Child and adolescent multisystem inflammatory syndrome temporally associated with COVID-19

As of May 15, 2020, more than 4 million confirmed cases of COVID-19 have been reported to the World Health Organization, including more than 285,000 deaths. The risk of severe disease and death was higher in the elderly and in people with underlying noncommunicable diseases, such as hypertension, heart disease, chronic lung disease, and cancer.1-4 The limited data describe clinical manifestations of COVID-19 that are generally milder in children than in adults.5-8 But it has also been found that some children need hospitalization and intensive care.9-11

Relatively few confirmed cases of infants with COVID-19 have been reported; Those affected developed mild illness.7 Strong evidence linking underlying conditions and severe illness in children is still lacking. Of the 345 children with laboratory-confirmed COVID-19 and complete information on the underlying conditions, 23% had an underlying condition, with chronic lung disease (including asthma), cardiovascular disease, and immunosuppression being the most common.12

However, recent reports from Europe and North America have described groups of children and adolescents requiring admission to intensive care units with a multisystem inflammatory condition with some features similar to those of Kawasaki disease and toxic shock syndrome. Case and small series reports described a presentation of acute illness accompanied by hyperinflammatory syndrome, leading to multiple organ failure and shock.13-15 Preliminary hypotheses suggest that this syndrome may be associated with COVID-19 based on initial laboratory tests showing positive sera in the majority of patients. The children were treated with anti-inflammatory therapies, including parenteral immunoglobulin and steroids.

It is necessary to characterize this syndrome and its risk factors, to understand its causation, and to prescribe therapeutic interventions. It is not yet clear the full extent of the disease, and whether the geographic distribution in Europe and North America reflects a true pattern, or if the condition has simply not been recognized elsewhere.

There is therefore an urgent need to collect standardized data describing clinical presentations, risk, outcome, and epidemiology. WHO has developed a preliminary case definition and case report form for Multisystem inflammatory disorder in children and adolescents. The initial case definition reflects the clinical and laboratory features observed in children reported to date, and serves to identify suspected or confirmed cases for the purpose of providing treatment, interim reporting, and monitoring. The case definition will be revised as more data becomes available.

Define the initial state[a]

Children and adolescents aged 0-19 years with a fever > 3 days

And the two who is next:

  1. Rash, bilateral non-purulent conjunctivitis, or signs of mucocutaneous dermatitis (oral, hands or feet).
  2. Low blood pressure or shock.
  3. Features of myocardial dysfunction, pericarditis, valvitis, or coronary artery abnormalities (including ECHO findings or elevated troponin/NT-proBNP),
  4. Evidence of thrombosis (by PT, PTT, elevated d-Dimers).
  5. Severe digestive problems (diarrhea, vomiting, abdominal pain).

And the

Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.

And the

There is no clear bacterial cause for the inflammation, including bacterial sepsis, staphylococcus, or streptococcal shock syndromes.

And the

Evidence of COVID-19 (RT-PCR, antigen testing or positive serology), or potential contact with COVID-19 patients.

COVID-19 Global Clinical Data Platform

The World Health Organization has a well-established platform for standardized, anonymous clinical data. Contributors can enter data into the web-based WHO COVID-19 Clinical Data Platform, which captures all COVID-19 variants included in case report forms (CRFs). The WHO platform facilitates collection, scheduling, and analysis across different settings globally and provides a secure, limited-access, password-protected electronic database hosted on a secure server at WHO. WHO will maintain appropriate technical and organizational security measures to protect confidentiality and prevent unauthorized disclosure of anonymous COVID-19 data.

Note: Contributors will retain control of their data. Health facilities will have access to their dataset in an analytic format.

How to become a contributor: Please email [email protected] and ask for login credentials. The data management team will contact you with data entry instructions and will assign you a 5-digit location code at that time.

Each CRF model contains two modules:

1) The first module is completed when a multisystem inflammatory syndrome is suspected, the results of the tests included in the case definition.

2) Module 2 is completed upon exit or death.

If the patient is transferred from one ward to another within the same hospital, the standardized reporting form must be updated throughout the hospital stay, from the date of admission to the hospital, until the date of transfer to another hospital, discharge from hospital, or death.

In settings where COVID-19 CRF data has already been entered into databases other than the WHO COVID-19 Clinical Data Platform, WHO will work with health facilities to transfer data from the original databases to the WHO platform. Please email [email protected] to request support. As the collection of COVID data is not considered a research study, but rather an observation of public health importance, consent of the patient or parent/guardian is not expected to be required in most settings; In addition, information is likely to be collected retrospectively through extraction from medical records in most cases.

Working group members

  • Stephen Friedman, Alberta Children’s Hospital Research Institute, University of Calgary, Canada.
  • Shanna Godfried Cato, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Richard Gorman, Department of Health and Human Services, USA.
  • Rakesh Lodha, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
  • Lynne Movinson, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
  • Srinivas Murthy, British Columbia Children’s Hospital, Vancouver, Canada.
  • Pablo Rojo, Pediatric Infectious Diseases Unit, October 12 Hospital, Madrid, Spain.
  • Callum Semple, Outbreak Medicine, University of Liverpool, UK.
  • Louise Siegfried, Center for Tropical Medicine and Global Health, University of Oxford, UK.
  • Elizabeth Whitaker, Pediatric Infectious Diseases and Immunology, Imperial College, London, UK.

Additional inputs

  • Rosie Haig, Royal Children’s Hospital, Glasgow, Scotland, UK.
  • Yae-Jean Kim, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • Naoki Shimizu, Tokyo Metropolitan Children’s Medical Center, Japan.
  • Alfredo Tajaro, Infanta Sofia University Hospital, Madrid, Spain.

WHO Secretariat

Rajeev Bahl, Aisha de Costa, Janet Diaz, Karen Edmund, Yasser Nazar, Nigel Rollins.

references

  1. Al-Qahtani JS, Oyelade T, Aldhahir AM, Al-Ghamdi SM, Al-Mohamadi M, Al-Qahtani AS, et al. Prevalence, severity, and mortality associated with chronic obstructive pulmonary disease and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. One Plus. 2020; 15 (5): e0233147. Epub 2020/05/12
  2. Tobacco use and COVID-19. Statement 11 May 2020. Geneva: World Health Organization (https://www.who.int/news-room/detail/11-05-2020-who-statement-tobacco-use-and-covid-19 Accessed at May 14, 2020)
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395 (10223): 497-506. Epub 01/28/2020
  4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for adult inpatient mortality with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395 (10229): 1054-62. Epub 2020/03/15
  5. Cai J, Xu J, Lin D, Yang Z, Xu L, Qu Z et al. Case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clen infect dis. 2020. Epub 2020/03/01
  6. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol. 2020; 55 (5): 1169-74. Epub 2020/03/07
  7. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel coronavirus infection in infants in hospitals under 1 year of age in China. Gamma. 2020. Epub 2020/02/15
  8. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J et al. SARS-CoV-2 infection in children. In Engel J Med. 2020; 382 (17): 1663-5. Epub 2020/03/19
  9. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) admitted to pediatric intensive care units in the United States and Canada. Gamma Pediatric. 2020. Epub 2020/05/12
  10. Qiu L, Jiao R, Zhang A, Chen X, Ning Q, Fang F et al. A typical case of a critically ill infant due to COVID-19 with persistent decrease in T lymphocytes. Pediatr Infect Dis J. 2020. Epub 2020/05/08
  11. Kamali Aghdam M, Jafari N, Eftekhari K.Newel Coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. It infects Dess (Lund). 2020; 52 (6): 427-9. Epub 04/03/2020
  12. CC-R Team. Pediatric coronavirus disease 2019 – United States, February 12 – April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69 (14): 422-6. Epub 2020/04/10
  13. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Severe inflammatory shock in children during the COVID-19 pandemic. Lancet. 2020. Epub 05/11/2020.
  14. DeBiasi RL, Song X, Delaney M, Bell M, Smith K, Pershad J et al. severe COVID-19 in children and youth in the Washington metropolitan area. J Pediatr. 2020
  15. Jones VG, Mills M, Suarez D, Hogan CA, Yeh D, Bradley Segal J, et al. COVID-19 and Kawasaki disease: a new virus, a new case. Hosp Pediatric Hospital. 2020. Epub 2020/04/09

The World Health Organization continues to monitor the situation closely for any changes that may affect this scientific brief. Should any factors change, WHO will issue an additional update. Otherwise, this document will expire two years after the date of publication.

Note: This scientific summary was updated to add accuracy and correct an email address error on May 17, 2020. Title edited from “With COVID-19” to “Tentatively associated with COVID-19” and text added in italics for this sentence “Initial hypotheses are That this syndrome may be associated with COVID-19 based on preliminary laboratory tests Positive sera appear in the majority of patients. “

[a] Consider this syndrome in children with features of typical or atypical Kawasaki disease or toxic shock syndrome.

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