Department of Health, Taipei City Government

Hsiao-Kuan is a lively and healthy 11-year-old boy with no chronic diseases. During the outbreak of Omicron this end of May, Hsiao-Kuan was too young for the children’s vaccine, and he and his family were infected. After suffering from a fever for two days, his condition improved, and he returned to his usual liveliness; however, one evening a month later, Hsiao-Kuan started having a fever of 39 degrees Celsius again. The fever returned even after taking prescribed antifever medication; he vomited 3-4 times at home, and his energy and activity fell remarkably. His family eventually decided to take him to the hospital.
 
Doctors there found a swollen lymph node on the right side of Hsiao-Kuan’s neck. His eyes were bloodshot, and his body was covered with red rashes. Given his previous infection history with Omicron, the doctor suspected that Hsiao-Kuan had multisystem inflammatory syndrome (MIS-C). Hsiao-Kuan was therefore hospitalized and treated with immunoglobulin and steroids.
Dr. Yen Pei-Ju, the attending physician at Pediatrics at the Yang Ming Branch of Taipei City Hospital, reminds us that if you have children at home who has been infected with Covid-19 and has a fever of uncertain cause within 6 weeks after the infection, you should be aware that your child might be sick with multisystem inflammatory syndrome (MIS-C).
 
Internationally, cases of MIS-C have been observed since April 2020. As to the precise cause of the disease and why it only takes place in children, the medical profession is still searching for the root cause. Currently, it is suspected that this is an overreaction of the immune system after being infected with Covid-19, causing damage to multiple organs, and may impair myocardial function in severe cases, resulting in pericarditis, valvulitis, or abnormalities in coronary arteries, and children may even experience hypotension or shock. In most cases, the onset of the disease is 2-6 weeks post Covid-19 infection, in children aged 0-19 years old.
 
Dr. Yen Pei-Ju pointed out that symptoms of MIS-C cases are much the same as those of Kawasaki disease – a disease better-understood by the medical profession. Its symptoms also include fever, swollen lymph nodes, rashes, red and swollen limbs, and reddening of oral mucosa. However, Kawasaki disease is generally seen in children aged below 5, whereas MIS-C can take place in older children (0-19 years old). Furthermore, in comparison to Kawasaki disease, cases of MIS-C display more often gastrointestinal symptoms and shock.
 
Dr. Yen Pei-Ju warned that if your child suffers from an ongoing fever for more than three days following Covid-19 infection, and at the same time shows symptoms of rashes, red eyes, diarrhea, vomiting, abdominal pain, or dizziness, seek medical attention immediately.
 
According to the information announced by the Central Epidemic Command Center on July 31, there have been 4,532,657 local confirmed cases in Taiwan since January. Among them, there were 140 severe cases in children aged under 12, with 74 cases sick with MIS-C. The number of MIS-C cases has continued to increase from the beginning of June – after the outbreak in April and May. Therefore, it is crucial for the parents to be extra careful and pay extra attention to their children’s health.
 
In cases where MIS-C is suspected by the doctor, hospitalization for performing blood tests and cardiac ultrasounds is usually suggested. Treatment of MIS-C – what medicines to administer (including steroids, immunoglobulin, immunosuppressants, etc.) – will depend on the severity of the conditions. In addition, for patients with MIS-C who have no special contraindications, treatment with blood thinners (e.g., aspirin) for at least 4 weeks is recommended; the treatment can be halted later after the doctor’s evaluation. Statistically, most children with MIS-C have a good prognosis, as long as they sought immediate medical attention. After being discharged from the hospital, it is suggested to continue routinely tracking heart function in an outpatient clinic.
 
Dr. Yen Pei-Ju suggested that the best way to prevent MIS-C is to prevent infection with Covid-19. Precautions such as washing hands regularly, wearing masks, and avoiding large gatherings can be taken to prevent Covid-19 infection. A statement has also been issued by the Taiwan Pediatric Association, saying that children are encouraged to be vaccinated against Covid-19 as early as they can. Research has shown that even a single Covid-19 vaccination is enough to effectively reduce the chances of getting MIS-C and protect our children.