- MIS-C is a rare, but dangerous, syndrome that has been linked to the Covid-19 virus and children aged 2–15 years
- A new UK study found that the most severe symptoms in patients generally resolved within six months after hospitalisation
- Dr Kate Webb, a Cape Town-based paediatric rheumatologist, spoke to Health24 about the status of MIS-C in South Africa
Children and teens who develop the relatively new inflammatory syndrome linked to the Covid-19 virus will have most of their serious symptoms cleared by six months, a new UK study suggests.
Known as multisystem inflammatory syndrome in children (MIS-C), the condition is very rare, but can be dangerous.
The findings of the study are, therefore, encouraging, the researchers said.
"These findings can hopefully signal cautious optimism that many of the most severe effects of [MIS-C] appear to resolve within six months," study co-author Dr Justin Penner, of the Department of Paediatric Infectious Diseases at Great Ormond Street Hospital in London, told CNN.
However, the authors noted that some children did experience persistent fatigue and difficulty exercising, and cautioned that these symptoms should be closely monitored.
The paper was published in The Lancet Child and Adolescent Health.
MIS-C in a nutshell
The first cases of MIS-C were reported in April 2020. The US Centers for Disease Control and Prevention (CDC) describes it as a syndrome that involves inflammation of multiple organs, such as the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal tract.
Children with MIS-C may experience unusual weakness or fatigue; a red rash; abdominal (belly) pain; vomiting and diarrhoea; red, cracked lips; red eyes; or swollen hands or feet, notes Johns Hopkins Medicine (JHM). The syndrome can develop within four weeks of exposure to the virus, and mostly affects children aged two to 15 years. It has not been reported in babies.
In their paper, the researchers explain that while experts are aware of the acute phase of MIS-C, little is known about rehabilitation requirements after the patients are discharged from hospital.
The study included 46 children under 18 years who were admitted to Great Ormond Street Hospital between April and September 2020.
Eight (17%) of them had pre-existing conditions; 30 (65%) were male and 16 (35%) female, while 37 (80%) of them were from minority ethnic groups.
They were followed up by a multidisciplinary team of specialists at six weeks and six months after admission.
At the time, the majority of the patients (98%) experienced gastrointestinal symptoms, and 52% had neurological symptoms, while 33% had heart symptoms.
Six months later, only one child still had systemic inflammation. Two children had heart abnormalities, and six were reported to still have gastrointestinal symptoms. None of the children died.
Despite the good news, some of the children were also reported to have trouble exercising, which was measured by a test of how far they could walk in six minutes, six months after hospitalisation. However, deeper investigation is needed as the researchers didn’t compare these findings to the walking speed of children not hospitalised with MIS-C.
Instead, it's possible that given the restrictions in movement during lockdown, even healthy children experienced reductions in their exercise ability, they said.
This is the longest study of MIS-C to date.
"The levels of fatigue and muscle weakness we found at six months follow-up are concerning and requires close monitoring, but it's difficult to determine whether this finding is caused directly by [MIS-C] or if it's a result of the disruption in children’s lives that the Covid-19 pandemic has caused on a wider scale," study co-author Dr Karyn Moshal, of Great Ormond Street Hospital's Department of Pediatric Infectious Diseases, said in a statement.
A key point made in their study is the possibility of additional long-term effects showing up in the children more than six months after hospitalisation, which stresses the importance of continuing these studies, the authors said.
MIS-C in SA
Dr Kate Webb, a paediatric rheumatologist at the Red Cross War Memorial Children’s Hospital, previously described MIS-C Spotlight as “an immune response that children and adolescents get to previous Covid infections and they get a hyper-inflammatory immune response.
“So, for some reason, your immune system doesn’t turn off as it does in other cases,” she said.
Webb told Health24 that MIS-C first emerged in the Western Cape in June 2020. Up until the end of February 2021, there have been 69 cases between the Red Cross Children’s Hospital and Tygerberg Hospital – the main secondary referral centres for the City of Cape Town.
“We estimate from discussions with clinicians across the country that there have been at least 250 cases in South Africa, at a conservative estimate. We guess that there have been more than this. This is a notifiable medical condition, but we are still working with the NICD (National Institute of Communicable Diseases) to gather and document all of these cases,” said Webb.
Webb added that the UK study’s results are encouraging and mirror what doctors have seen in the Western Cape.
“Although MIS-C is a severe and life-threatening condition that affects all organ systems, if recognised and treated early, it has a really good outcome,” she assured.
She added: “It is interesting that this paper has highlighted that although these children do well, there are perhaps under-appreciated longer-term emotional effects of having such serious conditions and we need to do more to support these children and families after discharge. Research is vitally important in this disease.”
The unknowns that remain
There are still important unknowns, including why some children develop MIS-C and who is at risk, and although JHM states that there are medicines available that can control the inflammation and help avoid lasting organ damage, there is actually no clinical trial-based evidence for the best treatments, said Webb.
“This paper highlights that MIS-C disproportionately affects children of colour and we have a duty in South Africa to work on the best ways to diagnose and treat this condition in local children,” she said.