Wisconsin DHS Health Alert #39: Update on Multi-System Inflammatory Syndrome in Children (MIS-C)
Bureau of Communicable Diseases
February 18, 2022
- MIS-C is a rare but serious condition associated with COVID-19 in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. These patients may require intensive care unit admission for cardiac and/or respiratory support, and testing for SARS-CoV-2 virus may be positive or negative at the time of admission.
- To date, 183 children in Wisconsin have been diagnosed with Multi-System Inflammatory Syndrome in Children (MIS-C), including 33 children diagnosed since January 1, 2022.
- One fatality of a child diagnosed with MIS-C has been reported.
- Several children have been diagnosed with MIS-C despite being fully vaccinated.
- Wisconsin clinicians and health departments are requested to report any cases of MIS-C that have occurred in their jurisdiction to DHS via the Wisconsin Electronic Disease Surveillance System (WEDSS) using the MIS-C disease incident.
Background:
Since January 1, 2022, 33 children have been diagnosed with MIS-C in Wisconsin, including one fatality of a child diagnosed with MIS-C. Several children have been diagnosed with MIS-C despite being fully vaccinated. A total of 183 children have been diagnosed with MIS-C since the start of the pandemic.
Clinicians should not delay seeking expert advice while waiting for results of these investigations. Early recognition by pediatricians and prompt referral to an in-patient specialist, including to critical care, is essential. This syndrome should be considered by pediatricians and specialists, particularly when other microbial etiologies have not been identified.
Pediatricians and specialists should elicit any recent history of illness with COVID-19 or close contact with individuals who are known to have COVID-19 in children presenting with symptoms that are compatible with MIS-C.
Most patients who have presented with this syndrome have tested positive for the SARS-CoV-2 virus with a diagnostic molecular test, or were positive on a SARS-CoV-2 antibody test.
Case Reporting:
COVID-19-Associated MIS-C should be reported to DHS for any patient who meets the following CDC case definition:
- An individual aged <21 years presenting with fever ≥38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours,
- Laboratory evidence of inflammation including, 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
- 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 exposure to a suspected or confirmed COVID-19 case within the four weeks prior to the onset of symptoms.
Sincerely,
Ryan Westergaard, MD, PhD, MPH Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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