CDC issues advisory for Kawasaki-like inflammatory disease associated with COVID-19

Georgia health agency probing mysterious illness in 15 children

At least 15 children — from toddlers to teens — have fallen ill in Georgia with a mysterious condition that could have links to COVID-19, The Atlanta Journal-Constitution has learned.

None of the children here has died from the condition, though three fatalities have been reported in New York. Cases also have been reported in several other states and in European countries.

The Centers for Disease Control and Prevention just recently drew up a description of the ailment, which it named Multisystem Inflammatory Syndrome in Children, or MIS-C. It resembles a rare childhood illness called Kawasaki disease, which can lead to an enlargement of blood vessels that, in severe forms, may cause heart damage.

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The symptoms of MIS-C include prolonged fever, lasting four or more days; very red eyes; a rash spread across the body; reddening or peeling on palms and soles of feet; abdominal pain; and vomiting or diarrhea.

While the exact cause of the condition — and any link to COVID-19 — is not yet clear, experts believe the coronavirus may trigger the immune system to overreact and cause widespread inflammation throughout the body.

The CDC sent a warning last Thursday to doctors across the country to be on the lookout for the signs of the rare illness in children who have been diagnosed with COVID-19, tested positive for the antibodies, or have had recent exposure to COVID-19.

Dr. James Fortenberry, chief physician officer at Children’s Healthcare of Atlanta, said a team of infectious disease, cardiology and pediatric critical care experts have treated about a dozen children over the last few months whose symptoms and medical history meet the current CDC definition of MIS-C. Most of these patients already have been discharged from the hospital after recovering, and the team at Children’s continues to monitor them closely as outpatients, Fortenberry said.

Medical workers, wearing masks to protect against the novel coronavirus, cross the campus of Emory University Hospital Midtown in Atlanta on Friday, April 17, 2020. JOHN SPINK/JSPINK@AJC.COM
Photo: The Atlanta Journal-Constitution

The state Department of Public Health is reviewing medical information on the Georgia children to either eliminate other illnesses or to confirm MIS-C. It will review the results of their COVID-19 tests to determine whether the children currently have the active virus or the antibodies triggered by the virus. Some cases have been reported in children whose coronavirus exposure was well past.

In general, children have much milder COVID-19 infections than adults, with some not even showing symptoms.

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The new syndrome started making headlines nationally more than two weeks ago. But the state public health department hasn’t reported any of the cases to the CDC. That’s because MIS-C has yet to be confirmed in the patients, said Department spokeswoman Nancy Nydam.

Dr. Stephen Thacker, director of pediatric infectious diseases at Savannah’s Memorial Health University Medical Center, said pediatric health experts are closely monitoring new data and still working to better understand how the new sickness is connected to COVID-19. One question he has is whether there’s a geographic link. The U.S. cases to date have been mainly in East Coast cities, he pointed out.


• Georgia health authorities are investigating 15 cases of a mysterious condition with likely links to the coronavirus and the disease it causes, COVID-19. The ailment, recently named Multisystem Inflammatory Syndrome in Children, or MIS-C, is extremely rare.

• Symptoms include prolonged fever (four or more days), very red eyes, a rash spread across the body, reddening or peeling on palms and soles of feet, abdominal pain, vomiting or diarrhea.

• The American Academy of Pediatrics says parents should call their pediatrician if their child is ill, and the doctor can advise whether the child should go to the emergency room.

• If your child is in respiratory distress (having trouble breathing and taking in enough oxygen), call 911 or bring the child to the closest emergency room. Call before going to a hospital, emergency department or urgent care so they can prepare for your arrival and prevent potential exposure to COVID-19.

SOURCE: American Academy of Pediatrics, Children's Healthcare of Atlanta and the Centers for Disease Control and Prevention

“I think we still really recognize there is a lot more to learn about this,” said Thacker.

While MIS-C is similar to Kawasaki disease, Kawasaki typically affects children under the age of 5. The syndrome is being seen in a wide range of young people under the age of 21.

Even under normal circumstances, it can be difficult to differentiate Kawasaki disease from other childhood diseases, Thacker said. There are no definitive blood tests, and diagnosis involves ruling out other diseases, including Scarlet fever, which is caused by streptococcal bacteria and results in fever, rash, chills and sore throat.

This file photo shows the Discovery Wall at Elevator Lobby Located at Children’s Healthcare of Atlanta Egleston Campus.Photo Credit: Jim Roof Creative Photography

One of the challenges in trying to determine any link to COVID-19 is that the children may no longer have the active virus. And tests to determine if children have had undetected cases of COVID-19 could come back negative because of a lag time in developing antibodies.

Antibody testing in some of the patients treated at Children’s Healthcare suggests they had been previously exposed to the coronavirus. Fortenberry said Children’s is working closely with the state health department to share information.

“While this syndrome remains very rare, parents should always seek medical attention for any concerning symptoms in their child,” he said.

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Thacker said treatment used for MIS-C has been similar to treatment for Kawasaki disease — steroids, intravenous immunoglobulin, high-dose aspirin and antibiotics. He said he’s seen only two probable cases, both still under review. He expects that health officials will find out there have been more cases as awareness of the symptoms increases and health authorities take steps to better track the illness.

He said both children treated Savannah’s Memorial Health University Medical Center recovered within a few days.

The Georgia health agency sent out an alert last week about the syndrome and instructed local health agencies and health care providers to immediately report suspected cases instead of waiting on COVID-19 testing.

In addition to three deaths in New York, at least 134 cases are under investigation in that state, according to the New York State Department of Health. About 90% of children who’ve fallen ill there have either tested positive for active COVID-19 infection or the antibodies.

“I think my message would be the same as before but the COVID pandemic has reinforced these key messages and how important they are — if your child has symptoms you are worried about, call your doctor,” Thacker said. “Don’t push off being evaluated.”

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