dr. Howard A. Zucker, said state officials were also investigating the unexplained syndrome.

The syndrome has received growing attention in recent weeks as cases began appearing in European countries hit hard by the coronavirus.

 

“There are some recent rare descriptions of children in some European countries that have had this inflammatory syndrome, which is similar to the Kawasaki syndrome, but it seems to be very rare,” Dr. Maria Van Kerkhove, a World Health Organization scientist, said at a news briefing last week.

Some states that have partially reopened are still seeing an increase in coronavirus cases, including Iowa, Minnesota, Tennessee and Texas, according to Times data. Indiana, Kansas, Nebraska and Arizona also are seeing an increase in cases and are planning on some kind of reopening soon. Alaska has also reopened and is seeing a small number of increasing cases.

 

While the country has stabilized, it has not really improved, as shown by data collected by The Times. Case and death numbers remain stuck on a numbing, tragic plateau that is tilting only slightly downward.

 

At least 1,000 people with the virus, and sometimes more than 2,000, have died every day for the last month. On a near-daily basis, at least 25,000 new cases of the virus are being identified across the country. And even as New York City, New Orleans and Detroit have shown improvement, other urban centers, including Chicago and Los Angeles, are reporting steady growth in cases.

 

The situation has devolved most dramatically in parts of rural America that were largely spared in the early stages of the pandemic. As food processing facilities and prisons have emerged as some of the country’s largest case clusters, the counties that include Logansport, Ind., South Sioux City, Neb., and Marion, Ohio, have surpassed New York City in cases per capita.

https://www.nytimes.com/2020/05/04/us/coronavirus-updates.html