A rare complication of COVID is affecting Australian children. Here’s what to look for

This article first appeared in The conversation.

One of the rare complications of covid in children is a inflammatory disease called pediatric inflammatory multisystem syndrome (PIMS-TS) that occurs within weeks of the time of infection with SARS-CoV-2 (the virus that causes the disease).

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It is also called multisystem inflammatory syndrome in children (MIS-C).

Two years after the first reported cases of this complication, about 120 children were diagnosed with it in Australia.

Pediatric inflammatory multisystem syndrome is actively monitored by a pediatric hospital monitoring system in Australia, called SEAPwhich includes eight children’s hospitals.

The PAEDS estimated that the syndrome affects approximately one in 2,500 children infected with COVID. However, the rate can be lower after infection with the Delta or Omicron variant compared to the original strain.

What it looks like in children

For most children, COVID infection is mild – even more so for the Omicron variant. It’s very unlikely a child will need to be hospitalized due to an infection.

However, a small number of children have an inflammatory disease that usually begins within the first six weeks after COVID infection.

We don’t know why, but the body “activates” an inflammatory response and this inflammation occurs in several different parts (systems) of the body at once: skin and eyes, gastrointestinal tract, heart, lungs , kidneys, brain. These children almost always require hospitalization.

Inflammation occurs in several parts of the body at once: skin and eyes, gastrointestinal tract, heart, lungs, kidneys, brain. File picture. Credit: Svetlana Gustova / EyeEm/Getty Images/EyeEm

Inflammation can cause a variety of symptoms and often several signs are seen at the same time. These to understand:

  • fever – usually for more than three days
  • vomiting
  • diarrhea
  • abdominal pain
  • headache
  • conjunctivitis – red, watery eyes
  • Rashes
  • lymphadenopathy – swollen lymph nodes in the neck or other sites around the body
  • sore throat
  • cough

Symptoms resemble another inflammatory condition in children called Kawasaki diseaseto which the multisystem inflammatory syndrome was compared very early.

Unlike Kawasaki disease, which occurs most often in infants, this condition occurs most often in school-aged children, involves gastrointestinal symptoms, and shows slightly different changes in blood tests.

These symptoms can also be seen in other diseases. It is therefore important for parents and doctors to know when to consult a specialist.

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What should parents pay attention to?

If your child has a fever for more than three days in the two to six weeks following a COVID infection, especially if they also have red eyes, a rash, and abdominal pain, the symptoms may be due to a multisystem inflammatory syndrome.

In this situation, it is important to see a doctor so that your child understands what may be causing the symptoms. These symptoms can also be caused by other viruses or bacterial infections.

Blood tests will usually need to be done to look for markers of inflammation such as C reactive protein.

Blood tests also detect changes in blood cell counts (including low platelet and white blood cell counts) and a slight increase in liver enzyme levels which all indicate inflammation.

Doctors will also be vigilant as inflamed blood may be more prone to clots, seen in certain cases.

Most children under investigation will also have a heart ultrasound to assess the functioning of the heart and to look for a complication where there are changes (dilation) in the arteries of the heart. Changes in the heart arteries occur in 8-24 percent cases of multisystem inflammatory syndrome.

At this time, we don’t know what predisposes some children to developing the disease as a result of COVID infection. We therefore cannot predict which children may be at increased risk.

Should parents be worried?

Multisystem inflammatory syndrome can make children very sick, and children with it will need to be treated in hospital.

The good news is that we have anti-inflammatory treatments that are very effective in treating children with these symptoms. Doctors from across Australia shared their experiences and expertise in caring for children with the disease.

Children are treated with drugs often used to treat Kawasaki diseaseincluding steroids and intravenous immunoglobulins.

These drugs reduce the body’s excessive immune response, decrease fever and inflammation, and allow heart function to return to normal.

It is also reassuring to know that almost all children recover without complications, even if they are very ill to begin with.

If your child has been diagnosed with multisystem inflammatory syndrome, you should wait until they are fully recovered and then discuss with your doctor whether to proceed with the COVID vaccination if they have not already been vaccinated.

Researchers are still investigating the risk of vaccination triggering another inflammatory event.

Vaccination remains the best protection

Preliminary data from the United States Centers for Disease Control indicate that two doses of the Pfizer COVID vaccine may protect children against the development of multisystem inflammatory syndrome after infection with COVID (approximately 80% protective in children aged 5 to 11 years and around 90% protective in adolescents aged 12 to 18).

Pediatric inflammatory multisystem syndrome is a rare but potentially serious event following COVID infection.

Do our best to prevent infection through the use of vaccines and other public health measures remains vitally important to protect all members of our society.

Nicholas Wood is Associate Professor, Discipline of Child and Adolescent Health, University of Sydney; Philip Britton is Associate Professor, Child and Adolescent Health, University of Sydney

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