Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Leora R Feldstein, Erica B Rose, Steven M Horwitz, Jennifer P Collins, Margaret M Newhams, Mary Beth F Son, Jane W Newburger, Lawrence C Kleinman, Sabrina M Heidemann, Amarilis A Martin, Aalok R Singh, Simon Li, Keiko M Tarquinio, Preeti Jaggi, Matthew E Oster, Sheemon P Zackai, Jennifer Gillen, Adam J Ratner, Rowan F Walsh, Julie C Fitzgerald, Michael A Keenaghan, Hussam Alharash, Sule Doymaz, Katharine N Clouser, John S Giuliano, Anjali Gupta, Robert M Parker, Aline B Maddux, Vinod Havalad, Stacy Ramsingh, Hulya Bukulmez, Tamara T Bradford, Lincoln S Smith, Mark W Tenforde, Christopher L Carroll, Becky J Riggs, Shira J Gertz, Ariel Daube, Amanda Lansell, Alvaro Coronado Munoz, Charlotte V Hobbs, Kimberly L Marohn, Natasha B Halasa, Manish M Patel, Adrienne G Randolph
New England Journal of Medicine 2020 June 29

BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.

RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).

CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.).

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