MIS-C is a condition where the child’s immune system overreacts after a Covid-19 infection, typically two to eight weeks later.

“It is speculated that Covid-19 antibodies produced by the child following an infection results in the development of this syndrome,” said Associate Professor Thaschawee Arkachaisri.

The senior consultant heads the paediatric rheumatology and immunology department at KK Women’s and Children’s Hospital (KKH).

He added: “According to the definition set by the World Health Organisation (WHO) and the Centre for Disease Control and Prevention (CDC), there must be a Covid-19 association before a MIS-C diagnosis can be given.”

MIS-C has symptoms similar to Kawasaki disease, which has been linked to various viral or bacterial infections and occurs in 150 to 200 children a year in Singapore.

Kawasaki disease is an illness that results in inflammation in blood vessels throughout the body and mostly affects children younger than five years old.

Paediatric immunologist Liew Woei Kang told ST that although MIS-C and Kawasaki disease may share overlapping clinical features, studies in the United States indicate MIS-C can affect a wider age range.

Children with MIS-C also tend to have more prominent gastrointestinal and neurological symptoms, present more frequently with low blood pressure and are more likely to display cardiac dysfunction than children with Kawasaki disease.

Prof Arkachaisri echoed the point made about MIS-C patients having more gastrointestinal symptoms.

“They are also at higher risk of low blood pressure, reduced level of certain white blood cells and blood platelet count,” he added.

Associate Professor Chong Chia Yin, senior consultant in infectious diseases at KKH, said the hospital found no MIS-C cases among more than 280 paediatric Covid-19 patients admitted to KKH last year.

Since 2020, KKH has been serving as the primary hospital looking after paediatric cases in the current pandemic.

Prof Chong noted that the hospital has not seen Covid-19-related cases of Kawasaki disease, adding: “The number of Kawasaki disease cases also declined… and none of the Kawasaki disease cases fulfilled the MIS-C criteria defined by WHO and CDC.”

Prof Arkachaisri said parents should not be overly concerned because the syndrome is treatable if detected early.

He added that most patients, such as those treated at KKH, make a full recovery and lead normal lives.

Nonetheless, parents should be vigilant for MIS-C if their child has a history of close contact, is infected or had been infected with Covid-19.

Severe symptoms that may indicate MIS-C include difficulty in breathing, persistent pain or pressure in the chest, vomiting, abdominal pain, acting unusually sleepy or confused, feeling unusually weak or dizzy, looks pale, has grey or blue-coloured lips.

Prof Arkachaisri said parents should seek the care of a paediatrician or children’s emergency care immediately if the child develops severe symptoms.

“The affected child will need to be treated in a specialist children’s hospital such as KKH, since some will require intensive care.”

As the mechanism of how Covid-19 triggers MIS-C is still under study, preventing Covid-19 infection is the best strategy to guard against MIS-C.

Thus, Prof Arkachaisri recommends complying with strict hygiene standards, such as washing hands with soap and water, avoiding contact with people who are sick and regular disinfection of high-touch surfaces.

“It is also recommended for children to take the Covid-19 vaccination when it is made available to them.”

Text: Tay Hong Yi/The Straits Times

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