New Inflammatory Syndrome

All About the New Inflammatory Syndrome Infecting Children After COVID-19

In general, children have suffered milder cases of COVID-19 than adults. However, reports from around the world now describe a multisystem inflammatory condition that is seriously affecting children and teens.  

According to the World Health Organization, hospitals in Italy, Europe and North America have recently reported that children and teens are being admitted to the intensive care units with symptoms of a multisystem inflammatory condition. What is this new syndrome?

The symptoms present similarly to Kawasaki disease and toxic shock syndrome. Kawasaki disease is characterized by self-limiting vasculitis – an inflammation in blood vessels throughout the body. It almost exclusively affects children and a lasting fever is typically the first sign. Toxic shock syndrome is a rare, life-threatening complication of particular types of bacterial infections. Regarding the new inflammatory syndrome, now being called Pediatric Inflammatory Multisystem Syndrome (PIMS-TS), early hypotheses are that it may bear a connection to the novel coronavirus.

A preliminary case definition of PIMS-TS, as outlined by the WHO, describes that children with the syndrome have a minimum of two of the following symptoms:

  • Rash
  • Hypotension or shock
  • Cardiac arrhythmia
  • Evidence of coagulopathy
  • Acute gastrointestinal problems
  • Elevated inflammatory markers with no other obvious microbial cause of inflammation
  • Have either had coronavirus or been in direct contact with someone who did

Prof. Galia Rahav, Director of the Infectious Disease Unit and Laboratories at Sheba Medical Center, reports that thus far, three known cases of PIMS-TS have occurred in Israel, and none of the cases were fatal. There was also one case of an adult who required treatment at Sheba recently for similar symptoms.

In early May, PIMS-TS appeared in scientific literature for the first time when approximately 15 cases were reported in New York. To date, about 70 cases have been reported in New York, but Dr. Efraim Bilavsky, head of the coronavirus program at Schneider Children’s Hospital in Petah Tikva, warned that conclusions about the rate of infection cannot be made from this number.

“It is a syndrome for which we do not know its exact incidence,” said Bilavsky. “It is clear that many children [in New York] have been infected with the coronavirus and have not been tested. So, when there are alleged reports of 70 cases in New York, we do not know out of how many infected. Is it common? Is it rare? If so, how rare? We do not know.”

The children in America all had fever and inflammation and required hospitalization. Some also presented with rashes, abdominal pain, vomiting or diarrhea. Less than half the children experienced respiratory involvement.

Both molecular and serological testing was done to check the children for the novel coronavirus. Four of the children were diagnosed with active cases of the virus; six of the children were negative for the virus but positive for antibodies, indicating that they had the virus already; five of the children did not have coronavirus nor antibodies.

Kawasaki disease is much more prevalent among Asian children, and as Bilavsky explained, different populations may similarly exhibit different incidences of the new syndrome. “The impression is that there are more cases in England and New York than elsewhere. I hope that Israeli children will not get sick,” he added.

Bilavsky cautioned parents against panicking about the new inflammatory syndrome. “Scary reports, stressful headlines and incorrect data help sell newspapers,” he said.

Fortunately, there are known treatments for this type of illness – especially when it is detected early. That’s why parents must be cautiously aware and take their children’s temperature regularly. If children run a high fever for more than three days, it’s recommended to bring them to the emergency room.

In addition, Rahav points out that as children return to school, they will catch colds and viruses, and parents should not immediately jump to the conclusion that their child has PIMS-TS.

In response to parents who are concerned about sending their kids back to school because of this new syndrome, Bilavsky said, “Is this new syndrome a reason to resume lockdown? Of course not.”