We do not yet know what causes MIS-C in children.
However, we know that many children with MIS-C had the virus that causes COVID-19, or have been around someone with COVID-19. Symptoms of MIS-C usually occur two to four weeks after the child has tested positive for COVID-19.
What is MIS-C?
This string of alphabets stands for Multisystem Inflammatory Syndrome in Children (MIS-C), a serious condition that appears to be linked to COVID-19. Most children who become infected with the COVID-19 virus have only a mild illness. But in children who go on to develop MIS-C, different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Such cases are characterised by: unremitting fever > 38oC, epidemiological linkage with SARS CoV – 2 and clinical features suggestive of MIS-C.
MIS-C is considered a syndrome - a group of signs and symptoms, not a disease - because much is unknown about it, including its cause and risk factors. Identifying and studying more children who have MIS-C may help to eventually find a cause. The US Centers for Disease Control and Prevention (CDC) and the National Institutes of Health are working with doctors and researchers to learn more about risk factors for MIS-C, share data and improve diagnosis and treatment of MIS-C.
Dr Gaurav Aiyappa, Registrar in Paediatrics and Neonatal Medicine, King's College Hospital NHS Foundation Trust, London shares, “MIS-C can happen have upto 2 months of coming in contact with a COVID-19 positive person. It is serious as it mimics an inflammatory disease in children and impacts multiple organs. In a large country like India, with a huge caseload of COVID-19, the spread of MIS-C is imminent and highly possible. We have seen how the virus affected the elderly during the first wave, then the middle aged in the second. Children aren't immune to it because if you see in any pandemic, this is how it occurs until the target population has herd immunity. The Indian government needs to ramp up facilities and keep the citizens informed about what's happening and educate them. There’s a need to fast track immunisation for age groups of upto 18 and below at the earliest.”
Prof Dr Meenu Singh, Senior Paediatrician, Post Graduate Institute of Medical Education & Research (PGIMER) Chandigarh, informed that in India only 14.2 per cent of cases are less than 20 years. This has reduced to 12 % in the second wave. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.
Dr Meenu says this is because most children have various protective mechanisms like stronger innate immune response, higher levels of melatonin which has anti-inflammatory and anti-oxidative properties and also are protected by the off target immunomodulatory effects of live vaccines like BCG and MMR that are mandatory after birth.
Children having mild symptoms can be managed at home provided there is easy access to a health facility in case of any deterioration. In case there is lack of proper arrangement to manage these children at home/ access to health facility is difficult, such children may be admitted.
When to seek hospitalisation/help for your child:
Alongwith High Fever, any TWO of these symptoms are indicative of MIS-C:
Breathing difficulty with rapid respiratory rate, chest indrawing, nasal flare and bluish/pale gray discolouration on skin, lips or nail beds
Hypoxia if monitored: SpO2 < 94%.
If the child is showing mild symptoms, it is necessary to rule out tropical infections first. Dr Meenu says, “Most MIS-C cases are those with co morbidities like congenital heart diseases, lung or kidney disease so they are at risk. Parents of children with pre-existing diseases must therefore be very careful. In severe cases hospitalisation will be necessary and the line of treatment includes Steroids and IVIB and continuous monitoring and in extreme cases, ventilators. However as mentioned earlier due to their inherent strong immunity, the rate of recovery is very good.”
She said that the medical fraternity is being watchful as India has already crossed the peak of the second wave. “We are two to three weeks ahead of that peak and this is the time MIS-C cases may show up. We have been discussing with authorities in states like Maharashtra and Kerala which had huge adult populations infected with COVID-19 - 50,000 cases a day or more, so understandably there are children who would have contracted COVID-19 as well. And a very small percentage of those children can develop MIS-C. So we have to be ready for that.”
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The govt has already looking at this likely scenario. Paediatric dedicated facilities have to be increased as children cannot be managed like adults. There is also a need to increase total number of PICU beds for children to meet the imminent surge in cases.
How to protect your child
Vaccination is one strategy but vaccines are not being given to children at present. Once the clinical trials are done, this age group can get their vaccine shots. But until then, adults can protect their children by getting themselves vaccinated as soon as possible. This will reduce the critical mass of COVID-19 infected adults. So the best way to protect your child against MIS-C is to get yourself vaccinated.