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Wednesday, June 16, 2021

Pune: No alarming rise in MIS-C in children, but preparedness stepped up

According to The Lancet, it is not known what triggers the condition but it is thought to be a rare immune overreaction that occurs approximately four to six weeks after a mild or asymptomatic SARS-CoV 2 infection.

Written by Anuradha Mascarenhas | Pune |
Updated: May 25, 2021 8:09:33 pm
Covid-19In the case of children with MIS-C, the ICU management teams are crucial.

Anticipating the likelihood of a rise in cases of multisystem inflammatory syndrome in children (MIS-C), the Pune paediatric Covid task force has urged parents to get vaccinated on a priority basis against SARS-COV2 infection.

Dr Aarti Kinikar, chairperson of the Pune division paediatric Covid task force, told The Indian Express that in the entire year, there have been 25 cases of MIS-C in children at Sassoon General Hospital. Early detection is vital here, she said.

According to the Lancet, the factors that trigger the condition are not yet known but it is thought to be a rare immune overreaction that occurs approximately four to six weeks after a mild or asymptomatic SARS-CoV 2 infection. The symptoms include fever for three days, rash, eye infection and gastrointestinal symptoms like diarrhoea, stomach-ache and nausea. In some rare cases, the condition can lead to multi-organ failure.

State Surveillance Officer Dr Pradeep Awate, who is also part of the task force, said that preparedness levels have been stepped up. “While there is no reason for panic due to limited scientific evidence on the predictions of a third wave of Covid-19… parents should remain vigilant and ensure correct clinical diagnosis,” Dr Awate said.

Dr Kinikar said that Sassoon was a tertiary care hospital which gets referrals from other centres. “Overall, there have been 181 Covid positive children treated at Sassoon General Hospital. Children with SARI-like illnesses are around 49-55 and slowly increasing,” Dr Kinikar said.

From January till April, the hospital has seen 55 children with Covid-19, of whom eight were newborns. Seven newborns were detected with Covid in April while one case was in March.

The paediatric Covid task force is also focusing on orphanages and juvenile homes to pick up early cases of Covid-19 in children. “We need to step up awareness, especially among parents, to be on an alert in case the child is not his/her usual self, has fever for three days, and has symptoms like rash and abdominal pain. Parents must take early treatment,” she said.

“Treatment is symptomatic, but on day four and five, the child can go into shock. A team of intensivists, cardiologists and others are involved in the ICU management of the child. IV immunoglobulin is expensive and we need more donors,” she said.

The task force has identified hospitals like Bharati, KEM, Ruby, Deenanath, Jehangir, YCM and Sassoon General Hospital, apart from PMC’s Rajiv Gandhi Hospital, for gathering information on ICU bed availability and number of paediatricians. In case of children with MIS-C, the ICU management teams are crucial.

“Last year, we had two deaths of children due to co-morbid conditions and SARS-CoV2. However from January to April, there were four deaths where children between two and eight years of age died. They had various conditions like congenital anomaly, chromosomal disorder, liver disease, or were mentally challenged. Parents must ensure that children with co-morbid conditions get better nutrition,” Dr Kinikar said.

Dr Rajan Joshi, head of the department of paediatrics, Deenanath Mangeshkar Hospital, said that essentially MIS-C condition occurs post Covid infection. “The body’s immune system starts acting against the virus and your own antibodies attack the system. Hence, it can’t be predicted which child is at risk. These antibodies then can affect the heart, skin and other tissues. There were 30 children with MIS-C who have been treated and discharged from our hospital. Of these, there was one death,” he said.

“This is a potentially life-threatening infection. There were 34 children with MIS-C at our Bharati Hospital. There was one death and others have been treated and discharged,” says Deputy Medical Director Dr Jitendra Oswal.

In the International Journal of Advances in Medicine, Dr Oswal and co-authors have shared their Pune experience: “We had taken up an observational study from June 1 till December 31 last year, where all the 25 children were critically ill with two or more systems involved. This is a life-threatening syndrome seen mostly in children above 5 years of age. Fever, gastrointestinal symptoms and hypotensive shock are predominant features requiring critical interventions,” Dr Oswal said, adding that it was imperative to increase awareness among paediatricians about understanding the disease spectrum, its evaluation and treatment.

Dr Sanjay Mankar, paediatric infectious diseases consultant at Bharati Hospital and one of the task members, said early diagnosis was crucial for ensuring proper treatment. “This is a post Covid phenomenon where the child may not be positive on RAT and RT-PCR tests. However, clinical presentation like fever for three days, abdominal pain and rash should not be ignored,” he urged.

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