18 June 2020 - NW1030
Ismail, Ms H to ask the Minister of Health
(1)Whether in the past three years his department has come across any cases of the condition called Paediatric Multisystem Inflammatory Syndrome that is responsible for the hospitalisation of hundreds of children overseas; if so, (a) what number of cases and (b) where were they found; (2) whether his department has found that this condition is in some way linked to the coronavirus; if not, what is the position in this regard; if so, what are the relevant details?
1. The Department is not aware of any cases of Paediatric Multisystem Inflammatory Syndrome in South Africa. This is not unexpected. The condition remains very rare, and has only been documented in areas which have experienced a very high incidence of COVID-19 infection. In addition, most children have presented two to four weeks after the peak of the epidemic.
It is therefore likely that any cases which may occur in South Africa will present later in the year, during or after the expected peak in COVID-19 cases. It is however important that health care workers and parents remain alert as cases may be missed unless a high index of suspicion is maintained.
Any cases that are identified will be notified through the Notifiable Medical Conditions system, as well as to the World Health Organization clinical database.
(2) Evidence of past infection with coronavirus or exposure to someone with COVID-19 infection is part of the WHO case definition of the condition. The Department of Health currently uses the same case definition.
Most children with COVID-19 infection are asymptomatic or exhibit mild symptoms. However, in the last three months a small number of children have been identified who develop a significant systemic inflammatory response.
This rare syndrome shares common features with other paediatric inflammatory conditions including: Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndromes. It can also present with unusual abdominal symptoms with excessive inflammatory markers. Affected children may require paediatric intensive care and input from paediatric infectious diseases, cardiology, and rheumatology specialists.
This syndrome has been named Paediatric Multisystem Inflammatory Syndrome, and the World Health Organization has developed the following case definition:
Children and adolescents 0–19 years of age with fever > 3 days AND two of the following:
- Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
- Hypotension or shock.
- Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP),
- Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).
- Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain).
Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.
No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.
Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.
As data on this condition remains very limited, clinicians have been requested to submit details of identified cases to a Global COVID-19 Clinical Data Platform.
Royal College of Paediatricians and Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf. Accessed 1st June 2020. ↑
World Health Organization. Scientific Brief: Multisystem inflammatory syndrome in children and adolescents with COVID-19. Geneva, World Health Organization. 15th May 2020. https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed: 1st June 2020. ↑