Multisystem Inflammatory Syndrome in Children (MIS-C)

Multisystem inflammatory syndrome in children (MIS-C), COVID-19 associated, is an emerging condition that is characterized by inflammation of multiple areas of the body, including the heart, lungs, blood vessels, skin, eyes, brain, kidneys, or gastrointestinal organs. The cause of MIS-C has not been determined. However, many children with MIS-C had the virus that causes COVID-19 or had been around someone with COVID-19.

Please be on the lookout for the following signs and symptoms and call your child’s doctor or go to an emergency room for evaluation if you think your child might be developing this potentially life-threatening syndrome.

Signs and symptoms of multisystem inflammatory syndrome in children (MIS-C) include those below, though not all children have the same symptoms.

• fever that lasts 24 hours or longer
• vomiting
• diarrhea
• pain in the stomach
• skin rash
• feeling unusually tired
• fast heartbeat
• rapid breathing
• red eyes
• redness or swelling of the lips and tongue
• redness or swelling of the hands or feet
• headache, dizziness, or lightheadedness
• and enlarged lymph nodes

Alabama Statistics

Although not explicitly reportable in Alabama, 159 cases of MIS-C have been reported as of February 26, 2024. One MIS-C-related death has been reported in Alabama.

MIS-C Summary Data Since 2020

• The median age was 10 years. The age range of patients were between 2 months to 19 years.
• 62% of reported case were males.
• Non-Hispanic accounts for 76% of cases.
• 45% of the cases reported were Black or African American, 42% identify as White, the remaining 13% identified as either Alaska Native or American Indian, Mixed, Asian, or unknown.

United States Statistics

As of February 26, 2024, 9,655 cases of MIS-C, including 79 deaths, were reported in the United States. For the latest information on cases reported by the CDC, visit the Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States.

Information for Providers

Reporting Criteria

As described in the CDC Health Advisory, “Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19),” using the following criteria is recommended for the identification of potential cases of MIS-C:

• An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, 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 exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.

*Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
**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
^†Individuals diagnosed with Kawasaki disease, or those that meet partial criteria for Kawasaki disease, should not be excluded if they meet the reporting criteria for MIS-C.

Additional comments:

• Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.

How To Report

COVID-19 associated MIS-C cases may be reported to the Alabama Department of Public Health (ADPH) via the Communicable Disease REPORT Card system. Upon opening the REPORT card, there will be a drop-down menu with multiple diseases listed. Select the "Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 associated" option and fill in the requested information and upload the following document files to the REPORT card:

• History and Physical
• Discharge Summary
• Laboratory Reports
• Imaging Reports [e.g., Chest Computed Tomography (CT), Chest Radiograph X-ray, etc.]

If the documents are not uploaded with the submission, ADPH staff will contact the reporter to request any additional information.

Resources

• CDC - Multisystem Inflammatory Syndrome (MIS-C)
• CDC - Coronavirus Disease 2019 (COVID-19)
• CDC - For Parents: MIS-C
• CDC - For Healthcare Providers