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COVID-19 Health Alert #29:
Call for Cases: Multisystem Inflammatory Syndrome in Adults (MIS-A)
Bureau of Communicable Diseases, March 18, 2021
Summary
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The CDC is now conducting surveillance for cases of Multisystem Inflammatory Syndrome in Adults (MIS-A), a rare and potentially severe clinical illness similar to the syndrome previously described in children (MIS-C).
- Clinical criteria for MIS-A are identical to those for MIS-C, but occur in adults aged 21 or older.
- Wisconsin clinicians and health departments are requested to report any cases of MIS-A that have occurred in your jurisdiction to DHS via the Wisconsin Electronic Disease Surveillance System (WEDSS) using the MIS-C tab. Case reports should include the clinical information listed in the body of this message.
Dear Colleagues,
The CDC is collecting reported cases of multisystem inflammatory syndrome in adults (MIS-A) to learn more about this recently-described phenomenon.
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe complication in children and adolescents infected with SARS-CoV-2, the virus that causes COVID-19. Since June 2020, there have been several reports of a similar multisystem inflammatory syndrome in adults (MIS-A). CDC recently published a number of cases that fit the description of MIS-A. This report shows the way the syndrome appears in adults may be more complicated than in children. For example, a significant number of patients with MIS-A had no preceding respiratory symptoms and negative results on SARS-CoV-2 PCR testing, indicating that the syndrome may be a post-infectious process with variable timing of onset.
Clinical criteria for MIS-A are described in the table below.
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Case Definition for Multisystem Inflammatory Syndrome in Adults (MIS-A)
- An individual aged ≥21 years, AND
- Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours, AND
- Laboratory markers of inflammation (including, but not limited to one or more: 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), AND
- Evidence of clinically severe illness requiring hospitalization, with involvement of 2 or more organ systems from the list below, AND
- Cardiac (e.g. shock, elevated troponin, BNP, abnormal echocardiogram, arrhythmia)
- Renal (e.g. acute kidney injury or renal failure)
- Respiratory (e.g. pneumonia, ARDS, pulmonary embolism)
- Hematologic (e.g. elevated D-dimers, thrombophilia, or thrombocytopenia)
- Gastrointestinal (e.g. elevated bilirubin, elevated liver enzymes, or diarrhea)
- Dermatologic (e.g. rash, mucocutaneous lesions)
- Neurological (e.g. CVA, aseptic meningitis, encephalopathy
- 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
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If any Wisconsin hospital providers or local health departments are aware of current or former patients meeting criteria for MIS-A, the Department of Health Services (DHS) requests that you please report clinical information about these cases using the Wisconsin Electronic Disease Surveillance System (WEDSS). At this time, cases of MIS-A should be reported in WEDSS using the MIS-C tab, while specifying that the disease has occurred in an adult patient. All case reports should include the following information:
- History and Physical
- Physician Consultations (Infectious Disease, Rheumatology, Cardiology Hematology, Dermatologic)
- Laboratory Results (Diagnostic and Chemistry)
- Radiology Results (if performed)
- Echocardiogram Results (if performed)
- Treatment Log
- Daily Vitals Log
- Discharge Summary
Questions about MIS-A or MIS-C reporting can be directed to the Communicable Disease Epidemiology Section at DHS by calling 608-267-9003 or via email to Thomas.Haupt@wi.gov.
Thank you for your collaboration on this matter.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
About the COVID-19 Health Alert Network
The content of this message is intended for public health and health care personnel and response partners who have a need to know the information to perform their duties. The HAN will be the primary method for sharing time-sensitive public health information with clinical partners during the COVID-19 response. Health care providers and other officials can subscribe and unsubscribe using their preferred email address at the DHS COVID-19 website.
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