Provider Reporting of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. PLEASE REPORT CASES OF MIS-C TO CENTRAL DISTRICT HEALTH.

Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to Central District Health (Phone: 208-327-8625 or FAX: 208-327-7100) or to the Bureau of Communicable Disease Prevention Epidemiology Section (208-334 5939).

Clinical presentation
Children with MIS-C usually present with persistent fever, abdominal pain, vomiting, diarrhea, skin rash, mucocutaneous lesions and, in severe cases, with hypotension and shock. They have elevated laboratory markers of inflammation and often laboratory markers of damage to the heart. Some cases may fulfill full or partial criteria for Kawasaki disease, but if they meet criteria for MIS-C, they should be reported as MIS-C.

MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact and, in some cases, the child and their caregivers may not even know they had been infected.

MIS-C Criteria for Reporting

• An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, 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 COVID-19 exposure within the 4 weeks prior to the onset of symptoms

ⁱFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
ⁱⁱIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), merythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin.

Resources
American Academy of Pediatrics Multisystem Inflammatory Syndrome in Children (MIS-C) Interim Guidance https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-
infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-
interim-guidance/

American College of Rheumatology: Clinical Guidance for Pediatric Patients with MIS-C
https://www.rheumatology.org/Portals/0/Files/ACR-COVID-19-Clinical-Guidance-Summary-MIS-C-Hyperinflammation.pdf

Centers for Disease Control and Prevention Provider Information:
https://www.cdc.gov/mis/hcp/index.html