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The Delaware Division of Public Health (DPH) is issuing this health advisory to ensure providers are aware of the reported Multisystem Inflammatory Syndrome in Children (MIS-C) potentially associated with COVID-19, and to provide guidance on reporting of cases to DPH and testing of patients who present with this disease. Please note that while older adults are at risk for severe COVID-19 illness, children can still get sick with COVID-19, most often presenting with mild symptoms, but rarely becoming severely ill. COVID-19 cases, and associated clusters, are considered conditions required as reportable to DPH.
Recently, coronavirus disease 2019 (COVID-19) has been reported as possibly linked with a pediatric multisystem inflammatory syndrome disease – Multisystem Inflammatory Syndrome in Children (MIS-C). As of May 12, 2020, 102 suspected pediatric clinical cases compatible with multisystem inflammatory syndrome associated with COVID-19 have been reported in children in New York State hospitals, including New York City. Additionally, Delaware has reportedly identified three cases.
If there is a strong clinical suspicion of MIS-C, potentially associated with COVID-19, call 1-888-295-5156 to consult with the DPH Office of Infectious Disease Epidemiology, or report through email@example.com, within 24 hours of clinical suspicion or submission of test samples to a commercial lab, to allow for surveillance and monitoring as appropriate. Reporting will enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.
In the United Kingdom and Europe, a possible link was reported between COVID-19 and a serious inflammatory disease recently termed "Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19." As of May 12, 2020, the New York State Department of Health identified 102 patients (including patients from New York City) suspected pediatric clinical cases compatible with multisystem inflammatory syndrome were reported in children in New York State hospitals, including New York City. Additionally, Delaware has reportedly identified three cases.
This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen.
Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome, referred to as MIS-C by CDC, may occur days to weeks after acute COVID-19 illness.
1 Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
2 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
Clinicians should not delay seeking expert advice while waiting for results of these investigations.
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