Kerala to declare Multisystem Inflammatory Syndrome in Children a notifiable disease

Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-COVID disease found in children with symptoms of fever accompanied by red-eye, stomach pain, etc.
A child looking at the sun set
A child looking at the sun set
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While the peak of the COVID-19 second wave may have passed in Kerala, the state cannot let its guard down as it still has to worry about another condition - the Multisystem Inflammatory Syndrome in Children (MIS-C). Sree Avittom Thirunal hospital (SAT), maternal and child care hospital wing of the Thiruvananthapuram Government Medical College has reported six cases of MIS-C in June this year.

The conditions develop in children within four to six weeks of surviving COVID. MIS-C is a condition where different parts of the body can become inflamed including the heart, eyes, lungs, kidneys, brain, or gastrointestinal organs. SAT had close to 75 MIS-C cases reported post the first wave of COVID-19. Fever and red-eye are the most common symptoms of the disease. The condition is usually found in children above five, mostly in those above seven, while the mean age for it is nine to ten years. In the cases reported at SAT in June, there are children from six to 12 years.

The hospital will study the MIS-C cases reported during the second wave. "Last month, there were no MIS-C cases reported in the hospital. The cases are reported not during the wave but post that," Dr Sheeja Sugunan, Associate Professor of the hospital told TNM. Sheeja, a Paediatric Intensivist (who treats critically ill patients), is part of the team that studied the disease after the first wave. A report of the study has been published in Indian Paediatrics, a journal of the Indian Academy of Paediatrics.

Notifiable disease

According to Sheeja, the Kerala government will declare MIS-C as a notifiable disease soon. A notifiable disease is any disease that is required by law to be reported to government authorities. "We have got the preliminary communication (from the government) regarding this," she said.

The treatment for MIS-C

The children with the condition will have fever. MIS-C is a multi-symptom disease that affects different children in different ways. While fever is the common symptom in all children affected by this condition, it can affect any of the organs. "But it mostly affects the heart and gastrointestinal system. It can also have kidney, brain, and liver involvements - but not as significant as the heart and gastrointestinal systems," Dr Sheeja said.

"We are expecting more patients in the second wave as more adults are affected by the novel coronavirus in the second wave because children are a reflection of the adults. Only after the entire cases post the second wave get reported, we would be able to evaluate if there was a difference in the pattern of the disease though worldwide no such difference has been observed yet. It may affect some children seriously while it could be mild in others," she added. But doctors advise admitting even the children with mild symptoms in hospital as the condition can turn worse.

Intravenous immunoglobulin and steroids are the presecribed treatment for the disease. The cost of the treatment is significantly high because of the need for intravenous immunoglobulin, which is a costly drug. Hence most of the parents prefer government hospitals for treatment as private hospitals are not affordable for many. The treatment is available at the district hospitals and in medical colleges (for those with severe symptoms). In Kerala, the MIS-C has been reported from everywhere in the state, including from private hospitals, while most cases have been reported from Government Medical Colleges in Thiruvananthapuram and Kozhikode post the first COVID-19 wave.

Parents should check symptoms

The children who seek treatment for MIS-C are not the ones who had COVID-19 with severe symptoms, but those with mild symptoms. Severe MIS-C condition could even turn fatal. Parents, hence, should take children to the hospital if they have a fever along with other symptoms such as red-eye, abdominal pain. They should take the children to the nearby hospital as not all MIS-C cases need treatment at a medical college or district hospital. 

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