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Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)
On May 14, the Centers for Disease Control and Prevention (CDC) issued a HAN alert on Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19).
"The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome."
Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)
- An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms
iFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
iiIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin
Additional comments
- Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
- Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection
LATEST NUMBERS
- AAP Children and COVID-19: State-Level Data Report
- JOHNS HOPKINS COVID-19 CSSE Dashboard
- TEXAS DSHS COVID-19 Texas Case Counts
- CDC EPIC Supporting Children and Adolescents During COVID-19
- AAP Pediatric Mental Health Minute Series
- PROJECT ECHO UNM HHS/ASPR COVID-19 Clinical Rounds
- PMI The Business Impact Of COVID-19 On Pediatric Practices
- AAP Child Abuse in the COVID-19 Era
- ACEP COVID-19: The Pediatric Perspective
- CHILDREN AT RISK Coronavirus Children's Resiliency Collaborative
- AAP Caring for Children with Complex Medical Conditions During COVID-19
- CHILDREN'S HEALTH Pediatric Insights: COVID-19 Insights for Providers
- NHTSA What EMS needs to know about COVID-19
- AAP Telehealth and COVID-19
- CDC Update for rural partners and communities
- CDC COVID-19 Information for Clinicians Caring for Children and Pregnant Women
- AAP COVID 19 Pandemic – Clinical Guidance for Pediatric Practices
- HMBANA Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital
- BW Airway/Respiratory Containment System: Open Source Device Reduce COVID-19 Occupational, developed by Texas Children's Hospital
- CDC Child Immunization Schedule Changes for 2020
- TMB Minimum Standards for Safe Practice Related to COVID-19
- ACEP COVID-19 Field Guide
- ACEP The Role of Emergency Physicians in the Care of Children
- CDC Hospital Preparedness Tool
- PEDIATRIC READINESS IN THE ED 2020 NPRP Checklist
- CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
- ASPR COVID-19 Healthcare Planning Checklist
- AAP Management of Infants Born to COVID-19 Mothers FAQs
- AAP Guidance on Newborn Screening During COVID-19
- TEXAS DSHS COVID-19 & Newborn Screening
- TEXAS CHILDREN'S HOSPITAL Incoming Patients Screening Algorithm
- TEXAS CHILDREN'S HOSPITAL Caring for a COVID-19 Patient
- CDC Phone Advice Line Guidelines for Children or Adults with Possible COV
- TX NAEMSP Practice Guidelines During the COVID-19 Pandemic
- ACEP Pediatric Readiness in Emergency Medical Services Systems
- HHS TRACIE Topic Collection: COVID-19 Pre-Hospital/EMS Resources
- EMSC/NHTSA Transporting Children in an ambulance
- EMS.GOV Managing Patient and Family Distress Associated with COVID-19
- ASPR EMS Infectious disease Playbook
- ASPR COVID-19 Healthcare Planning Checklist
- TX DSHS EMS Transporting Confirmed or Suspected COVID-19 Patients
- MEDSTAR High Consequence Infectious Disease Call Algorithm
- CMS Ambulances: CMS Flexibilities to Fight COVID-19
- CDC Interim Guidance for EMS and 911 PSAPs
SUPPORT FOR HEALTHCARE PROVIDERS
- COLLABORATIVE FOR CHILDREN Child care resources for essential employees
- FRONTLINE CHILDCARE Childcare Options for Texas Frontline Workers
- TDVR Volunteer Registry for Medical, Public Health and Lay Volunteer Responders
MENTAL & BEHAVIORAL HEALTH RESOURCES
- CRISIS TEXT LINE Free 24/7 counseling at your fingertips
- ELEOS HEALTH Project Parachute: Pro-Bono therapy for front line healthcare professionals
- KBEMS Compassionate Options for Pediatric EMS
- CHILD TRENDS Supporting Children’s Emotional Health During The Pandemic
- SAPIEN WELLNESS Before/After the Shift
- TX DSHS Mental Health Crisis Services
- TX DSHS COVID-19 & Behavioral Health
- CDC COVID-19 Stress & Coping
- HTU Austin Area Resources
- TCH Houston Area Resources
CONSIDERATIONS FOR PEOPLE WITH SPECIAL NEEDS
- TX COUNCIL FOR DEVELOPMENTAL DISABILITIES (TCDD) COVID-19 Resources
- TCCD Successful Communication with People with Disabilities
- TX EDUCATION AGENCY COVID 19 and Special Education FAQ
- ACEP Emergency Information Form for Children with Special Health Care Need (CSHCN)
- US DEPT. OF EDUCATION Providing services to CSHCN during COVID-19 FAQ
INJURY PREVENTION
The current COVID-19 pandemic may not affect children as much as the rest of the population, but it has exacerbated the need to increase disease and injury prevention efforts as children spend more time around the home.
- TCH Keeping Children Safe during the COVID-19 Pandemic
- POISON CONTROL Texas Poison Center
- SAFE KIDS Firearm Safety
- SAFE KIDS Children Around Medicine
- TDPA Drowning Prevention and Safety
- CSN Toy Injury Fact Sheet
- DRISCOLL CHILDRENS How to Help
CHILD ABUSE RESOURCES
Child abuse might go underreported during the pandemic as children spend more time at home then schools, where authorities rely on teachers and school nurses to report cases of potential child abuse. As shelter at home orders continue and schools remain closed, it remains everyone's responsibility to ensure that children feel safe in the environment they share with their families. Below are a few helpful resources.
- UNICEF Technical Guidance on Protecting Children During the Pandemic
- TEXAS DEPT. OF FAMILY AND PROTECTIVE SERVICES Abuse Hotline Website
VIDEO CHANNELS
OPENPediatrics is providing a collection of instructional videos to help healthcare providers care for pediatric patients during the pandemic.
MASSACHUSETTS EMSC has provided brief professional produced video clips for their Pediatric Emergency Care Coordinators (PECC). The video are meant to help professionals create a more family-centered environment for their emergency departments. In addition to helping children through minor procedures, the techniques presented in the videos also help the staff to feel more comfortable when a child presents requiring laceration repair, abscess I&D, etc.
FREE COURSES
- Texas A&M Agrilife Extension Free Child Care and COVID-19 Courses
- NC EMSC Pediatric Airway Course
- UNM SCHOOLS OF MEDICINE Pediatric Trauma Course
- OPENPEDIATRICS Ventilator Simulator
LATEST RESEARCH
- NEJM Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
- AAP COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
- LANCET Steam inhalation and paediatric burns during the COVID-19 pandemic
- LANCET Hyperinflammatory shock in children during COVID-19 pandemic
- NEJM Children with Covid-19 in Pediatric Emergency Departments in Italy
- AAP COVID-19: Overview and Evaluation – Pediatric Collection
- CLINICS COVID-19 Diagnostic and Management Protocol for Pediatric Patients
- KARGER NEONATALOGY COVID-19 and Neonatal Resuscitation
- NEW ENGLAND JOURNAL OF MEDICINE (NEJM) SARS-CoV-2 Infection in Children
- DON'T FORGET THE BUBBLES Summary of pediatric COVID-19 literature
IN THE MEDIA
- 8/15 | How to recognize Covid-19 symptoms in children, based on pediatricians' advice
- 8/11 | At Least 97,000 Children Tested Positive For Coronavirus In Last 2 Weeks Of July
- 7/18 | 85 babies under 1 year old in Nueces County have tested positive for COVID-19 since mid-March
- 6/29 | Researchers report nearly 300 cases of inflammatory syndrome tied to Covid-19 in kids
- 6/26 | THA U.S. Senators Request Financial Relief for Children’s Hospitals
- 6/4 | BBC How Covid-19 is changing the world’s children
- 5/31 | HOU CHRON Texas Children’s, Children’s Memorial Hermann treating several for mysterious coronavirus syndrome
- 5/25 | KXAN Mysterious illness linked to COVID-19 in kids reported to Texas health officials
- 5/4 | NIH Study to Determine Incidence of Novel Coronavirus Infection in U.S. Children Begins
- 4/27 | NY POST Coronavirus-related ‘inflammatory syndrome’ emerges among UK children: report
- 4/26 | UN NEWS Millions more children at risk with immunization services disrupted amid COVID-19 pandemic
- 4/15 | COOK CHILDRENS Spike in Severe Child Abuse Cases Likely Result of COVID-19
- 4/8 | TEXAS A&M Protecting Children with Asthma from COVID-19
- 3/27 | TEXAS TRIBUNE Out of sight, child abuse in Texas thought to be on the rise
- 3/27 | THE CHILDREN'S HOSPITAL OF SA COVID-19 Testing In Children
- 3/26 | NY TIMES Doctors Expect a ‘Huge Spike’ in Pediatric Injuries at Home
The Emergency Medical Services for Children (EMSC) State Partnership, Texas is a statewide collaborative project funded through the Health Resource and Services Administration’s EMS for Children Program. Baylor College of Medicine is the site of the Texas EMSC office and is working in partnership with the largest children’s hospitals in Texas, their affiliated colleges of medicine, and representatives of the Texas Department of State Health Services. Through this collaboration, the EMSC State Partnership, Texas has created the infrastructure to assess and achieve defined EMSC Performance Measures. In addition, the EMSC State Partnership, Texas works tirelessly to improve education, research and pediatric pre hospital care. For more information, please visit www.bcm.edu/pediatrics/emsc.
This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
1102 Bates Ave Ste C1850 | Houston, TX 77030 | (832) 824 3672 | emsctexas@bcm.edu
Updated on August 21, 2020
Credits:
Created with images by BlenderTimer - "coronavirus corona virus" • Annie Spratt - "untitled image" • camilo jimenez - "untitled image" • Helena Lopes - "Saturday. Summer. Beautiful sunny day, so my friends and I decided to make a picnic and watch the sundown. Pretty fun and relaxed day." • Senjuti Kundu - "This is two-year-old Malki, her name means Queen in Yiddish. We were at the park playing with paint and bubbles and this shot was a remarkably lucky one since toddlers move so fast. This photo is important to me because it captures her innocence and reminds me how happy and carefree I was that day, hanging out with her." • MI PHAM - "Children’s smile" • Jerry Wang - "untitled image" • DariuszSankowski - "phone mobile telephone" • Mr Cup / Fabien Barral - "A stack of old newspapers"