Infographic: Early Cases of MIS-C: Multi-System Inflammatory Syndrome in U.S. Children
The following infographic highlights key data from a CDC-authored study on MIS-Cexternal icon published in June 2020, in the New England Journal of Medicine. The study was conducted using Overcoming COVID-19, a CDC-funded evaluation, which seeks to understand severe COVID-19 among children and young adults up to age 25 by leveraging a national network of pediatric health centers. The study evaluated patients admitted for multi-system inflammatory syndrome in children (MIS-C) to participating health centers from March 15, 2020 through May 20, 2020. Read more about MIS-C case demographics in the United States.
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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
- 62% male
- 38% female
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
| Age < 5 years (n=66) |
Age 5−12 years (n=75) |
Age 13−20 years (n=45) |
|
|---|---|---|---|
| Gastrointestinal | |||
| Any gastrointestinal symptoms | 91% | 93% | 91% |
| Hepatitis or hepatomegaly | 2% | 8% | 7% |
| Pancreatitis | 0% | 7% | 2% |
| Gallbladder hydrops | 0% | 3% | 2% |
| Hematologic | |||
| Any hematologic symptoms | 68% | 81% | 80% |
| DVT[viii] or pulmonary embolism | 0% | 1% | 7% |
| Mucocutaneous | |||
| Any mucocutaneous symptoms | 79% | 80% | 56% |
| Respiratory | |||
| Any respiratory symptoms | 53% | 76% | 87% |
| Respiratory insufficiency | 32% | 67% | 87% |
| Infiltrates on chest X-ray | 33% | 39% | 62% |
| Pleural effusions | 9% | 37% | 36% |
| Invasive mechanical ventilation | 11% | 24% | 27% |
| Musculoskeletal | |||
| Any musculoskeletal symptoms | 8% | 25% | 42% |
| Myositis/myalgias | 5% | 7% | 16% |
| Arthritis/arthralgias | 0% | 4% | 2% |
| Neurologic | |||
| Any neurologic symptoms | 5% | 5% | 11% |
| Renal | |||
| Any renal symptoms | 3% | 9% | 13% |
| Acute kidney injury | 2% | 8% | 7% |
| Age <5 years (N=66) | Age 5-12 years (N=75) | Age 13-20 years (N=45) | Overall (N=186) | |
|---|---|---|---|---|
| Lymphocytopenia | 60% | 88% | 95% | 80% |
| Neutrophilia | 57% | 75% | 75% | 68% |
| Hemoglobin < 9 g/dL | 53% | 56% | 25% | 48% |
| Platelets < 150,000 | 42% | 55% | 73% | 55% |
| Platelets < 100,000 | 26% | 29% | 43% | 31% |
| D-dimer > 3000 ng/mL FEU[ix] | 63% | 69% | 69% | 67% |
| Fibrinogen > 400 mg/dL | 67% | 87% | 85% | 80% |
| INR[x] > 1.1 | 63% | 79% | 90% | 77% |
| Albumin ≤ 3 g/dL | 70% | 86% | 86% | 80% |
| C-Reactive Protein (CRP) ≥ 3 mg/dL | 83% | 96% | 93% | 91% |
| Ferritin > 500 ng/mL | 42% | 69% | 72% | 61% |
| ESR[xi] ≥ 40 mm/hr | 73% | 80% | 79% | 77% |
| Increased troponin | 33% | 56% | 62% | 50% |
| B-type natriuretic peptide (BNP) > 400 pg/mL | 64% | 82% | 69% | 73% |
| ALT[xii] ≥ 40 U/L | 51% | 68% | 77% | 64% |
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
| 4-5 KD Features | 2-3 KD Features + Labs | Other Features* | All KD Features | |
|---|---|---|---|---|
| Characteristics | 20% | 19% | 61% | 100% |
| Age (years) | 8.9 | 12.0 | 14.1 | 12.5 |
| Fever > 38 C° | 100 | 100 | 100 | 100 |
| Bilateral Conjunctivitis | 95 | 83 | 33 | 55 |
| Oral Mucosal Changes | 100 | 44 | 21 | 42 |
| Peripheral Extremity Changes | 95 | 39 | 17 | 37 |
| Rash | 100 | 75 | 40 | 59 |
| Cervical Lymphadenopathy | 18 | 8 | 7 | 10 |
| Z-Score of LAD or RCA ≥ 2.5** | 8 | 22 | 4 | 9 |
**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
Overcoming COVID-19
CDC Logo
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)