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Tracking MIS-C (Text Version)
Tracking MIS-C: Multi-System Inflammatory Syndrome in U.S. Children
186 MIS-C Cases, 26 states
March 15-May 20, 2020
Epidemiology of MIS-C
Hospital-reported MIS-C Cases by State:
- 16 states reported 1-6 cases
- 4 states reported 7-14 cases
- 1 state reported 15-21 cases
- 4 states reported 22-29 cases
MIS-C and COVID-19 Activity
[Chart showing percentage of positive COVID-19 tests and number of MIS-C cases from March 15-May 20]
By leveraging a national influenza surveillance network of pediatric ICUs[i], CDC and partners conducted targeted surveillance for MIS-C from March 15 through May 20, 2020, identifying 186 MIS-C cases in 26 states.
Gender
Age
- 7%, <1
- 28%, 1-4
- 25%, 5-9
- 24%, 10-14
- 16%, 15-20
Percentage of U.S. Children with MIS-C, by race and ethnicity*
- 31% Hispanic or Latino
- 25% Black, non-Hispanic
- 19% white, non-Hispanic
- 5% other, non-Hispanic
- 22%, unknown
*race categories were non-exclusive
Cases Met 5 Criteria
- Hospitalized patients < 21 years
- Fever ≥ 24 hours
- Laboratory evidence of inflammation
- ≥ 2 organs involved
- Evidence of SARS-CoV-2[ii] by RT-PCR[iii], antibody test, or exposure to a person with COVID-19 in the prior month
Impact on the Cardiovascular System
Percentage of Patients with Impact on the Heart
- Any CVI[iv] (80%)
- Elevated troponin (50%)
- B-type natriuretic peptide (BNP) > 400 (73%)
- Echocardiography performed (91%)
- Pericarditis or pericardial effusion (26%)
- Ejection fraction of < 30% (5%)
- Ejection fraction of 30 to < 55% (33%)
- Ejection fraction ≥ 55% (62%)
- Z-score of LAD[v] or RCA[vi] ≥2.5* (8%)
- Dysrhythmia/arrhythmia (12%)
- Vasopressor support/Vasoactive infusions (48%)
- ECMO[vii] (4%)
*among all MIS-C cases
Impact on Other Organs, by Age
Percentage of MIS-C Patients with Impact on Other Organs
Percentage of MIS-C Patients with Laboratory Evidence of Inflammation, by Age
Treatment
- Intravenous Immunoglobulin (IVIg) (77%)
- Second dose IVIg (21%)
- Systemic Steroids (49%)
- Il-6 Inhibitors (tocilizumab and siltuximab) (8%)
- Il-1Ra Inhibitor (anakinra) (13%)
- Systemic Anticoagulation (47%)
Highest Level of Care
- Ward (20%)
- Intensive Care Unit (80%)
Intensive Care Interventions
- ECMO (4%)
- Mechanical Ventilation (20%)
- Vasoactive Support (48%)
Outcomes
- Median Hospitalization, 7 days
- Still Hospitalized May 20,2020 (28%)
- Discharged alive (70%)
- Died (2%)
Percentage of U.S. MIS-C Patients with Features of Kawasaki Disease (KD) and Other Diseases
**among those with echocardiograms (n=170)
*This category includes patients who had 0 or 1 Kawasaki disease-like features or 2 or 3 features without additional laboratory findings.
Boston Children’s Hospital
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Abbreviations
[i] Intensive Care Unit
[ii] Acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
[iii] Reverse transcription polymerase chain reaction (RT-PCR)
[iv] Cardiovascular intention (CVI)
[v] Left anterior descending artery (LAD)
[vi] Right coronary artery (RCA)
[vii] Extracorporeal membrane oxygenation (ECMO)
[viii] Deep vein thrombosis (DVT)
[ix] Fibrinogen equivalent units (FEU)
[x] International normalized ratio (INR)
[xi] Erythrocyte sedimentation rate (ESR)
[xii] Alanine aminotransferase (ALT)