MIS-C Associated with COVID-19 Infection

Based on currently available data, the pediatric population appears to be affected by COVID-19 infection in much smaller proportion compared to adults, with only 2 percent of cases described in individuals under age 20. While children may be less likely to develop the disease, the numbers might not be fully representative since children may present with less severe, unexpected, or atypical symptoms leading to less testing and diagnosis of COVID-19. In pediatrics, the presentation of symptoms has yet to be clearly defined, thus leading to the concern that children may spread the disease while asymptomatic.

Due to the evolving nature of this disease, the National Association of Pediatric Nurse Practitioners (NAPNAP) continues to evaluate reports of Multisystem Inflammatory Syndrome (MIS-C) associated with COVID-19 in children. Initial cases of healthy children presenting with clinical findings similar to Kawasaki disease or toxic shock syndrome and associated COVID-19 infection were reported in the United Kingdom. Respiratory symptoms were not always present in these patients. Similar findings are now being reported throughout the United States. While we have limited information, NAPNAP joins the Centers for Disease Control and Prevention’s (CDC) recommendation to report suspected cases to local and state public health authorities so that we may better characterize the unknowns of this condition.

NAPNAP recommends:

  • Refer to the CDC website for clinical updates and case definition of Multisystem Inflammatory Syndrome in Children (MIS-C)
  • Follow established guidelines for the evaluation of Kawasaki disease or toxic shock syndrome and its associated features in any patient presenting with these symptoms.
  • Report to health officials if children meet the case definition or are suspicious for MIS-C. Children may fulfill full or only partial criteria for Kawasaki disease.
  • Collaborate with pediatric rheumatology, infectious disease experts, and emergency and critical care subspecialists, in your area on the management and treatment of this syndrome.
  • Suspect MIS-C in all pediatric deaths who have evidence of COVID-19 infection.
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